DEI initiatives in the U.S: SNACC’s Commitment and Current Constitutional Challenges

In 2017, SNACC’s then president, Dr. George Mashour, MD, PhD sought leadership for a diversity, equity, and inclusion (DEI) task force to assure that SNACC’s programming supported our increasingly diverse membership and that our mission reflected the disposition of our forward-thinking society. Drs. Linda Aglio, MD, MS and Marie-Angele Theard, MD accepted the call and began with a review of the myriad benefits of increasing diversity in healthcare: “academic and social growth at the university level; more favorable attitudes toward underserved populations and greater interest in serving them; more ground-breaking research; and financial institutions outperforming those whose constituency is more homogeneous.”¹ 

This effort compelled us to be leaders in welcoming the next generation of diverse educators, neuroscientists, neuroanesthesiologists, and neurointensivists, through re-examination of our mission statement, a survey to understand our membership, and an official committee to support and inform through innovative programming. In 2019, SNACC’s Executive Committee (EC) demonstrated its commitment to fostering a welcoming environment through promotion of diversity with approval of the SNACC Diversity, Equity, and Inclusion Committee. We were fortunate to have Dr. Aglio, an unwavering champion of DEI initiatives, serve as its first chair. She notes, “We accomplish our goals through innovative research, health equity-focused clinical innovations, and equity-informed medical education. We do this work in the context of compassionate, cutting-edge patient care, ground-breaking research, and outstanding medical education while effectively partnering with our surrounding communities.

SNACC remains steadfast in its commitment to diversity, equity, and inclusion. We aim to enhance the representation of underrepresented groups, retain and support their career growth (Coaching Scholarship for Women, WINNER programs), and promote a culture of inclusion, visibility, and well-being for all.”

We had no idea that four years later, universities and medical centers would be grappling with new policies and practices that would undermine our goal of a more diverse healthcare workforce and the educational experience of our trainees. In June 2023 the United States Supreme Court ruled that the admission policies at Harvard College and the University of North Carolina violated the Constitution’s equal protection clause, “which bars racial discrimination by government entities.”² This ruling “essentially ended the use of race-conscious college admissions programs” leading several states’ legislatures or university board of governors to suspend these programs.² The Texas and Florida state legislatures have actually passed bills banning DEI initiatives on college campuses. In North Carolina the state university Board of Governors voted to eliminate DEI efforts, gutting spending and resources for these programs.³

There is significant irony in not being able to consider race in admissions since America “has never been colorblind” as Justice Ketanji Brown Jackson notes in her dissent.² She rightly notes that “given the lengthy history of state-sponsored race-based preferences in America, to say that anyone is now victimized if a college considered whether that legacy of discrimination has unequally advantaged its applicants fails to acknowledge the well-documented ‘intergenerational transmission of inequality’ that still plagues our citizenry.”²

In this fraught environment for DEI, the Accreditation Council for Graduate Medical Education (ACGME) along with numerous other medical associations including the American Medical Association (AMA) and the American Board of Medical Specialties (ABMS) released a statement underscoring their commitment to the goals of DEI, noting that “our efforts to promote diversity, equity, and inclusion (DEI) seek to address the long-standing and well-documented inequities in our healthcare system and its impact on the health of our patients and communities. Excellence in patient care cannot exist until we have a physician workforce capable of caring for our increasing patient and their needs holistically, and until the profession of medicine is accessible to all qualified individuals.”⁴

In response to these mounting challenges to DEI efforts in the U.S., medical societies like the SEA and SPA have begun developing resources to assure that trainees in states prohibiting DEI efforts are able to complete their training with an understanding of important issues like the social determinants of health and their potential impact on outcomes. The SNACC DEI Committee continues to benefit from the strong support of the EC and our members. At the 2023 SNACC Annual Meeting, the DEI Committee presented a panel by our current DEI chair, Dr. Mia Kang, MD, MHS and Dr. Mauricio Giraldo, MD. It provided attendees with evidence suggesting that ERAS protocols might help to reduce racial disparities in health outcomes, as well as an overview of how to optimize care for neurodivergent patients.

The DEI Committee would like to take this opportunity to express our gratitude to SNACC and its members for their continued commitment to DEI. The leadership of SNACC from the president down has always engaged with the goals and activities of our committee and continues to be committed to fostering a welcoming and inclusive organization for ALL of our colleagues and trainees in the field of neuroanesthesiology and neurocritical care.

References

1. Aglio L, Theard MA, Diversity Initiative for SNACC. SNACC Newsletter (Fall 2017), https://snacc.org/wp-content/uploads/2017/fall/article3.html
2. Howe A, Supreme Court strikes down affirmative action programs in college admissions, SCOTUS blog (Jun 29, 2023), https://www.scotusblog.com/2023/06/supreme-court-strikes-down-affirmative-action-programs-in-college-admission
3. Knox L, UNC System Board votes to eliminate DEI Offices, Inside Higher ED (May 24, 2024), https://www.insidehighered.com/news/quick-takes/2024/05/24/unc-system-board-votes-eliminate-dei-policy-cut-spending
4. https://www.acgme.org/newsroom/2024/3/statement-on-improving-health-through-dei/