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Clinical Updates

Understanding Intersectionality: An Update from Board of Governors Diversity Pillar

by Cherisse Berry, MD, FACS, Governor, American College of Surgeons, Manhattan Council, Board of Governors Diversity Pillar

Intersectionality: the intersection and interconnectedness of identities such as race, gender, ethnicity, sexuality and disability. It is a term coined in 1989 by Kimberlé Crenshaw, JD, a University of California, Los Angeles, law professor who published, "Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics" in the University of Chicago Legal Forum. Discussing three legal cases involving the co-existing issues of racial discrimination and sex discrimination, Dr. Crenshaw introduced the concept of intersectionality: a problematic consequence of the tendency to treat race and gender as mutually exclusive categories of experience and analysis. For example, Black women are both Black and female and thus subject to discrimination on the basis of race, gender and possibly a combination of the two.

Within academic medicine, cultural patterns of discrimination and subsequent inequities are intertwined and difficult to separate solely on the basis of a single aspect of identity or experience.1 Thus, an intersectional lens is needed to better understand the impact of multiple identity experiences within academic surgery. Minorities and women remain grossly underrepresented in academic surgery, the disparity greatest at the highest levels: professor, chair and dean. According to the 2017 AAMC Faculty Roster, of nearly 16,000 department of surgery medical school faculty, 14.6 percent are Caucasian women, 3.5 percent are Asian women, 0.79 percent are Black women, and 0.52 percent are Latinx women.2 Of the nearly 3,500 professors of surgery, 318 (9 percent) are Caucasian women, 51 (1.5 percent) are Asian women, 10 (0.29 percent) are Black women, and five (0.14 percent) are Latinx women. Of the 337 chairs of departments of surgery, 12 are Caucasian women, two are Asian women, two are Latina/Hispanic women, and 0 are Black women.

Racial and gender disparities within academic surgery extend to research funding. Of the nearly 16,000 National Institutes of Health grants funded to surgeons between 1973 and 2017, only 1,667 (10 percent) were awarded to women.2 Over the last 20 years, 194 grants were awarded to a Black surgeon and of those 31 were awarded to Black women. In fact, 80 applications with fewer than 12 Black female surgeons were awarded NIH funding in the last 20 years. Lewit and colleagues3 recently examined NIH funding for surgeon scientists, assessing the correlation between sex and race/ethnicity for grant recipients: female surgeon scientists received less money per grant than men, and no Black women or female orthopaedists received R01 equivalent grants in 2019.

Evaluating academic surgery through an intersectional lens clearly shows inequities based on race, gender and the combination of the two. Race and gender are not mutually exclusive categories of experience and analysis. Thus, prioritizing intersectionality within academic surgery is critical in achieving diversity, equity and inclusion within the surgical workforce and within the surgical leadership. The underrepresented minority woman surgeon often may be invisible to individuals in powerful or leadership positions, making it vital to act intentionally in making the invisible visible. Why? Because "diversity at the highest levels of leadership at academic health centers contributes critical and innovative viewpoints and organizational-level changes that ensure excellent patient care, groundbreaking research, and serve as a model for health professions education."4

References

  1. Eckstrand KL, Eliason J, St Cloud T, Potter J. The priority of intersectionality in academic medicine. Acad Med. 2016; 91(7):904-907.
  2. Berry C, Khabele D, Johnson-Mann C, et al. A call to action: Black/African American surgeon scientists, where are they? Ann Surg. 2020; 272(1):24-29.
  3. Lewit RA, Black KM, Camp L, et al. Association of sex and race/ethnicity with National Institutes of Health funding of surgeon scientists. JAMA Surg. 2021;156(2):195-197.
  4. Shaikh U, Acosta DA, Freischlag JA. Developing diverse leaders at academic health care centers: A prerequisite to quality health care? Am J Med Qual. 2018;33(4):440-442.