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Underrepresented in Neurology: A New AAN Section

Article In Brief

Jose Posas, MD, FAAN, discusses his role as chair of the AAN's newest section, Underrepresented in Neurology, the value of diversity in medicine, and the importance of tackling systemic racism and disparities in access to care.

Jose Posas, MD, FAAN, said his pathway to becoming a neurologist was anything but a straight line. He applied more than once to medical school, adding that an assistant dean of admissions at Louisiana State University helped successfully guide him through the medical school admissions process.

That experience with a mentor is in no small measure why Dr. Posas, a senior neurologist and director of the neurology residency program at Ochsner Health System, embraces his new role as the chair of the AAN's newest section, Underrepresented in Neurology. The official mission of the section, which was established in 2020, is to support the professional concerns of practicing neurologists, neurology trainees, neuroscientists, and advanced practice practitioners from underrepresented backgrounds. The section is open to all members who are interested in its mission. It aims to establish an engaging and collaborative community and work to alleviate the workforce gap.

In a telephone interview, Jose Posas, MD, FAAN, Dr. Posas discussed his own pathway to becoming a neurologist, the reasons for forming the new section, and the value of tackling disparities in access to care. His comments are edited and excerpted below

Tell us about your own journey to become a neurologist.

My father is also a neurologist and “planted the seed” without saying “so when I was 15. He'd tell me I couldn't sit at home playing video games all summer, and would bring me into the clinic to hang out with him.”

My neurology rotation in medical school was like a déjà vu moment, realizing that my father had planted these seeds when I was 15. Originally in med school I thought I would be a minimally invasive laparoscopic surgeon. I love video games and I thought I'd do something with a DaVinci robot. I did love my surgery rotation, but then I did my neurology rotation and it felt good and familiar, and really like what I needed to do: observing other people and figuring out how the brain works with the body. It's a very Sherlock Holmes kind of thing.



My father, who is still practicing in rural Valdosta, GA, does this in English and Spanish, which I thought was super cool. He treats patients from all walks of life and treats poor people with the same dignity as those who have their own private jets. He taught me all this cool stuff about the human body, but also to treat everyone with respect.

When did you first become aware of the impact of health disparities in this country?

While COVID-19 has blown open the doors on health disparities all over the country, back in 2005, Hurricane Katrina [first] gave me insight into those disparities right here in New Orleans. I did volunteer rotations at the PMAC Center in Baton Rouge, where people from New Orleans were brought. I saw people who had no insurance, who barely had a home, coming in with their wounds and ER doctors trying to give them the best care they could. I thought, “We are their last line of hope. I have to keep coming back.”

There is a lot of systemic bias and we need to look at how the system is rigged to deliver worse care to underrepresented populations. I feel like it's only now, as time has gone on and I've become more educated, that I'm armed with the language to talk about the lessons I learned back during Katrina about how we treat communities of color and those with lower socioeconomic status. As underrepresented minority physicians in neurology, we must look for allies in all the spaces we can and shine a light on systemic bias.

Tell us about how the new section come about?

It's actually been a long time in the making, going back to the creation of the AAN's Diversity Leadership Program (DLP), which is designed to help neurologists from underrepresented groups in medicine develop leadership skills. The DLP, which graduated its first cohort in 2016, published recommendations in 2017 on what we could be doing to increase diversity in the AAN. One key recommendation was to give more of a voice and platform to folks who are underrepresented within neurology. Leaders from the DLP came together with leaders from the AAN's Special Commission on Racism, Inequity, and Social Justice as well as the Society for Black Neurologists to advocate about forming an official AAN section. The Underrepresented in Neurology section was officially formed in July of 2020. We had our first section meeting via teleconference in late summer, trying to outline the goals of the section and its direction.

What does the new section say about the AAN's priorities with regard to diversity, equity and inclusion?

I think this represents a strong commitment from the Academy. In addition to the DLP, this section builds on the work of the Equity, Diversity, and Inclusion Joint Coordinating Council, aimed at ensuring that we have a longitudinal, ongoing effort to give voice to those who may not always be represented within the AAN at all times and in all places. There is a trap that can occur for major institutions and organizations if they say, ‘Okay, we're going to take physicians of color, LGBTQI+ individuals, and others who are underrepresented and elevate them to positions of power and give them some authority,” and then that's it. They go no further. That's an important step and it helps a bit, but institutions can fall into the trap of tokenism, putting the onus on these few individuals to do all the work with regard to diversity and equity and serve as the “face” of inclusion for an institution.

The other pitfall is something called the “minority tax.” You're a physician of color and you've worked hard to get where you are, and you finally get that elevation or rank promotion to a place in your academic or clinical career where you were always told “You can't go that far.” No one else has done this before. You're the groundbreaker. But now the institution tells you that you have to bring up other people who look like you and come from a background like you. Now you have to do your own work and also be a lifeline to everyone else.

Of course, I want more Latino neurologists out there and I want to help them. I want to help out and mentor because I believe it's critically important. “Wow, this is beyond my wildest dreams.”

It's true that if you can't see it, it's hard to be it. But that doesn't mean that it should be solely the job of underrepresented minority physicians to mentor younger doctors of their own backgrounds. One of my favorite quotes I picked up when participating in the DLP in 2017 is this: “You don't have to be a person of color to mentor a person of color.”

How does the new section help address that?

I think the work we are doing on these issues will help people feel a bit less isolated and more connected to each other. There are times when you feel [alone] like, “Why am I the only person at my institution doing this work? How can I raise this issue without it being stereotyped or gaslit as, ‘Oh, that's just Jose, the Latino guy who always complains about this stuff’?” We can build cogent arguments together, almost like crowdsourcing.

What are some of your initial goals for the section?

We are very interested in improving the pipeline. How do we get more medical school undergraduates from diverse and underrepresented backgrounds interested in neurology? We could collaborate with historically Black colleges and universities and work with the Latino Medical Student Association and other diverse medical student associations on programming such as webinars and, once the pandemic is over, pre-med shadowing programs.

Another goal is to reduce these invisible barriers of tokenism and the minority tax, via education. We have a robust amount of educational material available through the AAN, a lot of which is online and through asynchronous learning, so we don't have to reinvent the wheel. We just need to get it out there and raise awareness. What can we do to not only make sure the system is equitable, diverse, and just but also inclusive? It's not only being at the table but also about having an equal voice when you're sitting at the table.

We have also discussed building a sort of speakers' bureau for whenever local media asks for an expert on race or diversity or implicit bias in neurology. In addition, we have discussed whether the section could play an advocacy role for underrepresented neurologists when systemic racism affects their career.

What will be the section's next steps?

If we weren't in the midst of a pandemic, we would have our first big in-person meeting at the AAN's Annual Meeting in April, but of course this time it will be virtual. At that meeting, we will have a discussion amongst the larger membership to set our main goals and agenda items. We definitely have a lot of interest: I was told that to be successful, a new AAN section needs to have about 100 members within its first year, and within our first month this section has 120. The response has been rapid and robust, and I think the membership will be passionate.