Perceptual and Structural Facilitators and Barriers to Becoming a Surgeon

A Qualitative Study of African-American and Latino Surgeons

Published in: Academic Medicine [Epub May 2018]. doi: 10.1097/ACM.0000000000002282

Posted on RAND.org on June 29, 2018

by Jesus G. Ulloa, Omar Viramontes, Gery W. Ryan, Kenneth B. Wells, Melinda Maggard Gibbons, Gerardo Moreno

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Purpose

As racial and ethnic heterogeneity in the U.S. population increases, it is important that the health care workforce, including surgery, mirror that diversity. Structural and perceptual barriers may contribute to an underrepresentation of African-American and Latino surgeons. Understanding these barriers may translate into interventions, and in turn, improved diversification of the U.S. surgery workforce.

Method

In 2016, the authors conducted in-depth semistructured interviews to explore structural and perceptual barriers African-American and Latino surgeons face. The authors used conventional qualitative techniques to analyze data and identify themes.

Results

The authors interviewed 23 participants and observed three major themes characterizing the path to becoming a surgeon: creating a path to medicine, surgical culture, and mentorship. Subthemes provided further nuance. For creating a path to medicine, the subthemes were personal attributes, family support, community assets/barriers, and minority experience. For surgical culture, the subthemes comprised quality of life, surgeon-patient relationship, and restoring health. For mentorship, the subthemes were aspirational figures, formal programs/peer support, and professional opportunities. The experiences described by African-Americans and Latinos were similar, but the experiences of participants of different self-identified childhood socioeconomic status were dissimilar.

Conclusions

The path to a surgical career as experienced by African-American and Latino surgeons is heavily influenced by mentors mediating their integration into surgical culture and engendering a feeling of belonging. Future surgeons from groups underrepresented in medicine would benefit from identifying aspirational figures early, a structured introduction into the rigors of the profession, and a deconstruction of negative surgical norms.

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