Dialogue

Op-ed & AOA response: AOA leadership must become more inclusive

It is time for the AOA to show a commitment to gender, LGBTQ and racial equity.

Editor’s note: This is an opinion piece; the views expressed are the author’s own and do not necessarily represent the views of The DO or the AOA. Find the AOA’s response to this commentary below the article.

On June 4, 2020, the AOA published the “AOA Statement Denouncing Racism and Inequality.” Rhetorically the AOA advocates for equity, yet inclusivity is not happening within its highest position—the presidency.

It has been since 1995 that the AOA was led by the distinguished William Anderson, DO, an African-American physician.

Today, 42% of actively practicing DOs are women. Since the AOA’s inception in 1897, Karen Nichols, DO, has been the only woman to serve as AOA president. She served from 2010-2011.

Of the 28 AOA Trustees, eight (29%) are women. The AOA sadly lags other medical associations who are actively electing women as presidents of their organizations.

Disparity must be addressed

The time has come for the AOA to make it clear that the persistent gender and racial disparities found among its members even after accounting for age, experience, faculty rank, measures of research productivity and clinical revenue are unacceptable. These disparities must be addressed by our AOA leadership. This must go beyond the dog-and-pony-show of saying we will study the phenomena. We must advocate for gender, LGBTQ and racial equity through the actions advanced by the executive board of the AOA.

Simply put: Equal pay for equal work starts with equal representation within our profession’s most prominent leadership position.

Incongruity between words and action is hypocritical. This is not as simple as giving female physicians or physicians of color better negotiating skills. The profession needs to address the underlying gestalt and culture or tokenism that causes this issue.

LGBTQ equity

Another area of diversity whose time has come is the need for LBGTQ equity in leadership representation. Leaders can hardwire diversity into all areas of the profession rather than limiting it to education and patient care. Diversity also must be considered when it comes to policy development and its implementation.

Individuals should not have to continue to force rights through the courts in order to be equal. Professional organizations can make us equal and whole now. The time for rhetoric is over. Equity means action.

It is time the AOA shows commitment to gender, LGBTQ and racial equity by owning the issue. Isn’t it time a woman or a physician of color leads the AOA again? Or for that matter, someone who is LGBTQ?

I gave the above remarks at a United Federation of Osteopathic Societies meeting on Sept. 12, 2020. Since then I have received multiple comments, most of them supportive. The theme that keeps coming up is, “I have felt this way for a long time but feared saying something because I thought I would be perceived as being angry.”

As a professional organization, how can we allow this to continue? Fears of retribution, retaliation and shaming must be acknowledged, confronted and cleansed from our professional and historical tradition. This is part of an underlying unspoken gestalt that needs to be addressed. Not one individual should feel they are unable to speak their mind out of fear of misperception.

Open dialogue needed

I implore the AOA to take immediate steps to ensure an environment that fosters openness in dialogue and meaningful growth. Otherwise the AOA will stagnate and become disconnected to our values, which will in turn cause diverse members to view the AOA as arrogant and not join because the organization provides little room for alternative thoughts and opinions.

In this unprecedented era of COVID-19, the AOA has been given an opportunity to change the status quo. Women make up 50.8% of the U.S. population and 42% of practicing osteopathic physicians. This is a call to action to change the gestalt of the AOA leadership by electing a women as president and put the profession on notice that we are not misogynistic or discriminatory against others on the basis of race or sexual orientation.

The AOA needs architectural changes in its current electoral process which should allow the membership to directly elect its governmental body as other medical professional organizations do. This truly will make the AOA reflect all osteopathic physicians, not a select few. AOA, are you listening? If so, show it by making meaningful changes.

About the author: Larry Suess, DO, PhD, is a child psychiatry professor at Touro University Medical Group in Stockton, California.

AOA Response

Dear Dr. Suess,

On behalf of the American Osteopathic Association, we would like to publicly thank you for your letter and acknowledge your longstanding passion for and commitment to gender equity. We agree that there is significant work to be done to address these issues at a systemic level, in general and particularly within health care. The AOA’s leadership is committed to the tenets of equity, diversity and inclusion. While your former experience with the AOA on this crucial topic may have prompted the penning of your letter, we assure you, and others, that in countless ways, today’s AOA is much different than the AOA of the past.

You asked, “Are we listening?” The answer is yes, but we are doing more than listening. We have been and are being proactive by constructing programs that we genuinely hope will affect the profession for the better. What may be most important is the fact that our motivation has been to do what is right for our members and our professional community. In other words, although we are listening, we were self-directed to move to action to correct inequities and to work toward true diversity and inclusion in service of what our members, AOA staff and the osteopathic profession should expect from the AOA.

Here are a few things that the AOA is doing to positively impact equity, diversity and inclusion in the osteopathic profession:

Creation of a Chief Engagement and Diversity Officer role at the AOA
In late 2019, for the first time in AOA history, a Chief Engagement and Diversity Officer position was created to address equity, diversity and inclusion efforts. This role is charged with creating a strategic plan to ensure these concepts are developed and integrated into every part of the AOA’s structure in governance, operations and programmatic development.

Defending the profession and promoting gender equity
As you may know, the osteopathic profession and women physicians came under attack when FIGS, a designer scrubs and medical apparel company, promoted an advertisement that featured a female physician with a “DO” nametag reading a “Medical Terminology for Dummies” book upside down. The AOA immediately and vigorously responded in defense of women DOs, women leaders and the osteopathic profession. We contacted FIGS and demanded that the offending ad be removed. In addition, the AOA requested and received, among other things, an apology to the profession and women physicians along with a $100,000 donation to support our ongoing efforts in diversity and inclusion and to address gender inequity. More information on this issue is available here.

Creating a leadership development program with the Bureau of Emerging Leaders
The AOA Bureau of Emerging Leaders (BEL), with the Chief Engagement and Diversity Officer, is creating a leadership development program with content pulled from across the profession. The program will focus on the BEL’s constituents of osteopathic medical students, postdoctoral trainees, and new physicians in practice. The program’s goal is to bring underrepresented minorities through this program and get their foot in the door to start participating at the leadership level at any organization, not just the AOA. We expect the first cohort to be in place by late 2021.

Increasing diversity and inclusion within the AOA governance structure
We, with the support and guidance of AOA President Thomas Ely, DO, enhanced our appointment process this year by including diversity and inclusion as considerations for appointment to the AOA’s bureaus, committees and councils (B/C/Cs), with the goal of increasing racial, ethnic and gender representation in the leadership pipeline and moving toward a physician leadership structure which more closely approximates the demographics of our membership and the patients our members serve. This process is now hard-wired into the AOA leadership appointment processes.

Below are some charts that depict the AOA’s progress so far in this area:

The chart above describes the gender makeup of both the osteopathic profession and the 2020-2021 B/C/Cs. As you stated in your letter, 42% of all actively practicing DOs are women, according to the 2019 OMP report. Currently, women represent 34% of the makeup of the B/C/Cs.

The chart above indicates the racial and ethnic makeup of both the osteopathic profession and the B/C/Cs. According to the race and ethnicity data that we currently have (which is approximately 27% of the profession, or a little less than 33,000 physicians), almost 17% of the profession identifies themselves as a race other than white. Within the B/C/Cs, that statistic is 12%. Please note that the legend for the race and ethnicity data is not meant to be an exhaustive list of all races and ethnicities represented.

These data illustrate that while we are making progress, as indicated by our narrowing gap between diversity in the profession and representation on our B/C/Cs, we still have a lot of work ahead of us to ensure that we are engaging our profession and members and rightfully incorporating them into the governance of the AOA. Equity, diversity and inclusion aren’t merely about changing the demographics of membership and leadership, but also entail welcoming the diverse thoughts and opinions that reflect the beliefs of our members and profession.

We take this charge very seriously and provide the examples above as a representation of some of what the AOA is working on, but recognize that achieving true equity, diversity and inclusion requires a permanent commitment and is an ongoing endeavor in service of those who comprise this wonderful profession.

We welcome additional input, collaboration and guidance from you, Dr. Suess, and others, as we strive to get this right. Please feel free to email Priya Garg, Chief Engagement and Diversity Officer, at pgarg@osteopathic.org for more information or to share your thoughts.

Sincerely,

Kevin M. Klauer, DO, EJD
AOA CEO

Priya Garg, MBA
AOA chief engagement and diversity officer

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