The Importance of Diversity in Leadership in Influencing Change in Academic Plastic Surgery and Its Subspecialties

Gender disparities in academic plastic surgery has become a burgeoning topic in recent years. Valiant disruptors have pertinaciously highlighted the overt discrepancies that exist between the careers of male and female surgeons, most notably that few women have successfully assumed a position of leadership.1 Lack of mentorship, home life responsibilities, and demands of childbearing, among others, are recurrent themes.2 It is time to disentangle gender and racial biases, which impede academic progress, and develop equitable solutions. Women comprise more than 50 percent of medical students, but within plastic surgery, they comprise only 38 percent of residents, 20 percent of faculty, 13 percent of program directors, and 8 percent of chairpersons.3 The notion that simply expanding female representation in our specialty will open equal opportunity for success, absent of external influences, should be denounced. Instead, we advocate a top-down approach as most effective, focusing on the potential influences that minority leaders hold when in positions of power. We set out to define the current state of diversity within the multidisciplinary but niched field of hand surgery. We curated a list of all currently active hand surgery faculty, fellowship program directors, and program chiefs or chairpersons. A separate list of recent graduates of these fellowship programs was created that was representative of the trainee cohort. Gender and racial designations were delineated for all surgeons, analyzing minority presence among faculty and trainees, and correlations with minority leadership representation. Similar to other specialties, we found a greater percentage of women and racial minorities at the trainee level (25 and 29 percent, respectively) compared with academic hand faculty (17 and 24 percent, respectively). Minority presence decreased with promotional rank and chief and chair positions were significantly more likely to be held by men or White persons. Most enlightening was that programs led by a female chief or chair employed triple the number of female faculty and graduated twice as many female fellows compared with programs with male leadership. Similarly, racial minority leadership yielded double the percentage of minority faculty and a significant increase in the percentage of minority fellows. We did not identify a single fellowship or department leader intersecting gender and racial minority groups. Our surgical specialty should be encouraged by the increasing diversity, both gender and racial, that we and others have found in the younger surgeon cohorts in plastic surgery and its subfield of hand surgery.3 We would like to underscore the association of diversity of leadership with increased gender and racial diversity at the faculty and fellow level. We did not measure other areas of diversity, such as religion, sexuality, or physical disability, and the unique needs of all minority surgeons should be vocalized. Nevertheless, these findings support the paradigm that greater diversity in leadership positions promotes greater overall diversity at junior and training levels, which buoys the pipeline. Plastic surgery should continue to improve diversity within all ranks through qualitative change and by addressing unspoken biases and microaggressions in order to support the growing diversity of our specialty and society.4 DISCLOSURE The authors have no financial interests or conflicts of interest to report. This study did not receive any funding.