Leaders in ophthalmology see hope in diversity

NEW ORLEANS – Leaders at the American Academy of Ophthalmology (AAO) see signs of hope their profession will become more ethnically and racially diverse despite decades of slow progress.

Subspecialty groups have formed task forces seeking to make ophthalmologists more representative of the population they serve, and the AAO’s mentorship program for under-represented groups received an injection of donations over the course of the past year, said AAO President Tamara Fountain, MD.

These efforts may not yet be reflected in race and ethnicity statistics – which are among the worst of any U.S. medical specialty – but they provide crucial encouragement, she said. Medscape Medical News.

“It hit a wave of people who have felt marginalized in our workforce, in our training programs, who come to these Academy meetings and realize that there is something for them, to whom we, this behemoth of a medical organization dedicated to eye care, let’s talk to them and watch over them and provide them with the support they need, ”she said.

Fountain was one of 18 panelists who spoke here at a symposium dedicated to diversity, equity and inclusion at the 2021 American Academy of Ophthalmology (AAO) annual meeting.

One by one, the speakers presented slides demonstrating the gross under-representation of most ethnic groups in ophthalmology.

Together, blacks, Hispanics, Native Americans, Alaskan Natives, Hawaiians and Pacific Islanders made up just 6% of practicing ophthalmologists in 2015, according to a JAMA ophthalmology study cited by Basil Williams, MD, assistant professor of ophthalmology at the University of Cincinnati College of Medicine, Cincinnati, Ohio.

This contrasted not only with the 30.7% share of these groups in the total United States population that year, but also with their proportion among ophthalmology residents (7.7%) and medical students ( 16.4%). The study also found that those numbers had barely budged in a decade. Quoting a item in Ophthalmology that she co-wrote, Kristen Nwanyanwu, MD, MBA, said university departments of ophthalmology are the third least diverse among all American medical specialties.

“The numbers you’ve shown are dismal, just dismal,” said panelist Terri L. Young, MD, MBA, chair of the Department of Ophthalmology and Visual Sciences at the University of Wisconsin, Madison. “People are given different pay scales. They are given different resources. They are given different leadership opportunities. They are certainly not getting the right coaching for a promotion.”

The lack of ophthalmologists from under-represented groups has implications for patient care, said Angela R. Elam, MD, assistant professor of ophthalmology at the University of Michigan, Ann Arbor.

Racial and ethnic minorities are at greater risk of losing their sight due to eye disease, she said, citing an article she co-wrote in Ophthalmology survey. Part of this is due to income, she said. For example, people enrolled in Medicaid receive less care for glaucoma than people enrolled in commercial health plans.

But even after controlling for other socioeconomic factors, disparities between black and white patients persist. For example, black patients are more likely than white patients to experience enucleation or evisceration after eye trauma, Elam said.

Jayanth Sridhar, MD, associate professor of clinical ophthalmology at the Bascom Palmer Eye Institute in Miami, Fla., Who has researched diversity in ophthalmology, said several explanations have been proposed for the poor history of glaucoma compared to other medical specialties.

First, many people from under-represented backgrounds see primary care as an obvious way to contribute to their community, he said. Medscape Medical News.

Second, many medical schools don’t include ophthalmology internships, so students don’t see them as an option for their residencies. Third, more than in other specialties, ophthalmologists are exposed to the specialty because a family member is an ophthalmologist.

Finally, ophthalmology is a competitive specialty, with more students applying relative to residency count than the average specialty, said Sridhar, who was not part of the symposium.

“When it comes to applying and matching in a competitive field, you might not be prepared,” he said. “You didn’t get enough mentorship. You did not start observing and researching from the start, you did not seek out the ophthalmologists at your facility. So you’re a little behind ball eight. “

The AAO is trying to solve the problem in collaboration with the Association of University Teachers of Ophthalmology through its Minority Ophthalmology Mentoring program, Fountain said. Founded in 2016, the program pairs medical students with ophthalmologists and offers student support and training programs. It has grown rapidly in recent years, doubling in size to reach 50 students from 2019 to 2020. Its budget is $ 297,459 for 2021.

Keith Warren, MD, who has a private practice specializing in retina, said it bothered him that he was the only black American ophthalmologist in Kansas City, Missouri. Ten years ago, he raised the issue to the leadership of the American Society of Retina Specialists (ASRS) but got few responses, he said. Medscape Medical News.

Then, the COVID-19 pandemic made many people aware of disparities in health care, and incidents of police brutality that became public in 2020 brought racism to the fore. So he wrote an article in the ASRS publication Retina time, calling for further efforts to diversify the subspecialty. This time, the management asked him to form an ad hoc committee, which is looking for ways to solve the problem.

One idea: mentoring “families” in which ophthalmologists at all stages of their careers mentor each other. For example, the younger members of each group can offer advice on new technologies to the older ones, while the older ones give career advice.

Warren is also encouraged by the changes at the top of the AAO. Fountain and the organization’s CEO, Stephen D. McLeod, MD, are both black. Warren is pleased that the Stage 1 US Medical Licensing Exam exam will fail effective January 26, 2022 because some studies found the test to be biased against people from under-represented groups.

White ophthalmologists also have a role to play, Warren said. The first ophthalmologist to encourage him in his career was his mother’s doctor, a white man.

And sometimes it’s about creating a safe space where people from under-represented backgrounds can voice their opinions. “Part of safety is listening,” he said. “It’s compassion. You have to understand that in the end it will benefit you because you would have employees who can bring things to the table that you might not have heard otherwise. Your people. patients could certainly increase if you have a diverse workforce. “

As she left the podium after the symposium, Fountain was greeted by Harry Levine, a medical student from Mexico studying at the University of Miami, Florida. “Every time I see something like that it gives me reassurance that I am choosing the right career,” he told her. “The people at the top care about minorities and we are valued. It’s gratifying to see that.”

“It’s an example of why I’m optimistic,” Fountain said.

American Academy of Ophthalmology (AAO) Annual Meeting 2021: Summary SYM39. Presented on November 16, 2021.

Laird Harrison writes on science, health and culture. His work has been published in magazines, newspapers, public radio and on websites. He is working on a novel on alternative realities in physics. Harrison teaches writing at Writers Grotto. Visit him at lairdharrison.com or follow him on Twitter: @LairdH.

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