By: Priyanka V. Chugh MD, MS
When I started medical school, nearly ten years ago, I had an idea of what a surgeon looked like. Largely rooted in the perspective of the media, it was “supposed” to be a white, affluent, straight, cisgender man without any visible or invisible disability. As a South Asian woman, who is part of the LGBTQIA+ community, and lives with invisible disability, I never contemplated becoming a surgeon. In fact, I believed that my unique experiences and challenges would not be understood or accepted by surgeons. When I discovered that surgery felt like the right path for me professionally, a new anxiety clouded my excitement. I had never met a surgeon that lived at the same intersection of identities that I did. I met with women surgeons and South Asian surgeons; I spoke with disability advocates and followed queer surgeons on social media. I craved for that experience that echoed mine or at least for someone to acknowledge my background. I wanted reassurance that it would be okay to be me.
Intersectionality, a term coined by civil rights advocate and scholar Kimberlé Williams Crenshaw in 1989, is defined in the Oxford English Dictionary as “the interconnected nature of social categorizations such as race, class, and gender, regarded as creating overlapping and interdependent systems of discrimination or disadvantage; a theoretical approach based on such a premise.” #1 We don’t live with each of our identities partitioned off. For example, I don’t experience the same challenges as all women or all South Asian people. We are instead, uniquely impacted by the amalgamation of these identities and the challenges presented by each.
This plays out in the field of surgery in multiple ways. For example, the intersection of gender, race, and ethnicity in surgical leadership was recently explored by Iwai et al. #2 The authors found that the majority of surgical chairs were white males, followed by Asian males and then white females. In fact, there had not been any black female chairs of surgery at an academic center in the United States until 2021. #2 It has been demonstrated that a greater number of women trainees report experiencing mistreatment than men, but LGTBQ+ women report even higher rates of mistreatment. #3 This trend plays out over and over with different identity groups. So, while many have applauded the great strides achieved by certain groups in surgery, there are still gaps when we examine the intersections of identities.
Those gaps in representation are palpable to those in minoritized groups. Even as surgery diversifies, there are still operating rooms around the country where no one looks like me or some of my peers. There are many places where talking about a same-gender partner would be met with uncomfortable silence, or a request to use appropriate pronouns would not be respected. Surgeons or trainees from the same racial or ethnic background might be confused for each other. A surgeon who discloses a disability might fear for their job. A trainee who has to financially support their family may not be able to attend the same conferences as their more affluent peers. The weight of these challenges compounds and the onus to educate or make change often falls to those who are the most impacted. This takes time and mental space that should be used for learning how to be a surgeon. This means working twice as hard to be given the same treatment as peers who come from the historical majority.
While the obvious solution is to increase diversity and representation in surgery, that takes time and intention. Minoritized surgeons and trainees don’t have the time to just wait, action has to be taken now. Organizations such as the Association of Women Surgeons (AWS), Society of Asian Academic Surgeons (SAAS), Association of Out Surgeons and Allies (AOSA), and more have made progress in representation and education. Institutions across the country have invested in diversity and equity initiatives. This is just the start. Everyone deserves a safe and welcoming environment to learn and practice, regardless of their unique intersections of identity. It is an institution-level and a person-level problem and the solution all begins with creating a culture of respect and humility. Recognizing that none of us comes to the table with the same experience as another is the first step. Having the willingness to learn and help, regardless of background, is the second.
My mentors have almost never shared my identities, but importantly, they all understand the value of cross-mentorship, or creating a mentorship relationship across differences. #4 They all see me for who I am as a person and who I am as a surgical trainee. They don’t make assumptions and they respectfully ask questions. They treat me like my peers and invest in me in the same way. We all owe it to each other to cultivate these types of relationships; to be better, more informed, be sponsors and allies, and to be humble. Help each other at the intersection of person and surgeon. We will all be better for it.
References
- Dictionary OE. Oxford English Dictionary: Oxford University Press; 2023.
- Iwai Y, Yu AYL, Daniels NC, et al. Racial, ethnic, and gender diversity among academic surgical leaders in the US. JAMA surgery. 2023;
- Heiderscheit EA, Schlick CJR, Ellis RJ, et al. Experiences of LGBTQ+ residents in US general surgery training programs. JAMA surgery. 2022;157(1):23-32.
- Koprowski MA, Dickinson KJ, Johnson-Mann CN, et al. Cross-mentorship: a unique lens into the realities and challenges of diversity in surgery. Annals of surgery. 2022;275(1):e6-e7.
Priyanka V. Chugh MD, MS is a general surgery resident at Boston Medical Center and currently a research fellow at Boston Children’s Hospital. Dr. Chugh received her undergraduate degree from New York University where she majored in Psychology with minors in Public Health and Policy, Child/Adolescent Mental Health Studies, and Chemistry. She then went on to continue her studies at Johns Hopkins University where she received her Masters in Biotechnology and then to Cooper Medical School of Rowan University for her medical degree. Dr. Chugh’s research focuses on understanding the experience of children and adolescents with chronic surgical conditions such as intestinal failure/short bowel syndrome. She also has a passion for improving equity in surgery, and founded Advancing Cultural Competency and Equity in Surgical Specialties (ACCESS) within the Boston Medical Center Department of Surgery. In her free time, Dr. Chugh can be found trying new gluten free spots, boxing (with appropriate hand wrapping for protection!) or napping on a beach. Her Twitter/X handle is @antiwheatgirl.