A commitment to diversity, inclusion and equity is critical to the practice of laser medicine, and to the provision of quality, unbiased patient care. The mission of ASLMS is to promote excellence in patient care by advancing biomedical application of lasers and other related technologies worldwide. Without a dedicated commitment to the advancement of diversity, inclusion, equity and accessibility across health care and organized medicine, such a mission cannot be approached in a way that ensures the needs of all individuals are met such that they are able to thrive. As a cornerstone of such a commitment, this position statement is intended to serve as a guidepost for ASLMS as it moves forward in its pursuit of the highest quality of equitable care for all patients.
Efforts and initiatives are needed to increase diversity in the medical workforce inclusive of BIPOC and SGM individuals, ensuring that workforce and leadership representation reflects the diversity of the US population. The American Association of Medical Colleges (AAMC) defines the term underrepresented in medicine (URM) as “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”2 Included in this term, Black or African American and Hispanic/Latinx physicians and scientists comprise a smaller portion of the workforce in comparison to their standing within the general population. Other BIPOC communities, including Native Americans, are also significantly underrepresented in the field. These discrepancies between the general population and composition of the medical and scientific workforce are widening over time across many specialties.3-5
The pipeline of URM and SGM students entering graduate school, medical school, residency programs and advanced fellowships needs to be increased. It is well-established that disparities in health care, access and outcomes present immediate and existential threats to marginalized populations.6-16 Diversity in medical and scientific training and in the workforce optimizes preparedness to serve diverse communities.5 Additionally, studies have shown that URM clinicians are more likely to practice in areas where health care disparities are prevalent, thereby more broadly contributing to the mitigation of critical access and outcome gaps. Studies highlight that race-concordant clinical encounters are more successful than race-discordant encounters on a variety of metrics, indicating that increasing racial / ethnic diversity among providers improves the health care experience for minority populations.17 The achievement of greater URM representation in science and medicine must be realized at all levels of the educational continuum from the undergraduate and graduate/medical school years through residency, fellowship and continuing medical education.
Inclusive curricula in undergraduate, graduate and continuing medical education needs to address the unique health concerns of racial / ethnic minorities as well as SGM individuals. Opportunities for structural change include: joint collaboration with educational institutions, development of mentorship networks and publicly accessible resources regarding medical concerns in racial / ethnic minority populations, facilitation of earlier exposure to laser surgery and medicine in medical/graduate training, increasing the pipeline of URM students into medical/graduate schools, residencies and fellowships, consistent reevaluation and adaptation of higher education selection criteria and revision of educational curricula to increase representation of skin of color.
Comprehensive research that will expand knowledge of social determinants of health and mitigate health disparities facing BIPOC communities as well as SGM individuals is needed. SGM persons, including but not limited to lesbian, gay, bisexual, transgender and queer individuals and non-binary individuals, represent a rich diversity of gender expressions and identities, sexual orientations, attractions and behaviors. SGM persons’ unique health care needs, and the health care disparities they experience, have increasingly received widespread recognition and demand urgent action.
The social and cultural discrimination faced by SGM individuals is perpetuated by inadequate access to high-quality, sensitive and respectful health care. Such inequity results in avoidance of the health care setting with subsequent care delays due to legitimate concerns about discrimination and harassment.18-21 Adequate training of medical professionals with regard to the unique health care needs of SGM people and continued research into best care practices are necessary to provide care that facilitates trust and resilience while ensuring the ability of SGM individuals to thrive.
Importantly, racial and ethnic minority persons who also identify as SGM face additional stigma and health care disparities, emphasizing the importance of intersectionality, as inequity in these marginalized populations is appropriately addressed.22-23
Transgender and other gender diverse individuals should have access to and coverage for gender-affirming therapy and procedures. For transgender and other gender diverse individuals, access to gender-affirming care is critical for holistic health and well-being and leads to improvement in health outcomes.22,23 The benefits of gender-affirming care are numerous, a few of which include improved mental health and substantial reduction in suicide attempts, improved self-esteem and body satisfaction with the achievement of congruence, decreased substance use and healthier, more rewarding human relationships.24-29 Across the country, disparities and inequities exist with regard to insurance coverage for gender-affirming care and services. Voices across the house of medicine affirm that such care is medically necessary and should not be excluded from public or private insurance programs.30-36
Students, trainees, employees, other health care providers and industry leaders as well as organization staff should be trained in cultural humility and structural competency.Training should emphasize the development of structural competence, including familiarity with and comfort utilizing appropriate terminology, while fostering cultural humility.26-28 Laser surgeons should ensure that their practices and practice settings are welcoming and affirming safe spaces for SGM patients and patients of color.36
The society should aggressively work with allied partners (foundations, other societies, industry) to find and exploit areas of common interest/adoption to accelerate impact. There will be opportunities to leverage common ground amongst various stakeholders. Potential collaborations and shared strategic tactics could create critical momentum, generate additional resources and develop much-needed long-term alliances to advance our mission.
Approved by the Board of Directors August 4, 2021