Hidden In Plain Site: Working with Medical Societies to Actualize a Just, Equitable, Divers, Inclusi

Darilyn Moyer, MD FACP, FIDSA, FRCP

The elevator story is compelling, the urgency never more critical. Organizational success, including for those in health care, is catalyzed and created by a Just, Equitable, Diverse and Inclusive, or JEDI, environment, free of harassment and discrimination (1). The imperative has never been greater as accrediting and licensing organizations in health care recognize, and require, that safer, higher quality patient care and medical education must be delivered in a JEDI environment. Inaction, or action without significant change, implies tacit perpetuation of the status quo. Despite more than 30 years of organizations trying to ensure that women and others underrepresented in medicine have appropriate representation at AHCs, the needle has barely moved (2). We should not suffer the tyranny of low expectations of just getting one woman and/or Underrepresented Racial Ethnic Group, or UREG, to a position of power but rather settle only for tectonic shifts that give appropriate representation proportional to patient populations. In 2015, 51%, 17.6%, 13.3%, and 1.2% of the U.S population were women, Latina/Latino, Black , and indigenous persons, respectively. In fact, there has not been an increase in proportion of Black men entering medical school since the late 1970s and the number of racial and ethnic minorities in U.S. medical schools only increased from 11.3% in 1980 to 13.7% in 2016 (3).

Strong signals for patient-physician racial and gender congruity leading to improved patient outcomes are accumulating (4). Yet, despite the rapid, recent expansion of new medical schools and medical school classes, none of the last 30 have been in conjunction with a historically Black college or university (5). The first medical school opened in conjunction with Cherokee Nation in 2021 as the Oklahoma State University School of Medicine at the Cherokee Nation. The tsunami of data regarding systemic disadvantages and barriers to women and others underrepresented in the health care workforce are incontrovertible. Women, UREGs and other traditionally marginalized and excluded groups in medicine are recruited, evaluated, promoted, advanced, mentored, sponsored and compensated differently (6,7). Women and UREGs in health care suffer more harassment and discrimination, including in social media (8,9). Now is the time to fix this as potential new physicians, and others in health care, cannot be what they cannot see. As the world’s largest medical specialty organization with 163,000 members, the American College of Physicians has a strong voice in representing internal medicine physicians, who comprise roughly 25% of practicing U.S. physicians. The “practicing” life of a physician is the largest proportion of a physician’s life cycle, hence the important interest, impact and role of physician medical societies in the discussion and solutions. Health justice, becoming an anti-racist organization, and achieving a diverse, equitable and inclusive health care environment are part of ACP’s strategic priorities and goals, as well as for many other medical societies (10).

As I stated in a recent interview for the 2020 WIM Conference, “Every society should do the foundational work of systematically and comprehensively resetting its organizational vision, mission and goals through a JEDI lens. This foundational work should be directly accountable to the fiduciary board and governance body and should permeate every structure in the organization including committees, councils and local chapters. These new structures, informed by metrics, need to be transparent, evaluated, adjusted and continuously measured. Societies need to generously share their data through publications and presentations. There is excellent language in medical school, graduate medical programs, and health care accreditation and regulatory standards that recognize more JEDI health care environments lead to safer and higher quality outcomes for our patients. The Council of Medical Specialty Societies, comprised of 45 national, professional physician societies representing more than 800,000 practicing U.S. physicians, has Diversity, Equity and Inclusion as one of its top two strategic priorities.” I urge academic health centers, hospitals, medical practices and other key stakeholders in health care to look to medical professional societies for collaboration and meaningful action to create the rapid-response teams that are needed to catalyze, synergize and diffuse this critical imperative in an actionable and generalizable fashion.

Despite the tsunami of data documenting that “Houston, we have a problem,” there is a paucity of impactful and generalizable solutions. Here are a few suggestions:

1. Perform foundational work – review your organization’s mission, vision and goals with a JEDI and anti-racist lens and modify accordingly.

2. Review your policies and procedures for governance of your organization to remove explicit and implicit bias in all recruitment, retention, appointment, promotion, leadership, educational and advancement processes.

3. Ensure that your organization has JEDI, anti-harassment and discrimination policies – including those for patients/family members/visitors – and accessible mechanisms for activation of processes to enforce these policies.

4. Establish a body for ensuring a JEDI/anti-racist environment in your organization that is empowered in education and enforcement and can actively intervene in a rapid-response fashion, as well as have oversight with all governance and other germane policies relevant to establishing and maintaining a JEDI/anti-racist environment.

5. Review the allocation and prioritization of financial and other critical supporting resources to ensure that allocations prioritize creating/sustaining/augmenting a JEDI/anti-racist environment.

6. Institute deliberate practice in transparent data collection and review to assess your organization’s cultural environment, with a focus on safety, quality, JEDI and anti-racist principles.

7. Review and actively track total compensation, recruitment, appointment, advancement and leadership positions, and benchmark to rank and file of your organization and patient characteristics, if applicable.

8. Transparently publicize your organization’s data regarding your review of data in total compensation, recruitment, appointment, advancement and leadership in your organization.

9. Educate all in the organization regarding the benefits of a JEDI/anti-racist environment in terms of human and financial outcomes, safety and quality.

10. Review all local, regional, national licensing, accreditation and certification of JEDI/anti-racist standards and ensure that your organization is adhering to them – e.g., AAMC, ACGME, Joint Commission, state/local licensing boards and health departments.

It is critical that we collectively make a difference for those who previously couldn’t see what they could be. Let’s work together to finally achieve the efficacious vaccine to eliminate systemic, structural and other barriers in our organizations that are preventing us from getting to a JEDI/anti-racist environment. ACP and other medical societies stand ready to meaningfully collaborate with other organizations to unleash a powerful collaboration to make meaningful and impactful progress, and not spend one day more hidden in plain sight!

Darilyn V. Moyer, MD FACP, FIDSA, FRCP EVP/CEO American College of Physicians Adjunct Professor of Medicine, Lewis Katz School of Medicine at Temple University