Published 12/31/2019
Terry Stanton

AAOS Aims to Increase Diversity—Strategically

The Academy acts on goal of greater inclusiveness within its ranks

As the Academy begins its second year of implementing the 2019–2023 Strategic Plan, its efforts and initiatives to deliver on its goal to promote diversity are coming into focus and entering into action.

On the organizational front, the Diversity Advisory Board (DAB) will be sharpening its mandate to better execute strategy and improve diversity at the Board, council, committee, and volunteer levels. This year, the DAB will broaden its reach with a change in reporting structure from infrequent interaction with the Board of Directors to a direct line to the new Membership Council. The enhanced DAB will serve as a connection point for orthopaedic societies that focus on underrepresented minorities (URMs) and women, partnering on diversity initiatives and communications with the J. Robert Gladden Orthopaedic Society (JRGOS), Ruth Jackson Orthopaedic Society (RJOS), and American Association of Latino Orthopaedic Surgeons (AALOS).

“By increasing women and URMs in leadership roles within the Academy, and through culture changes as outlined in the Strategic Plan, this is a great step forward to improve the diversity of the leadership structure within the Academy and to promote diversity within the specialty itself,” said Ann E. Van Heest, MD, FAAOS, cochair of the DAB, along with Cordelia Wheeler Carter, MD, FAAOS.

Dr. Carter added, “One of the first recommendations implemented has been to increase the transparency of the selection process within AAOS’ committee and volunteer structure. We are excited to see how this moves the needle over time toward an increased representation of women and URMs on AAOS committees and within the leadership structure.”

The DAB will be instrumental in the rollout of training on diversity and implicit bias for Academy leaders and volunteers, as well as staff, and in other efforts to promote a culture that embraces diversity, inclusion, and equity within the Academy.

In December 2019, the Academy Board of Directors approved an initiative that will offer all members the opportunity to participate in leadership training designed to expand and develop the pool of aspiring future AAOS leaders and achieve greater inclusivity in the committee selection process.

‘Evolve the culture’

In her inaugural speech for her term as 2019–2020 Academy president, Kristy L. Weber, MD, FAAOS, implored fellow members to “create a more welcoming culture and remove subjective barriers to inclusion, advancement, and leadership in our practices, institutions, and the Academy.” Barriers to inclusion, she said, “are not written in our bylaws—they are less obvious but are certainly real and relate to tradition, culture, and unconscious bias. I ask all of us—myself included—to acknowledge our biases, appreciate a different point of view, lean into the discomfort of change, and let go of the stereotype of what orthopaedic culture has been.”

In that speech, and in an interview for this article, Dr. Weber emphasized the importance of the five-year Strategic Plan that the Board adopted in December 2018 toward ensuring the Academy’s vitality, relevance, and role as beacon for the profession. Goal 3 of the plan is to “Evolve the culture and governance of AAOS’ Board and volunteer structure to become more strategic, innovative, and diverse.” In June 2019, the Board approved recommendations from the DAB for goals, tactics, and targets to strive toward that goal. The DAB set forth four main tactical touchstones:

  1. targeted and focused recruitment of URMs and women into AAOS committees, cabinet and council membership, and leadership positions
  2. transparency in the selection process for filling those positions
  3. enhanced retention of women and URM volunteers with onboarding, mentoring, leadership development, and support
  4. promotion of an orthopaedic culture that embraces diversity, inclusion, and equity

Dr. Weber noted that although the glaringly small number of women and URMs among the ranks of orthopaedic surgeons remains a pressing issue that merits resolve by the Academy and other groups working in this space (e.g., the Perry Initiative, American Orthopaedic Association, Nth Dimensions), the Academy, as the organization representing practicing surgeons, best serves its mission by focusing on inclusion and diversity within its own volunteer structure.

“It is important to differentiate efforts within the Academy to increase diversity versus addressing overall numbers in the field,” Dr. Weber said. “I care deeply about expanding the pipeline of young people into orthopaedic surgery, but the Academy needs to successfully model diversity and inclusion in its structure before we move to bigger goals. While it is incumbent upon every Academy member who has any interaction with young, underrepresented people to encourage them to go in the field, the Academy doesn’t have specific reach into medical schools. We are a member organization.”

And within the Academy, she said, “Our premise is that there are qualified people out there, and we need to improve individual skill sets and reduce bias in selection as much as possible.” She said the Strategic Plan and its diversity goal, with its tactics of recruitment, transparency, retention, and culture, both seek “to mitigate the bias by putting a spotlight on the committee appointment process to encourage people to remember their biases and make sure the staff and volunteer leaders are trained to think about this when making selections among applicants.”

Reaching out

The recruitment element of the diversity initiative will require engagement with those in underrepresented populations to encourage qualified individuals to apply for positions and to offer information and training to all who are interested. “There are plenty of qualified people among women and minority groups, and to that end, the Board is clear that we want objectively qualified people,” Dr. Weber said. “For this reason, we want to reach out to underrepresented groups, through RJOS, JRGOS, and AALOS, and make sure people know how you apply and what skills are necessary for positions at every level.”

She noted that opportunities to participate in the Academy abound at the entry level. “At the entry level, you need effort and perseverance,” she said. “As you move up in the Academy ranks, you do have to know something about leadership. You must have some skills. We want to make members aware of that and help them to get there.”

The leadership training program recently approved by the Board and poised to roll out at the AAOS 2020 Annual Meeting under the stewardship of incoming president Joseph A. Bosco III, MD, FAAOS, will open up opportunities to individuals who previously may not have perceived a path to participation.

“Everyone will be eligible; it won’t be only 10 people,” Dr. Weber said. “It will offer modules that everyone has access to. With this program, we want to encourage as many people as possible to go through it to enhance their leadership skills.” She noted that completion of modules will be required for eligibility in some of the leadership roles.

Dr. Weber noted that progress has been made in increasing participation by women in Academy governance positions. Statistics show that women and men have been picked equally in proportion to applications. “That means the more women who apply, the more will get in, presumably,” said Dr. Weber.

Minority applicants, however, have been selected at a lower rate. “Whether that is a lack of qualified applicants, implicit bias, or both, I don’t know,” Dr. Weber said. “In 87 years of the Academy, we’ve had one African American male and one woman as president. We can do better than that in the future. Leadership roles continue to be somewhat elusive.”

To those who want to get involved but may feel shut out, Dr. Weber offered suggestions: “Could you serve in advocacy? Could you be a member of the Board of Councilors? Could you be involved in your state society? Everybody can be involved in some way. Some committee positions are popular, so if you want to get involved in quality efforts, you can apply to be on a work group to develop a clinical practice guideline, appropriate use criteria, or performance measure prior to applying for a standing position on a quality committee.”

All Academy members should recognize the importance of diversity within its leadership ranks, Dr. Weber said. “When you allow diverse opinions to be present at the highest levels of leadership, better decisions will be made—data show that. This field needs to be relevant. Seeing a diverse leadership and volunteer force makes it possible for young people to see that it is possible for them to become a leader. Diversity in the field will help us care for our patients, because we will better mirror the population.”

Terry Stanton is the senior science writer for AAOS Now. He can be reached at tstanton@aaos.org.