Abstract
Hate crimes can be based on ethnicity, race, sexual orientation, or religion, with a few recent examples including the murder of Ahmaud Arbery, a Black man jogging in a public road in Georgia, the burning of a Presbyterian Church in a Black community in Springfield Massachusetts, and the attack of the Poway synagogue in California, and the list keeps going. 1 In medicine, overt examples from the past include the forced sterilization of non-White individuals and the Tuskegee experiment, where Black men unknowingly participated in a study on the natural history of syphilis without informed consent and were denied treatment when it became available. 2 In present times, subtle and sometimes unconscious behavior can carry the same devastating consequences for patients and healthcare providers.
Minorities are frequently underrepresented (termed ‘underrepresented in medicine’ [URM]) in various industries relative to numbers in the general population, and the medical field is no exception. Historically, Black and Hispanic individuals were not allowed to study medicine and not admitted into society memberships that would provide a platform for success and networking.3,4 A similar situation occurred for women. This resulted in structural racism and discrimination, which perpetuates underrepresentation and negative behaviors (also known as microaggressions). These microaggressions include questioning one’s competence and decision making, devaluating contributions, questioning one’s belonging and assuming an individual has other roles rather than being a physician, or assuming that one is not from the United States. Although there has been an increase in women entering medicine, they experience more harassment and discrimination, differences in forms of address, and receive less compensation for the same work as their male counterparts. 5 There are fewer URMs and women in medical leadership. Black and Hispanic physicians account for only 5.0% and 5.8%, respectively, of all doctors in the United States according to the Association of American Medical Colleges (AAMC); 6 whereas the 2020 Census reported that Black and Hispanic populations account for 12% and 18% of the US population, respectively. 7 This underrepresentation is more evident among medical subspecialties, where, for example, Black vascular and cardiac surgeons account for only 2% in the field. 8 In the field of vascular medicine, this rate is unknown. There are limited data on those who identify as lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ+), possibly due to fears of self-reporting.
Disparities in healthcare are seen with URMs and exist at all levels, including patients, students, trainees, physicians, leadership, administrators, and researchers. This directly or indirectly impacts health outcomes due to historical and systematic social or economic obstacles to health related to racial or ethnic group, gender, religion, socioeconomic status, geographic location, sexual orientation, age, or disability. 9 Race refers to a group sharing physical traits that one may identify with, and ethnicity refers to the cultural identity one identifies with. 10 Efforts to address healthcare disparities are increasingly being pursued by many organizations on local, national, and international levels by increasing awareness of systemic racism/discrimination and biases responsible for the disparities and the influence on communication, patient experience, decision making, access to care, opportunities, and measurable health-related outcomes. 11 A bias is based on prejudice and stereotypes that can be intentional (explicit) or unintentional/unconscious (implicit). Most biases are implicit and can also be from within the same sex or racial/ethnic group. 12
Health disparities are known to begin as early as the prenatal period, resulting in poorer maternal–fetal health and newborn outcomes in URMs. In vascular medicine, persons categorized as Black with peripheral artery disease have a nearly twofold rate of leg amputation, mainly due to underutilization of screening procedures. 13 The decline in deaths from cardiovascular disease is not seen equitably across racial and ethnic groups despite controlling for socioeconomic status. 14 White patients have higher rates of coronary artery revascularization compared with Black patients. 15 Black patients have an increased risk of death at the time of presentation of pulmonary embolism, attributed to multiple baseline comorbidities.16,17 These disparities may be due to bias and/or chronic stress from the experience of racism, with its effects on economics and the environment. 18 These factors, along with disparities in health insurance limiting adequate access to care, result in poorer health outcomes, which was highlighted by the COVID-19 pandemic. 19 Similarly, discrimination and violence against the LGBTQ+ community is well known. In the 1980s and 1990s, this discrimination reached unprecedented levels during the HIV epidemic. Today, this remains a significant problem in our society, including discrimination at doctors’ offices, which can result in refusal to seek medical care and an elevated risk of suicide.20,21 Insurance coverage in patients seeking gender transition and hormonal therapy is also challenging. 22 Disparities and potential biases should be considered when researching outcomes in addition to genetic and biologic differences alone. One way that these disparities can be reduced is by diversifying the caregiver workforce at all levels.
In 2020, the Society for Vascular Medicine (SVM) established the first Diversity, Equity, and Inclusion (DEI) Task Force to minimize and work to eliminate these disparities to align with its mission. The creation of this Task Force affirms a commitment of the SVM to their members to analyze, monitor, and advise on relevant parameters related to diversity, equity, and inclusion at all levels of the Society.
When we talk about diversity, we acknowledge the presence of differences among members.
When we talk about equity, we commit to provide fair access, opportunity, and support to all members.
When we talk about inclusion, we commit to have a sense of belonging, voice, and involvement in decision making for all members.
As an initial self-assessment, this Task Force created a member survey to collect demographic data of our Society (Figure 1). Identifying where we are in terms of DEI within the Society helps focus our attention on opportunities for improvement and measure our impact over time with repeat surveys.
Race and ethnicity distribution among 62 participating members of the Society for Vascular Medicine (men 75%, women 25%) in 2021.
Secondly, to promote DEI along with cultural competence from within the SVM, Society leadership has implemented a requirement to complete cultural competency training. All current Board of Trustee members and Executive and Associate Directors have successfully completed the training, and we will be extending this requirement to Committee and Task Force leadership. The DEI Task Force further aims to:
Extend the survey to those in training and advance practice providers.
Promote DEI resources within the SVM through its website, journal, and societal meetings and through strategic partnerships.
Advise on matters related to DEI as they apply to all Society functions, including membership, leadership, education, research, quality, clinical care, and advocacy.
Support research on DEI and highlight outcomes relating to arterial, venous, and lymphatic disease that is inclusive of URMs and the effect of structural racism on these outcomes.
Engage in community service, providing education and screening to ensure diverse representation of those involved.
Collaborate with institutions and organizations actively engaged in training and retention of URMs in medicine, such as historically Black colleges and universities.
Monitor and inform members on contemporary DEI language, trends, and resources.
Create an anonymous forum/discussion board for DEI-related issues.
DEI is an evolving topic and process. Although discrimination and bias are usually unintentional, we must understand and be mindful that systemic racism/discrimination and social injustice are among the foundation of these disparities. Diversifying our workforce helps to reduce disparities and improve patient outcomes owing to increased understanding (including with language concordance), satisfaction, and compliance. Fortunately, we are already seeing some positive changes in this area. In 2021, there was an increase in admission rates of first-year medical students who are Black (11.3%) and Hispanic (12.7%) according to the American Medical Association. 23 Also, the Human Rights Campaign created the Healthcare Equality Index, which measures the equity and inclusion of healthcare facilities across the United States regarding patients and employees who identify as LGBTQ+. 24 In the same way, SVM pursues fostering a safe environment with equal opportunities for patients and healthcare providers in the field of vascular medicine.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
