A Surgeon Turns Activist

A few years ago, Dr. Richard T. Bosshardt waded into a minefield. He had been a Fellow of the American College of Surgeons (ACS) for over thirty years when he expressed his opinion that the ACS’s diversity, equity, and inclusion initiatives were threatening their dedication to excellence.

Dr. Bosshardt has garnered support for his objections and has published his opinions in The Wall Street Journal, City Journal, and National Review. Like Dr. Järvinen’s piece on the prevention of fractures in older people published here a couple of weeks ago, his submission highlights how difficult it can be to express opinions that challenge mainstream thinking these days.

Some readers will find Dr. Bosshardt’s objections misdirected. Some, including many close to me, will find them objectionable. I think it is crucial to hear diverse opinions. When we deal with any difficult issues, hearing diverse views helps us to determine the best way forward. At very least, if you disagree with an opinion, only by considering it will you be able to formulate a convincing counter argument. As Voltaire supposedly wrote, “I Disapprove of What You Say, But I Will Defend to the Death Your Right to Say It.”

As always, if you would like to join the conservation, please feel free to submit your own piece to Sensible Medicine.

Adam Cifu

At 71 and nearing the end of a 45-year career as a surgeon, first a general surgeon and later a plastic surgeon, I find myself an activist. I never imagined that title would be applied to me. Surgeons tend to be solitary creatures. As children, we were often the ones who did not play well with others. We tended to be pushy, not bullies really, but assertive. Put ten surgeons in a room and ask them a question and you will often get ten answers, each one vigorously defended. One of my favorite aphorisms regarding surgeons is “seldom wrong, but never in doubt.”

I am a founding member of the Foundation Against Intolerance and Racism (FAIR) in Medicine and a Senior Fellow of Do No Harm. Both are organizations whose mission is to push back against the invasion of the ideology of critical race theory, in the guise of antiracism and diversity, equity, and inclusion (DEI) in medicine.

The frog-in-the-pan analogy applies perfectly to my path to activism. My evolution happened so slowly, over such a span of time, that it was not until I was fully engaged, in a pitched battle of wills with the leadership of the American College of Surgeons, that I appreciated just what I had gotten myself into. 

It began with the Olga M. Jonasson lecture given by Joan Reede MD at the ACS Clinical Congress in 2018. Dr. Reede is a pediatrician and Dean for Diversity and Community Partnership at Harvard. Although her lecture was titled “A Pathway Toward Diversity, Inclusion, and Excellence” no mention was made of excellence. I commented on this, objecting to the elevation of diversity and inclusion over excellence. The text of Reede’s lecture and my comment were published in the ACS Bulletin March 2019.

In 2020, in the middle of the Covid pandemic, George Floyd was killed and the country erupted in racial protests amid accusations that the US and all of its institutions were systemically racist. The ACS appointed a Task Force on Racism to “to address the issue of structural racism within the American College of Surgeons (ACS) and within the profession of surgery.” The task force recommendations were to install antiracism and DEI initiatives into the ACS.

By then, I had begun to educate myself on critical race theory (CRT), antiracism, and DEI. I strongly objected to the characterization of the ACS as racist, of my fellow surgeons as racists, and of the practice of surgery as racially discriminatory. I wrote a letter to then President of the ACS, J. Wayne Meredith, MD in which I stated my objections and said that, if the ACS continued on this path, I would give up my membership as a Fellow in good standing in the ACS for over thirty years. That letter received no response.

In April 2021 I published a post to the effect that the ACS was on a path I strongly disagreed with and would leave the ACS if this continued. I posted this on the general surgery discussion forum on the ACS website. My post led to a four-month-long comment thread, the longest with the most engagement (75 individual surgeons) in the history of the forum. Two-thirds of the responses agreed with me. The leadership of the ACS reached out to me and invited me to a Zoom call, which took place in March 2022. I was encouraged by the willingness of the leadership to engage on this topic. Within weeks, however, the rules of the forums were changed to prohibit further discussion of DEI, antiracism, or CRT on clinical forums, and I was banned for life from further engagement on any forums. I was even blocked from access to the members directory and my own private messages.  

I was accused of using disrespectful language on the forums and posting non-clinical material on the forums as the basis for my lifetime ban. My request to be shown what comments were the basis for this were ignored as were my appeals. My ban was enacted in violation of the ACS bylaws for disciplining members, and I was denied a hearing, as was my right.

It was during this time that I joined FAIR in Medicine and Do No Harm and went public with my battle with the ACS leadership. I published articles in The Wall Street Journal, City Journal, and National Review.

It has been a lonely battle. The ACS leaders refuse to engage with me. I believe most of the membership remains unaware of this history. I have received private encouragement from a few surgical colleagues but almost none publicly. Many are afraid of the repercussions of objecting to DEI initiatives. I understand. I have been labeled a racist. A read of my biography will give you a sense at how this is particularly painful for me.

Why does this matter? So what if one surgeon can’t post comments on the ACS forums?

It matters because the ACS has focused on the claim that racism is the cause of disparities in surgery, including the extraordinarily toxic claim, without proof, that patients may fare better under the care of surgeons of their race. This is a slap in the face to every surgeon who treats all patients with all the skill they have. The goal of increasing the numbers of surgeons coming from groups historically under-represented in the field is a laudable one. However, it must be done in a way that does not erode the quality of surgeons. This is not an easy task in a society rife with disparities from a multiplicity of causes and in a field where our measures of excellence are flawed.

If racism is accepted as the de facto cause of disparities in surgery and debate and discussion on the issue is banned, then the ACS has ceased to be a legitimate professional organization whose stated mission is “To Serve All With Skill and Fidelity” and has degenerated into just another institution captured by the DEI/antiracism/CRT ideologues. My ban is as clear proof of this as one could ask for.

Dr. Bosshardt is a plastic surgeon with over three decades of practice. He is an avid reader and writer who contributed a weekly column on medical matters to the Orlando Sentinel for over twenty five years. You can view more of his work at richardbosshardtmd.substack.com.