By Marvin E. Dingle, MD

Creating opportunities is the key to achieving diversity, equity, and inclusion in hand surgery. Specifically, to create opportunities for people from racial, gender, and socioeconomic backgrounds that have historically been kept from pursuing higher education and therefore unable to become hand surgeons. The past laws and practices in America that were targeted toward racial and gender minorities had a direct effect on who had the opportunity to pursue hand surgery. Such practices dictated where you could live, which in turn dictated the quality of your elementary and high school education. In addition, access to educational funds such as the Montgomery GI Bill were denied and acceptance to any graduate level education was unattainable. The racist Jim Crow laws were still in full effect in 1946 when the great Dr. Sterling Bunnell founded the American Society for Surgery of the Hand. Although these laws and other restrictive practices have been reversed on paper, their lasting impact is still seen today in the composition of the applicant pool for orthopedic surgery, plastic surgery and hand surgery fellowship programs.

I believe that biases based on race and gender that were pervasive decades ago continue to influence the applicant selection process today. Published literature on the racial and gender disparities in residency training are worrisome (Joinski et al 2020). While encouraging progress in gender diversity has been made at the medical school level (Lett et al 2019), that progress has not been reflected in the surgical specialties that serve as pipelines to hand surgery (Joinski et al 2020). These reports have shown a disappointing lack of improvement over the last decade in racial diversity—specifically for trainees of African American and Hispanic descent–at the medical school and surgical specialty levels. Although there have been encouraging changes over the past year with the creation of DEI committees and focused resource allocation, we are likely still decades away from reaching the threshold of racial and gender diversity in hand surgery that would ensure lasting change in the trainee selection process.

When I think of this lack of opportunity, I think of all the talented people who never had the opportunity to apply their talent and hard work to the pursuit of medicine. I am also reminded of my own journey in medicine. The opportunity to pursue hand surgery could have easily passed me by. I’m the son of an African American man who grew up in the foster care system in Philadelphia, PA in the 1950s. My mother was born in a rural town in the Philippines. I was fortunate to benefit from an accelerated education in elementary school through a “gifted” program and military scholarships for undergraduate and graduate school. Every day I reflect on how fortunate I am to be one of the very few who are afforded these opportunities. I also think of my three daughters of mixed race. Although they will now have the privilege that my education and financial stability affords, they likely will still experience the biases that I faced.  

As someone who was never supposed to reach a career in hand surgery, but did anyway, I know that it’s the people practicing in the field that make a difference. Each of us: you and me. I believe that everyone who has the desire, empathy, and compassion for the work that we do should be given a shot to be the best and brightest recruits. Each of us can support this through scholarship programs at each level of education, active recruitment, volunteering for mentorship, or hiring and retaining surgeons who demonstrate commitment to creating this change. I wholeheartedly believe that we have the surgeons with the minds and hearts right now who can drive this change. Our future trainees, colleagues, and patients depend on it.

Marvin E. Dingle, MD
Lieutenant Commander, United States Navy
Orthopaedic Surgeon, Walter Reed National Military Medical Center