Nigeria Abroad
No one would make eye contact with Dr. Brian Nwannunu.
“A few of my rotations, the general culture and underlying message was, ‘We don’t want anyone that doesn’t look like us,’” said Nwannunu, an adult-reconstruction fellow in orthopedics at Baylor College of Medicine. “They don’t feel like they can relate to you. They would shun me. Active teaching residents wouldn’t look at me and only talk to other students. I knew I wasn’t wanted.”
Nwannunu, 34, has wanted to be an orthopedic surgeon since he injured his ankle playing basketball in high school. He remembers eyeing the sports memorabilia on the wall and thinking how different the orthopedist’s office was compared to his pediatrician’s. His interest was piqued.
While the Dallas-based Nigerian was navigating internships during his time at Howard University and Georgetown University, he felt his experience of being “othered” wasn’t isolated only to him. Throughout his residencies, he worked with practicing orthopedic surgeons who said they wanted to promote diversity and inclusion. But they were all white and all male, he remembered.
“When you talk to them, it was evident they didn’t want someone here who was different,” he said. “It’s not that we’re not applying.”
After Nwannunu’s Baylor fellowship ends, he will move to Dallas to join a residency with five other orthopedic surgeons. He’s excited to move closer to his home in Fort Worth and be part of a practice that celebrates diversity.
“Multiple people come up to me and say I’m the first Black doctor they’ve ever seen,” said Nwannunu, a first-generation Nigerian American. “They said they don’t trust the older, White guy, but they trust me to do their surgery. That’s the type of difference that can be made when the career of orthopedics is diverse.”
COVID-19’s devastation in Black and Latino populations has shed more light on the realities of deeply entrenched health disparities for US communities of color. For Dr. Melvyn Harrington, the pandemic has shown the importance of minority representation in doctors’ offices and hospitals so patients of color can establish trust more easily.
The key is getting the medical students interested in the field early, he said. And that’s not easy.
In 2019, Harrington, a professor of orthopedic surgery and adult-reconstruction director at Baylor, co-wrote a paper on the lack of gender and racial diversity in his field. The 53-year-old surgeon said there’s a great need for the orthopedic workforce to be as a diverse as the patients it serves.
Harrington said orthopedics is “far and away” the least diverse field in terms of race, ethnicity, and gender, but there’s no single reason.
The lack of diversity is evident in other surgical fields as well. In 2020, the American Society for Plastic Surgeons reported that there has been an increase of 0.3 percent of Black plastic surgeons in the previous 12 years and only 1.7 percent more plastic surgeons who identify as Latinx.
“It would take more than 8,013 and 863 years for Black and Latinx Americans, respectively, to attain parity in plastic surgery,” the society reported.
According to a 2018 Association of American Medical Colleges report, 56.2 percent of all physicians, regardless of specialty, in the US were White. Asian Americans make up the second-largest group at only 17 percent, Hispanic people make up 5.8 percent, and Black people account for 5.3 percent of doctors.
“A lot of it is these stereotypes of orthopedic surgeons is we’re ‘strong as an ox and half as smart,’” he said. “A lot of them are ex-jocks, and the perception is you have to be a big, strong guy to be able to do the procedures. It’s really misinformation.”
In “The Orthopaedic Workforce Is Not as Diverse as the Population It Serves: Where Are the Minorities and the Women?,” Harrington and three researchers found that while current medical school classes are split evenly — with women leading men in 2017 and 2020 — the percentage of women in orthopedic surgery residencies has remained at 14 percent since 2009.
Though the overall number of women in orthopedics has doubled since 1995, there has been only a “modest increase” in the numbers of Black, Asian American and Latino orthopedic residents, according to Harrington’s paper.
The American Academy of Orthopaedic Surgeons did not address race in its field surveys until 2004, according to Harrington’s research. At that time, 89 percent of orthopedic surgeons identified as Caucasian, and 9 percent were from a minority race; Asian American members have the highest minority representation in the academy.
By 2016, 86.6 percent of orthopedic surgeons identified as Caucasian and 6.7 percent were Asian American. Less than 2 percent were Hispanic or Black or multiracial.
“There’s been definitely some inherent bias against underrepresented students and women in programs over the years,” Harrington said. “Programs will not hire a woman because they might get pregnant and need to take time off. It’s been a very stereotypical old boys club, locker-room culture.”
Sports medicine, a subspecialty within orthopedic surgery, is the fastest-growing specialty in medicine. But the number of women and people of color in sports-medicine residencies has remained small, too.
Since 2004, Harrington has worked with Nth Dimensions, a program that serves as a pipeline for underrepresented medical school students to orthopedic residencies. The program’s goals include addressing and eliminating health care disparities for all communities through summer internships, mentoring and project-based education.
“It’s really lack of early exposure, which is one of the challenges all subspecialties face,” he said. “The stereotypical route to orthopedic surgery that a lot of guys have is, ‘I tore my ACL playing football in high school and fell in love with orthopedics.’”
Early in medical school, orthopedics is offered as elective courses, and many students don’t have the chance to take their first class until their third year, when it’s time to choose a specialty, Harrington said.
More than 30 percent of practicing orthopedic surgeons who identify as female are products of the Nth Dimensions Pipeline Curriculum program, according to Harrington’s paper. More than 65 percent of those women identify as minorities.
Each summer, Harrington mentors a first-year student — either a woman or person of color — from another medical school. This year’s intern, Olaoluwa Omotowa, has shadowed Harrington and Nwannunu at Baylor’s orthopedic clinics, and he will finish a research project in early August.
Omotowa, 28, is in his first year of medical school at the University of Utah in Salt Lake City, where he is one of a few Black students. After expressing an interest in orthopedic surgery, a colleague recommended he look into an internship at Nth Dimensions.
In 2020, AAMC reported less than 3 percent of American doctors are Black men. Omotowa, also Nigerian American, wants to be part of the first large generation of Black male physicians.
Omotowa is one of 43 orthopedic surgery interns matched with residency programs through Nth Dimensions. Though he doesn’t have to declare a specialty until his third year, he likely will stay in orthopedics.
“I’m the first person in my family to go to medical school, and I’ll be the first physician in my family,” Omotowa said. “It’s a challenge being the first anything and navigating it without anyone else in my immediate family not going through it; after all the experiences I’ve had this summer, it’s hard to envision doing anything else.”
Though he didn’t know it nine years ago, Nwannunu’s entire career path changed when he started working with Nth Dimensions. For him, the program was about representation and seeing in person what he never saw growing up — Black doctors treating patients of all races and backgrounds.
Since he’s been in Houston this summer, he has worked with patients from diverse backgrounds. But he still doesn’t see many people of color in clinician roles, especially in orthopedics. He says he’s lucky to have had a chance injury as a high school athlete, which put him on this career path. But many Black men don’t have that same exposure.
Though the field has diversified slightly since Harrington started 30 years ago, he said the number of new orthopedic surgeons from underrepresented backgrounds does not match the increasing number of procedures they have to perform. Since the American population is aging, there is a need for more orthopedic surgeries as baby boomers try to remain active.
“The challenge in medical school is exposure and getting them early on,” Harrington said. “Orthopedics is not the most competitive specialty for students to get into. Our challenge is trying to make it more diverse, too.”
This story first appeared in Nigeria Abroad
