Why Patient Inclusivity Is Important to the OMS Professional

Inclusivity in our specialty shouldn’t simply mean social equity, it should be a primary tenet of practice for all surgeons to ensure effective health care for every one of our patients. I see two distinct applications of inclusivity in oral and maxillofacial surgery. First, recruitment of a representative cohort of surgeons, and second, assuring that we can meet the needs of a diverse patient population — in full and with empathy, even when the surgeon does not herself represent that population.

The consensus in higher education is that recruitment of a diverse group of resident surgeons is important to address disparities in healthcare access and quality. Historically, surgical fields have been predominantly male dominated, with minority and female representation significantly lagging behind. This certainly does not suggest we should recruit unqualified female or minority surgeons to fill the void. This would be a tone deaf, counterproductive response, since recruitment of underqualified surgeons is certain to result in worse healthcare outcomes for patients and may in fact exacerbate health disparities if minority populations unknowingly seek care with less qualified surgeons. However, attention to fostering interest at the dental school level would encourage inclusivity of highly qualified female and minority applicants to our field, thereby increasing overall diversity and representation in the field. Similarly, groups such as Women in OMS Consortium, the Women in OMS Facebook group, and dental organizations that attract diverse student populations such as SNDA, as well as those representing the LGBTQ+ community can also set examples of inclusivity in the specialty.

Some are certain to claim that inclusivity in surgical recruitment is pandering or window-dressing, but I believe it’s quite the opposite; it is essential for inspiring future generations of healthcare professionals from underrepresented backgrounds. By showcasing successful surgeons who come from diverse racial, ethnic, and socioeconomic backgrounds, surgical fields can attract a broader pool of talent and encourage aspiring surgeons who may not see themselves represented in the current landscape.

Inclusivity brings varying perspectives and experiences to treatment planning and patient care, which may lead to better patient outcomes. For example, a study published in the Journal of the American College of Surgeons found that female surgeons achieve slightly better patient outcomes compared to their male counterparts in certain procedures, suggesting this type of representation in surgical teams can enhance overall surgical care. If these outcomes can be translated across all members, then the overall quality of healthcare is improved by the contribution of this small group.

Patient diversity also plays a crucial role in shaping surgical practices and healthcare policies. In our society, patients come from various cultural, political, linguistic, and socioeconomic backgrounds, each with unique health beliefs and preferences. Inclusive surgical practices prioritize understanding and respecting these differences in order to deliver effective, patient-centered care.

How and where does that translate to the real world of oral and maxillofacial surgery? Consider three hypothetical groups of patients presenting for orthognathic surgery. The first derive from an affluent group whose parents sought early orthodontic care for them and likely have the basic biomedical understanding allowing them to reasonably understand the rationale, complexities, and treatment options for orthognathic surgery. This population may also have the financial or insurance resources to fully cover the costs.

A second group is from an extremely low socioeconomic class, utilizes Medicaid coverage, and presents with suboptimal occlusion given that Medicaid often requires gross dentofacial malformations in order to provide coverage. This second cohort of patients may reasonably be expected to have parents with lower levels of basic science understanding, less ability to appropriately weigh the risks and benefits associated with orthognathic surgery, and fewer resources to facilitate ideal post-operative care.

The third cohort present with craniofacial syndromes or deformities. These patients can come from a variety of socioeconomic backgrounds, and yet the specific challenges surrounding each case can be very different, requiring a different approach by the surgeon. 

Oral and maxillofacial surgeons need to be ready and willing to treat this variety of patients — and many more — with the same acumen and quality of care. We need to employ sensitivity to the individual culture and other groups from which they derive. Language barriers, socioeconomic status, individual beliefs about illness and treatment, and varying levels of health literacy can all impact a patient's experience and outcomes. Surgeons who are sensitive to these factors and those who have personal experience from which to draw understanding are better able to build trust with these patients, improve communication, and tailor treatment plans that align with patient preferences and values. This, in turn, leads to higher patient satisfaction, improved adherence to medical recommendations, and — not to be overlooked — potentially fewer claims of substandard care.

Inclusivity in patient care extends beyond cultural competence to encompass considerations of education, sexual orientation, gender identity, and disability. For instance, LGBTQ+ patients may face discrimination or discomfort in healthcare settings, which can hinder their willingness to seek surgical care. By promoting inclusivity and respect for all patients, surgical fields can create environments where each individual feels valued and supported throughout their healthcare journey. In my practice, inclusivity of transgender patients brought not only an enormous patient population that had previously been unable to find surgical care, but also opened the door for innovation. I have been able to change and adapt standard orthognathic osteotomies to enhance patient outcomes, develop surgical guides specific to feminization surgery that are now used throughout the subspecialty, customize various facial implants for gender-specific surgery, and disseminate my own findings so others can better treat these patients.

From recruiting and supporting diverse surgeons to embracing patient diversity and fostering inclusive healthcare practices, inclusivity is essential for achieving the best healthcare outcomes and driving innovation in surgical care. By prioritizing inclusivity, surgical fields can ensure that all patients receive high-quality, patient-centered care that respects and addresses their individual needs and preferences. A commitment to inclusivity not only improves healthcare delivery today but also paves the way for a more equitable and innovative future in surgical medicine.

Elda Fisher, MD, FACS

Dr. Elda Fisher is an involved member of both ACOMS and AAOMS, as well as of the Association of Women Surgeons and the World Professional Organization for Transgender Health. Dr. Fisher is an associate professor and director of the Oral and Maxillofacial Surgery Residency Program at the University of North Carolina at Chapel Hill.

She specializes in facial aesthetic surgery and gender affirmation surgery. Dr. Fisher attended medical school at the University of North Carolina where she also completed her surgical residency program. Following residency training, she completed a fellowship in full-body and facial aesthetic surgery. Dr. Fisher is board-certified through ABOMS in Oral and Maxillofacial Surgery and through the American Board of Cosmetic Surgery in General Cosmetic Surgery.

She is a fellow of the American College of Surgeons and has lectured nationally and internationally on facial aesthetic surgery, gender affirmation surgery and corrective maxillofacial surgery. She has a particular interest in facial gender affirmation, including facial feminization and masculinization surgery, orthognathic surgery as a component of gender-affirming facial surgery, and the use of injectable medicine as a complement to facial gender affirmation.