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"It's steeped in tradition," says Dr. Johnston. "Surgical professionals like the structure of surgery, but is what we're doing now good enough?" Our diverse backgrounds should be the starting point of conversations cen- tered on understanding, listening and learning. This divisive time in the nation's history could create a more unified republic. "I don't think this is a moment," says Dr. Johnston. "This feels like the beginning of a movement, and hopefully a paradigm shift." He believes underrepresented groups are now more comfortable pushing for change. "That includes me," says Dr. Johnston. "Early in my career, I wouldn't have spoken out or advocated for equality. I would have done so quietly within my microenviron- ment. There's a greater recognition that more people need to fill these roles, and that members of minority groups should feel more comfortable advocating for themselves and others." Even providers who don't prioritize equity and greater representation in health care can agree that quality patient care matters, points out Dr. Johnston. "The nation is diversifying, and disparities in access to providers for minority groups ultimate- ly impacts quality outcomes and the overall cost of health care," he says. "Sometimes we need to reframe issues for people in ways that are relevant to them." Increasing numbers of allyships are a positive step forward, according to Dr. Johnston. "More sur- gical professionals who are in the majority feel com- fortable speaking up about the need for more diver- sity," he says. "There's increasing recognition that the responsibility to create change can't fall only on minority groups. It's an open conversation we all need to have. When respected leaders voice their support for greater diversity, equality and inclusion, more people will be pushed to join the movement." Dr. Johnston acknowledges it can be exhausting to face systemic racism on a daily basis and advo- cate for change. "I'm also heartened," he says. "I feel good about the trajectory we're on." Support for mental health Healthcare providers go into medicine to care for patients and to make a difference in the lives of oth- ers. They put the needs of their patients well before their own and thrive on adrenaline and plenty of long days. But when the day-to-day stressors are compounded with a nationwide pandemic, many were not prepared for the feelings that came bub- bling to the surface. Providers were collectively experiencing many of the same emotions, and knew they couldn't keep ignoring them. "Everyone is dealing with something right now, which makes it understandable that there's some degree of struggling, pain, hurt or emotional reac- tion to the world as it stands," says Jessica Gold, MD, MS, an assistant professor of psychiatry at Washington University in St. Louis. "The normal- ization of mental health issues did not exist before, because even though we would variably have tough experiences together, we were taught to brush them off." Dr. Gold says COVID-19 is causing extra stres- sors in a profession that already has high rates of depression and burnout. Providers are at risk of contracting COVID-19 or bringing it home to their families. They worry about not having enough resources for patients or enough PPE to protect themselves. "Day-to-day work looks a lot different for some nurses because people are dying at higher rates than they're used to seeing and they don't D E C E M B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 2 7 NEEDED BREAKS Healthcare professionals who have faced incredible personal and professional stress are learning about the importance of self-care. Lee S. Weissman/Northwell Health