The Value of Diversity
By Michael G. Galvez, MD FACS
Dr. Sterling Bunnell, the founding father of hand surgery, introduced the concept of bringing together several surgical specialties to take care of all the tissues of the hand and upper extremity to repair and reconstruct all the necessary structures in a coordinated fashion. To become a hand and upper extremity surgeon one must either complete an orthopedic, plastic or general surgery residency and then complete an additional one-year fellowship in hand and upper extremity. We are all aware that the starting point of our training in hand surgery is based upon the amount of hand surgery that was experienced in residency. This can be incredibly different experiences depending on one’s training program.
We know there is significant variability in hand surgery fellowships with the breadth of hand surgery performed (from shoulder to fingertip), which can include shoulder, elbow, forearm, distal radius, wrist, microsurgery, replantation, complex reconstruction, congenital hand differences, etc. This variability in training results in variable types of practices. Orthopedic hand surgeons can sometimes be less comfortable with microsurgery and therefore less likely to perform. Plastic hand surgeons can sometimes be less comfortable with complex distal radius and forearm injuries and less likely to perform them.1 When we think about hand surgery, this combines all these levels of expertise with our ability to change form and anatomy, change function, and use technology such as the microscope and hardware to truly reconstruct the diverse tissue of the upper extremity. As hand surgeons, we value diversity of pathways for training so that we can consider all the tissues when performing reconstruction.
In this same fashion we should value the diversity of who is being trained to become a hand surgeon. Why? Because diversity in the physician/surgeon workforce has been shown to improve patient outcomes.2 In hand surgery the number of women has increased over time, although remains overall low, and the number of underrepresented minorities have remained persistently low.3 Hand surgeons of the United States should reflect the diversity of our populations. As an example, to my knowledge, I am the only Latino/a full-time pediatric hand surgeon in the United States that has just reached the qualifications to become a member in the year 2021. How can that be? There are 18.6 million Latino/a children in this country (making up over 26% of all children). We have disparity in the access for hand surgeons in the United States,4 therefore we should be working on recruiting the next generation of hand surgeons that are hopefully more likely to work within their own community to help close these gaps.5 We must make an active and concerted multi-faceted approach to make a change. We respect and honor the founders of our society, but it is time to change those at the table to better reflect our diverse patient populations of the United States.
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