Inside the DEI Battle in Dermatology

Must read

The American Academy of Dermatology’s annual meeting in San Diego next month will include sessions like “Biopsies in Challenging Locations” and “Critical Gaps and Controversies in Laser Treatment of Port Wine Birthmarks and Other Vascular Abnormalities.” But the real heat in those super-chilled convention rooms is likely to be a passion-filled topic that has caused agita from universities to C-suites to cable news to millions of social feeds: Diversity, Equity, and Inclusion (DEI).

On March 8, the American Academy of Dermatology (AAD) will discuss a proposal put forth by AAD members earlier this month to eliminate all of the academy’s Diversity, Equity, and Inclusion programs and “adopt a more inclusive and unifying ideology in its place,” per the resolution’s language. With several dozen AAD members initially listed as coauthors, Resolution AAD/A 003, titled “Sunsetting All Diversity, Equity, and Inclusion (DEI) Programs,” was published on the AAD member website on February 15. It immediately inspired emotional discussion — both privately and on social media — within this community of 20,000 skin doctors. By February 18, the AAD had issued a statement to its members about the “intense debate…and unwanted public division,” and warned them that “public admonitions or personal attacks on social media platforms are inappropriate and may be considered ethical violations.”

The resolution, introduced by Brian Raphael, MD, a board-certified dermatologist in East Syracuse, NY, and at one point listing about 100 dermatologist coauthors, calls for the AAD to remove its current DEI initiatives. The goals of those initiatives, according to the AAD, include increasing the representation of skin-of-color patients in academic research, improving dermatological services for underserved populations, and boosting the number of dermatologists who are Underrepresented in Medicine (URiM), as well as providing development and leadership opportunities for them. (URiM is defined by the Association of American Medical Colleges as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”)

Resolution AAD/A 003, reviewed by Allure, says that, “since October 7, there have been instances where the DEI movement has been perceived as being filled with antisemitism, weaponizing the concept against Jews by labeling them as ‘oppressors,’ and allegedly justifying extreme hate speech and violence.” It reads, “the role of DEI has evolved in recent months into a political movement that categorizes certain groups as oppressors and others as oppressed, creating a binary system of ‘racist’ or ‘anti-racist’ without allowance for neutrality.” The document goes on to say that “while initially well-intentioned, [DEI] is now believed to hinder rather than help the diversity in our specialty and the broader health care field,” and the evolution of DEI as a framework has “seemingly led to the control of speech and the stifling of diversity of thought and professional conversations regarding difficult issues.” The resolution claims that DEI programs in general are “believed to contribute to a decrease in the ability to provide unbiased and equal medical care for everyone, as it is seen to foster division rather than unity.”

Concern regarding diversity in dermatology is justified: A 2020 article published in Clinics in Dermatology describes dermatology as the second least diverse medical specialty (after orthopedic surgery). And that lack of diversity can affect patient care. “To this day, there’s inappropriate treatment of skin of color. Then Black people get the sense that, well, they don’t really know my hair, they don’t really know my skin,” says Chesahna Kindred, MD, a board-certified dermatologist in Columbia, MD, when Allure editor in chief Jessica Cruel sat down with a group of Black dermatologists and dermatology residents in 2021. In that roundtable discussion, Dr. Kindred and her colleagues also spoke of the disconnect between the patient population and their dermatology textbooks, which rarely show Black and brown skin.

Though a more “inclusive and unifying ideology… one that genuinely promotes the end of racism and supports the equal treatment and respect of all individuals” was suggested in Resolution AAD/A 003 to replace the AAD’s current DEI initiatives, no alternative programming to address diversity within the organization was proposed in the document. Allure reached out to Dr. Raphael, the resolution’s lead author, to ask for more details, but he remained vague as to what, specifically, he recommends in lieu of the AAD’s current DEI programming, or how its initiatives should otherwise be changed. “The original intent of the proposal was always to work with our colleagues and the AAD/A to adopt an even more inclusive policy, one that promotes the end of racism and hate speech — and supports the equal treatment and respect of all individuals, especially within the health care system,” he said in a statement to Allure by email.

“I regret this resolution was not received in the manner we intended, and therefore we are clarifying our position,” Dr. Raphael wrote. Though the resolution clearly called for all AAD DEI programming to be removed, he told Allure, “We fully support AAD/A’s existing diversity programs that are focused on promoting inclusivity and creating opportunities for all groups. We are working with the AAD/A to arrive at a more inclusive policy that recognizes the horrifying rise of antisemitism and the need to protect against all forms of hate and discrimination.” At press time, Dr. Raphael had not yet clarified in response to Allure‘s follow-up questions, who “we” refers to; provided examples of what, exactly, the group plans to propose and in what capacity it is working with the AAD; or specified the current AAD diversity programs that he supports.

Among the dermatologists concerned about a call to sunset all DEI programs at AAD were Wendy Roberts, MD; Jeanine Downie, MD; and Heidi Waldorf, MD. They quickly authored their own resolution: Opposition to the Resolution to Dismantle/Remove The Current American Academy of Dermatology Association (AADA) Diversity, Equity, and Inclusion (DEI) Initiative. In an accompanying petition meant for AAD members, they propose that any possible instances of antisemitism “be presented to the DEI committee and AAD board so that they can be addressed directly and corrected immediately.” And that “this can proceed without discontinuing its current programs.” The petition speaks to DEI initiatives being expanded, and Dr. Waldorf told Allure that the resolution is currently being updated to reflect that same language. She also noted that recent DEI efforts at AAD are working — the racial imbalance in dermatology is beginning to improve.

According to the AAD, dermatology resident graduates of Hispanic, Latino, or Spanish origin more than doubled between 2016 and 2022 (from 3.3% to 7.5%), while Black dermatology resident graduates grew from 3.4% to 5.1% in the same period. The organization also reports a 12% increase in Underrepresented in Medicine (URiM) physicians — those of Black, Latinx, and Indigenous descent — participating in its committees. Though improvements have been made, these groups remain underrepresented, given that Black people make up 13.6% of the US population and Hispanic people 19%. In 2022, AAD DEI programming supported the publication of 201 case reports, created an article collection, and launched an image atlas in the Journal of the American Academy of Dermatology (JAAD) to improve available information on skin-of-color patients.

Dr. Waldorf stresses that there are “very real concerns about antisemitism” around the world. The resolution currently states that it may be helpful for the organization to add clear language denouncing any form of antisemitism, racism, anti-LGBTQ+, anti-disability, or hate speech to its statement of intent.

“As a proud Jew and Zionist, I am horrified at the societal acceptance of antisemitism and its explosion since October 7, 2023,” Dr. Waldorf, a recently retired dermatologist who practiced for nearly 30 years, told Allure. “The AAD DEI includes religious minorities in its mission statement. However, relative to the minuscule overall Jewish population, we are not strictly ‘underrepresented’ [within the field of dermatology]. Having said that, the organization of the AAD has the flexibility to establish ways to fight antisemitism without disempowering other at-risk groups.”

Dina Strachan, MD, a board-certified dermatologist and clinical assistant professor in the department of dermatology at New York University Grossman School of Medicine, has also introduced an alternate resolution titled Support Diversity Equality, and Inclusion Initiatives and Form a Task Force on Antisemitism, Anti-Arab Bias, and Islamophobia. Calling for an end to DEI programming, full stop, didn’t sit right with Dr. Strachan, who attributes positive change in the specialty to diversity initiatives. She correlates the climb of women in dermatology to 53% from 6.9% in the 1970s to the work of organizations such as the Women’s Dermatologic Society, which was founded in 1973. The AAD’s first initiative to address diversity and health inequities in the specialty was launched in 1994, with the formation of its Diversity Committee.

In the two weeks since Drs. Waldorf, Downie, and Roberts published their petition, it has garnered almost 6,000 signatures, including those of AAD members who signed the original Sunsetting DEI resolution, according to Dr. Waldorf. She says some members communicated to her that they later realized it did not reflect their intent. Many have asked to have their names removed from the Sunsetting DEI resolution.

Emma Guttman-Yassky, MD, PhD, and chair of the department of dermatology at the Icahn School of Medicine at Mount Sinai, is one such member. In addition to reaching out to Dr. Raphael, Allure requested comments from more than 30 dermatologists listed as coauthors on the original resolution reviewed by Allure. Of the few who responded, only Dr. Guttman-Yassky agreed to be interviewed.

Upon seeing the resolution as published to the AAD site, Dr. Guttman-Yassky says she immediately requested that her name be removed and shared her corrected position in a letter sent to her department on February 18: “To be clear, I wholeheartedly support efforts to increase the number of underrepresented minorities in the field of dermatology and all efforts by the AAD to that end.”

Dr. Guttman-Yassky says she first learned about Resolution AAD/A 003 sometime in January when a colleague emailed it to her. “I made a mistake and didn’t read it very carefully. I eyeballed the first two paragraphs, and something about antisemitism that resonated with me, and I put my name on it… My meaning in this was just to maybe transform DEI to also include antisemitism. That was my intent,” Dr. Guttman-Yassky told Allure. “I’m Israeli. What happened in October is very hard for me as an Israeli and as a Jewish person living in New York. I think [we need to] create something against antisemitism, but DEI initiatives are very important too.” She says she had no intention of supporting any resolution that abolishes DEI programming. “I’m an immigrant, and as an immigrant, it’s very, very dear to my heart that minorities are supported. The idea of no glass ceiling to anyone and the inclusiveness of all is very important.”

When she was approached about AAD/A 003, Dr. Guttman-Yassky says she thought she was simply supporting the idea that a conversation take place among AAD members. “I did not expect my name to be listed as a coauthor, and as I understood, this [was intended] to create a discussion to bring antisemitism into the mix and to make DEI more inclusive to also include antisemitism,” she told Allure. The dermatology chair points to the diversity in her department’s faculty, residency program, and patient population, along with its community outreach and research aimed at serving a diverse population. For example, says Dr. Guttman-Yassky, “Mount Sinai has the largest clinical trials underway for keloids and for scarring alopecia, something that affects disproportionately, particularly, women of color.”

While the framework of DEI has become a political lightning rod in recent years, in the context of dermatology, diversity and inclusion have very practical applications that benefit people sitting on exam tables in awkward paper gowns. “The AAD diversity initiatives which were started in 1994 have contributed to a flourishing of ideas and efforts to make the way we teach dermatology more expansive,” says Kavita Mariwalla, MD, a board-certified dermatologist and member of the AAD’s Diversity Committee. She points to both the uptick in initiatives to include photographs on how common skin diseases present in skin of color as well as, on the aesthetic side of dermatology, an increase in teaching injection techniques in a global way, rather than relying on facial structures based on Western facial archetypes.

“As a South Asian woman, I am not considered underrepresented in the field of medicine even though I am a minority in the United States,” says Dr. Mariwalla. “DEI may mean I personally get less opportunity to serve on AAD committees because I am not from an underrepresented group and I practice in New York and not in an underrepresented area, but if it’s better for our specialty, I am okay with that. Varied voices and perspectives generate better ideas for clinical trials, deeper understanding of skin diseases, and evolving ideas about aesthetics. The goal of DEI is to not need DEI, but we are not at that point.”

Victoria Barbosa, MD, a board-certified dermatologist, associate professor of dermatology at the University of Chicago, and president-elect of the Skin of Color Society, shared similar sentiments in an email to Allure: “Diversity and inclusion in our specialty foster diagnostic and therapeutic advances, build community trust, improve cultural competence, result in better patient outcomes, and ultimately move us toward health equity for all patients,” says Dr. Barbosa. “This is borne out by the scientific literature and the vast collective clinical experience of our members.”

“The biggest failure would be that the public loses faith in their doctors,” says Dr. Mariwalla, who also fears that the DEI debate will distract the specialty from tackling important issues that could negatively impact patient care, “like Medicare reform that will decrease access to doctors.”

So what happens next? If any of these resolutions is approved by the AAD’s advisory board at its annual meeting in early March, it will be taken to the AAD’s 24-person board of directors for a vote during a meeting scheduled for May 4. Approval will require a majority vote.

For its part, AAD leadership says a push for greater diversity within the organization is part of its legacy — and these efforts aren’t likely to stop. “The American Academy of Dermatology has a long history of recognizing diversity as a part of our mission to advance excellence in dermatology on behalf of our patients,” AAD president and board-certified dermatologist Terrence A Cronin Jr., MD, said in a statement sent by email to Allure. “While the national debate on race and diversity is often turbulent, the Academy remains steadfast in its dedication to the highest-quality patient care for all and the professionalism of all of our members.”

Whether DEI as a framework survives at AAD — or something more expansive or restrictive takes its place — is yet to be seen. But as the DEI issue continues to play out on a national stage, what happens in San Diego on March 8 will be a significant signal of what’s to come in the field of dermatology.

More on dermatology:

Now, see how skin care has evolved throughout history:

Follow Allure on Instagram and TikTok, or subscribe to our newsletter to stay up to date on all things beauty.

More articles

Latest article