The Forward Movement: Amplifying Black Voices on Race and Orthopaedics-No Room for Bystanders.

Abstract

If you are neutral in situations of injustice, you have chosen the side of the oppressor. — Desmond Tutu In the fight against racism there are no bystanders. An individual or an institution is either actively fighting racial injustice or shares in the responsibility for its continued existence. History will judge those who did not accept the call to purge themselves of this cancer, just as it has judged those who remained passive in the face of slavery, Jim Crow, and mass incarceration previously. Now is the time for orthopaedic surgery to stand on the right side of history. During the spring and summer of 2020, I noticed a renewed energy among my orthopaedic colleagues regarding diversity and inclusion. This burst of energy was undoubtedly born from the Black Lives Matter protests of that season, which brought anti-Black racism to the forefront of the national consciousness. This energy sparked deep conversations, introspection, and well-meaning social media posts. That is good, but insufficient. What happens when the events of 2020 and 2021 fade from memory? When the zeal for racial equality dissolves into complacency? Without urgent and immediate action, we run the risk of finding ourselves no better off from all the soul searching. The time for conversation has passed. Effective action requires a clear sense of the goal. We need to take several leaps (not steps) beyond the goal of having greater racial diversity in our specialty. Our goal should be for orthopaedic surgery to be anti-racist, a phrase popularized by author and historian Professor Ibram X. Kendi. Anti-racism is rooted in active change. It dictates the deconstruction of deeply engrained norms rather than integrating minorities as token figures in the status quo. So, while the current numbers (only 1.5% to 2% of orthopaedic surgeons are Black, only 4.2% [1] of orthopaedic residents are Black) are indicative of an underlying problem, this is not purely a problem of numbers. The numbers are the symptom, not the disease. This is a problem of power structure. A central tenet of anti-racism is that the power structures that promote ongoing inequality need to be challenged and rebuilt. Rebuilding is the only way true equity can be achieved. But this requires the acceptance from the majority that they will no longer continue to dominate. This requires action beyond a well-meaning tweet or Facebook post. This is where conversations get uncomfortable. So be it. I have encountered many well-meaning white colleagues who are interested in diversity, so long as it is on their terms. Consider this comment, made by one of my attendings, when I was a resident: “I have no problem interviewing more Black candidates, so long as they are qualified. We have to be careful to maintain our culture of excellence.” The implication is that a challenge to the overwhelmingly white makeup of the field will somehow lead to diminished quality. As if the presence of Black faces somehow denotes a lowering of standards. This notion is of course based on no published research or empirical evidence. It is the by-product of deeply seated racist attitudes that have been the frustration of many a Black orthopaedist, I among them. And yet we are commonly asked to maintain patience and civility when encountered with such bigotry. We are to believe that passive inaction and comfortable conversations will somehow correct the current state of disparity. Just give us more time, they tell us. This raises the question: What is the appropriate degree of patience in the face of injustice? None. Passive diversity efforts will do little if they maintain the same old constructs with occasional Black faces present. We need top-down leadership dedicated to asking deep institutional questions about why things are the way they are. Questions like, why have institutions failed to see the value of Black academic leadership, as evidenced by the paucity of Black Residency Directors and Department Chairs? Or, why are the presidential lines for our major orthopaedic organizations disproportionately white? What injustices exist in the leadership selection process to facilitate such blatant exclusion of Black surgeons? And then once the questions have been asked, we need leaders courageous enough to make those questions obsolete. We must acknowledge that there is intrinsic value to Black presence in seats of power in our field, and then act on that knowledge. Diversity cannot be an end goal, but rather a means by which the existing power structure is dismantled. To this end, orthopaedics must come to terms with the ways in which Black excellence has been stymied and work every day to remove those hurdles. I encourage the reader to take an anti-racist allyship. Insist that orthopaedic organizations recruit Black surgeons into their presidential lines. Insist that academic institutions promote Black individuals and facilitate their ideas to improve attitudes and culture. Insist on equitable partnership with us either on an individual basis or through organizational partnership similar to the relationship between the J. Robert Gladden Society and CORR. Insist on work culture change and boldly challenge wrong-minded behavior when it is encountered. The elevation of Black voices in orthopaedics is to the benefit of all patients, all orthopaedists, and all of medicine.