Welcoming diversity in plastic surgery

Those of us with two X chromosomes in a surgical occupation are increasingly asked to speak on the topic of ‘women in surgery’ or ‘women in plastic surgery’. Although the promotion of women in our profession is important, the broader principle that people and groups who have experienced disadvantage in the past should now be more welcomed is one that perhaps has a more fundamental basis and is, in some ways, less developed. The problem of categorising people as ‘women surgeons’ or ‘ethnic minority surgeons’ is that it puts emphasis on one particular attribute and pigeonholes people in a simplistic way.


Welcoming diversity in plastic surgery
Nicola R Dean PhD FRACS (Plast) 1,2 Those of us with two X chromosomes in a surgical occupation are increasingly asked to speak on the topic of 'women in surgery' or 'women in plastic surgery'. Although the promotion of women in our profession is important, the broader principle that people and groups who have experienced disadvantage in the past should now be more welcomed is one that perhaps has a more fundamental basis and is, in some ways, less developed. The problem of categorising people as 'women surgeons' or 'ethnic minority surgeons' is that it puts emphasis on one particular attribute and pigeonholes people in a simplistic way.
This idea of homogeneous categories of disadvantaged people has been replaced in sociological peer-reviewed literature by the concept of 'intersectionality'. 1 Intersectionality acknowledges that many people will have complex mixes of attributes that have led to historical disadvantage. I, for example, am an immigrant, a bit on the short side and female.
While intersectionality is the academic, theoretical term for this idea, 'diversity' is the term used in its practical application in policy. Diversity is an apt term, as it encompasses all attributes, and in any combination of mixtures, rather than focusing on one particular classification of characteristics.  It is clear, then, that the profession of plastic surgery in Australia is not currently as diverse as the community we serve. Some may ask: Does this really matter? or Is diversity really that important?
Meanwhile there will be some who would contend: Didn't the 'old boys' club system work pretty well?
There is a real mindset that believes it is best to pick people with similar traits to oneself. It is not helpful to write-off this kind of attitude as just 'nonsense' and to do so risks alienating and disenfranchising colleagues who may hold such attitudes. It is important to acknowledge the rationale of this sort of selection. There is, in fact, some evidence that 'fitting in' is easier in a very homogenous group and perhaps team cohesion occurs more rapidly.
Cox and Blake, in their seminal paper on diversity, acknowledged that similarity is an aid to cohesion but they also pointed out that homogeneity has serious downsides in terms of decision-making and creativity. 5 Overall, they found that as long as there were core similarities, the pros of diversity significantly outweighed the cons.    If we accept that diverse teams will reflect the community better, will problem solve better and deliver better outcomes, and that we are most likely to get the best and brightest if we attract a diverse group to surgery, how can we make it happen? There is no single silver bullet-diversity management has many different elements. It is about generating a welcoming culture, promoting  So why can welcoming diversity like this be directly good for your unit? It is because people who feel that they are allowed to be themselves perform at their best, whereas those who feel they do not belong are stressed and perform poorly. Studies in healthcare show that those who feel discriminated against in any way have higher rates of absenteeism and lower productivity. 12,13 The next challenge is competently selecting for diverse teams. 14 The greatest barrier to this is the issue of unconscious bias. 15  Surgery is entering a new era in which embracing diversity is the norm. It is important that our specialty of plastic and reconstructive surgery stays ahead of the curve.

Disclosure
The authors have no financial or commercial conflicts of interest to disclose.