Coming to the United States from Russia, a country where the population is almost entirely white and women have been integrated into the workforce for centuries, I was not exposed to the concepts of diversity. Everyone spoke the same language with barely a regionalism to distinguish their background. Being a stay at home mom was not an option: everyone worked. Discussing sexual orientation simply wasn’t done: it was rude. In fact, I did not realize that there were orientations other than heterosexual until I was in my 20s.
All of that changed, however, when I moved to the United States in 2000. My eyes opened, not only to diversity, itself, but to the major role it plays in the treatment of patients. As I became more enlightened, I began to notice that female patients preferred to see female providers for their gynecologic care; Spanish speaking patients opened up more to Spanish speaking staff; older patients would hesitate to talk to younger physicians, and so forth. These simple, seemingly common sense attitudes and reactions startled me. In earnest, I began reading articles related to patient compliance when faced with “like” and “unlike” practitioners. The medical community in America, indeed the world, needs to recognize and embrace these simple concepts and train physicians to best serve the needs of all patients.
In 2015, I took it upon myself to actively seek diversity training. Recognizing that, of course, I cannot change my race or gender or upbringing in order to be “like” my patients, I knew I could learn more in order to better care for a diverse population. In addition to my reading and constant observation of actions and reactions in both hospital and outpatient settings, I determined to study transgender surgery first hand. I was on the faculty at the University of Rochester and collaborating with Trillium, an organization with the mission to promote health equity by providing affordable primary and specialty care, including the LGBTQIA+ community. They wanted to create a pelvic health component to add to their well-designed primary care program. I quickly realized that I lacked the knowledge and training to better help the local transgender population. I scheduled observerships in the most recognized transgender centers in Europe including Serbia, Netherlands, and Belgium. This experience, witnessing pre- and post-op care, as well as the surgeries themselves, provided immeasurable training which enabled me to care for my transgender patients with greater understanding and sympathy.
Since moving on from The University of Rochester, I now enjoy working with fellows in my current role as Program Director for FPRMS Fellowship at Cooper University Health Care. Promoting diversity within a small group of people, such as our fellowship program, is not an easy mission. It is very important to keep a balance, to make sure the initiatives operate efficiently. It would have been very easy to identify diversity as number game. We have now one male fellow and one Asian fellow, hence, one would say we have achieved the diversity targets. I, however, do not see diversity as a set metric. My personal goal, as director, is to create an inclusive environment so that a person of any of gender, ethnicity, or orientation would feel comfortable being a fellow on our team and have the best opportunity for personal growth and who is able to contribute productively to the team.
Certainly, there is a myriad of reasons for the “leaky diversity pipeline” in medicine. For example, one cause may be that women are not promoted: 50% of female medical students are recruited, but only 11% are in leadership roles at the department level, according to Columbia University. Another cause may be a lack of an “all are welcome” culture. I have noticed, on too many occasions, how women seated at a big C-suite table surrounded by men, are made to feel uncomfortable: micro aggression is real, as in the old adage, “It is not what they say, but how they say it.” Related, one of my driving missions as the fellowship program director has been to create an environment where biases against any “other,” be it gender, ethnicity, gender orientation, or an unrecognized “+” are eliminated. Everyone should feel included and supported. Last year I convinced the faculty in my division to eliminate the use of USMLE step scores as a cut off for fellowship applicants’ interviews. This year I proposed that the Harvard implicit bias association test be completed by each faculty on the selection committee in hopes that, by exposing their, often unrecognized, biases we could work together to eliminate the inequality and be open to the true potential of each applicant.
With more inclusivity, recognition, and elimination of biases, and broadening of services, we have actively addressed diversity in our work, institution, and community in many ways. When we address fellows, medical students, and residents we stress that everyone is different – not just patients, but the cohort of trainees, as well. In addition to different styles of learning, generational differences exist, as well. Millennials, for example, not only understand technology quicker than their elders, they expect to use it. Making sure that this strength does not hamper personal interaction presents a specific set of challenges. Likewise, patient materials must be tailored to background, ethnicity, and social-economic status, and, yes, age. Attention to clear communication including method and message, vocabulary and delivery is high on our training watch list. Our fellows have been encouraged to participate in research targeting health care disparities. Cooper Health University is currently a site for the Fellows’ Network Diversity Study, a project investigating differences in attitude towards pelvic floor disorders between Caucasian populations and various minorities.
Ideally, the goal for FPMRS Division would be an environment of inclusivity, where all people feel safe raising concerns and feel empowered to propose changes side by side within a culture of accountability. Everyone has strengths and weaknesses – being a leader requires the ability to direct the balance between these sides.
Certainly the medical landscape is constantly changing: women used to be the minority in OBGYN. Soon it could be a struggle to recruit men into the field. It is of the utmost importance to be in touch with the ever fluctuating local and global trends in medicine, business, and populations, staying current and using every opportunity to tailor a team to address, cope with, and practice within these shifting needs and demands. If you are an applicant to our fellowship and identify yourself as underrepresented minority in medicine please contact us with your diversity statement: we would like to hear from you!
Lioudmila Lipetskaia, MD, MSc, FACOG
Female Pelvic Medicine and Reconstructive Surgery Fellowship Program