Diversity and inclusion finally are being addressed within academia, corporations, governments and general society. AAPL remains committed to leading in these efforts.
While completing this piece, I happened to be attending a December meeting as AAPL’s representative in Manhattan on the same day as the state funeral of President George H.W. Bush in Washington, D.C. New York was full of the pre-holiday joy and busyness that so many people from round the world come to seek as a rite of passage.
In contrast, the ceremony for President Bush was equally global in its breadth of representation, but clearly much more somber in its purpose and intent. Both, however, created reflection on our global diversity and our ongoing needs to be more inclusive with one another as human beings.
The association’s board of directors recently has been reflecting on our own diversity as well — an association that continues to move toward creating significant positive change in global health care. The demographics of our membership and constituency continues to become more representative of a diverse international community. Participants in our programs, products and services are from all walks of life, and from many different countries (more than 40 at last count). By example, our Certified Physician Executive capstone events routinely have 5 to 10 percent of the participants from outside the United States. Similarly, if you look at the board of directors itself, there has been successful inclusion of diversity there — a competency-based board that cohesively represents the association’s membership. As well, the association’s staff is highly representative of a diverse and inclusive workforce.
And while AAPL historically has been physician-centered, participation in our onsite programs (Lx Solutions) now continues to incorporate nonphysicians as well (upward of 20 to 25 percent of participants, at times). Recognizing these shifts, the AAPL board recently agreed unanimously that our strategic plan should reflect changes in diversification of health care leadership by incorporating the language of “interprofessional leadership” within certain areas of our strategic plan. Be assured, however, we remain focused on how physicians can best function as leaders within interprofessional teams.
AAPL is not alone in these efforts, however. Most of us recognize more women have been entering medical school for many years now, and the data is starting to show positive change. In 2009, the Liaison Committee on Medical Education, for one, introduced two diversity accreditation standards, mandating U.S. allopathic medical schools to engage in systematic efforts to attract and retain students from diverse backgrounds.
In a recent letter to JAMA, Dowin Boatright, MD, of Yale School of Medicine and lead researcher of a recent study on the effect of this LCME program, notes:
There are more than 950,000 licensed U.S. physicians. The average age is 51.3 years, and roughly two-thirds are male. But female physicians have increased by about 8 percent annually — and 34 percent of them are younger than 39. Demographic shifts are occurring rapidly.
“From 2002 to 2009, before the standards were introduced, the proportion of women entering medical school was decreasing by 0.29 percent a year. That changed to an increase of 0.85 percent from 2012 to 2017. For blacks, the proportions went from an annual decrease of 0.09 percent to an increase of 0.27 percent over the same time periods. Hispanic matriculation was already increasing by 0.18 percent a year in the earlier period, and almost doubled to 0.35 percent.”
And while there are more than 950,000 licensed U.S. physicians, according to the Federation of State Medical Boards, the average physician age is 51.3 years, and roughly two-thirds are male. But female licensed physicians have been increasing annually by about 8 percent, compared with only 2 percent for males. However, 34 percent of female physicians are younger than 39, compared with only 19 percent of male physicians. And, actively licensed physicians are growing faster in older physician populations, compared to those in younger generations.
Clearly, shifts are occurring in our professional demographics, and we all need to be prepared to accommodate these ongoing changes. So how, as leaders, do we proactively address these shifts?
In his report, “What Makes a School Multicultural?,” Eastern University sociologist Caleb Rosado, who specializes in diversity and multiculturalism, identifies seven important actions involved in defining multiculturalism:
- Recognizing the abundant diversity of cultures.
- Respecting the differences.
- Acknowledging the validity of different cultural expressions and contributions.
- Valuing what other cultures offer.
- Encouraging the contribution of diverse groups.
- Empowering people to strengthen themselves and others to achieve their maximum potential by being critical of their own biases.
- Celebrating rather than just tolerating the differences in order to bring about unity through diversity.
As you consider your own personal and leadership efforts in this regard, and how best to incorporate change, here are a couple of definitions from diversity.com to help in your reflections:
What is diversity? The short answer for the question, in terms of AAPL learners, is: “diversity and inclusive practice includes gender, religious, race, age, disability, linguistic differences, socio-economic status and cultural background.”
What is inclusion? Likewise, a brief answer in terms of AAPL learners is: “Inclusive practice is known to be attitudes, approaches and strategies taken to make sure that students are not excluded from the learning environment because of their differences.”
Giving of oneself, for me, is a core philosophy by which I recognize the ongoing need to keep giving of myself, so that I can best shift my own attitudes and approaches with others. I do this to continue improving and incorporating internal changes, to become even more inclusive of diversity in all its forms and formats. Hopefully, I keep growing as a result. This is a never-ending process of change… I encourage each of you to also move along this particular path of perpetual learning and maturing as leaders in your own organization, and within your personal lives.
Tom Nasca, MD, president and CEO of the Accreditation Council for Graduate Medical Education, recently told Georgetown University School of Medicine graduates, “Every patient has a ‘why.’ We need to listen. We need to hear it, so we can help them with the ‘how,’ so that they can achieve it. Your soul will be enriched by each person you care for. Pursue your calling with vigor, with commitment, with kindness, and, whenever in doubt, remember the ‘why’ that’s in your hearts today.” It’s a powerful message, recognizing the importance of giving that is as true for each of us promulgating leadership as it is for fresh physician graduates.
Giving of oneself also can be viewed as an uncommon form of gifting to others. While giving and gifting is too detailed a topic to cover here, Lewis Hyde’s book, The Gift, provides a twist on the concept of gifts and giving of ourselves. He writes, “It is also the case that a gift may be the actual agent of change, the bearer of new life.” He talks about how the gifts within ourselves are also awakened when we experience the work of others and how they are shared. He further notes “… it is essential gifts are shared and kept moving within a community. This leads to increased connectivity and relationships, and transformative inspiration.”
For those who might be intrigued, since Marcel Mauss’ influential book, Essai sur le Don, first appeared in 1925, the primary work on giving and gift exchange apparently has been within anthropology as it relates to giving among or between groups of individuals. Medical sociologists only recently have begun to emerge in their considerations of gift-giving — earlier work being done by Richard Titmuss in 1971, when he published The Gift Relationship, a study on how we handle human blood for transfusion. For example, the British system classifies all blood as a gift, whereas the U.S. system has a mixed economy in which some blood is donated, and some is bought and sold.
An interesting side thought, perhaps: Within our scientific communities, gifts also can be viewed as coming in the form of scientific presentations, intellectual articles and the sharing of theories within various communities. Therefore, the sciences arguably already have advanced rapidly in giving and gifting — increasing our connectivity and our communities.
At their core, physicians are compassionate, giving people who care deeply about others and give of ourselves routinely. Let your own altruism continue to surface so that all those around you are aware of the giving you provide with your gifts to humanity. It is what we do — it is our calling to help and care for others that ultimately benefits society. Accept the gifts of others in the process so that you are able to remain healthy and better balanced in your own approaches within this complex profession.
Atul Gawande, MD, a prominent surgeon in the Harvard system and now CEO of the health care venture formed by Amazon, Berkshire Hathaway and JPMorgan Chase, said in a 2004 commencement speech: “The life of a doctor is an intense life. We are witnesses and servants to individual human survival. The difficulty is that we are also only humans ourselves. We cannot live simply for patients. In the end, we must live our own lives.”
We must live our own lives in a healthier, more-balanced fashion to minimize the untoward effects of this demanding profession. Giving of ourselves, while honorable and uplifting, can be draining at times. As Hyde suggests, a gift from others may be the actual agent of change, the bearer of new life. It is therefore acceptable to not only give, but to also receive.
Leading change is the association’s overall intent, by helping to create significant change in health care through physician leadership. AAPL heavily promotes the message that, at some level, all physicians are leaders. AAPL maximizes the potential of physician leadership to create significant personal and organizational transformation. In so doing, AAPL gives on many levels in its efforts to build a stronger health care system.
I encourage each of us to continue seeking deeper levels for how we can become more inclusive of the diversity in our evolving society. We can generate positive influence in this at all levels. As physician leaders, let us get more engaged, stay engaged and help others to become engaged. Creating a broader level of positive change in health care — and society — is within our reach.