PracticalDermatology

How have the resolutions been going? They definitely weren’t televised, but I’m sure they were broadcast…nothing like a little self-assessment to start the year. Maybe Joel’s advice will resonate better than mine; he is a lot wiser.

Ever since we were kids, we have had the drive to fit in and be accepted—and this desire has certainly continued in our roles as physicians. Whether it’s a peer group to play with or to identify with and make our legacies with, we are all drawn to people…even the biggest of introverts, including our incoming AAD President. But breaking into circles of friendships, even as a kid, is challenging as you try to identify with common grounds and eventually feel like you fit in. Even as adults moving to new neighborhoods or cities, it can be a struggle to make friends, which usually means gravitating to similar circles based on occupation, kids’ activities, the love of the same sports teams, or even frequenting the same saloons. In the end, the pundits who quoted “be cool or be cast out” from the high school halls may have been on to something.

The feeling of being brought into friendship circles, medical societies, and other organizations, especially if an election or appointment is involved, brings a sense of accomplishment and even relief. Of course the drive that FOMO creates to belong can be overwhelming, and there is always a secret drive to be part of the inner sanctum, the mafia, or the secret cabal…which of course don’t really exist accept in dermatology folklore. Having been through a few elections and appointments, and having had the honor of being part of leadership and membership of many groups, I can say first hand that there is joy in the chance to both be part of something and to give back. But part of that giving back means opening the door for those who are now wearing the shoes you wore, trying to find identity, a niche, and a group to feel welcome in. Mentorship is essential to keeping the ball rolling, and in every environment we do our best to cultivate the next leaders, even when it is our own kid taking over the practice. Everyone has to start somewhere and be allowed to sink or swim.

So where does the adage “birds of a feather flock together” merge into “cronyism?” By definition, Merriam-Webster.com defines cronyism as “partiality to cronies especially as evidenced in the appointment of political hangers-on to office without regard to their qualifications,” while YourDictionary.com calls it “favoritism shown to close friends.” Interesting dichotomy of definitions given the times, and of course the old emphasis on politics which could basically translate into almost any circle or group that propagates itself, as perceived from the outside. For years we thought of cronyism in business and politics, as the old guard closing the door behind them or elevating those of parallel characteristics and tendencies. No doubt we defined it in medicine, especially in leadership groups, but have we done enough to combat cronyism, or have new groups of cronies taken the place of the old? We have groups that promote education, advocacy, and we have a movement of DEI—and yet sometimes the “I” gets forgotten in place of favoritism.

Do we know the difference between cronyism, cultivation, and expansion? Cultivation of new society leaders, new speakers for a meeting, and new authors for a book are all examples of academic endeavors that are based on merit but also taking a chance on performance to allow the next generation to fly on their own. We all know the comfort of familiar faces and backgrounds and often choose not to leave our security bubbles to try to get to know or take a chance on new people. And even more commonly, many of our contemporaries choose to cultivate like-minded mentees who will continue trends they believe to be beneficial to the cause. Whether those are built on gender, race, socioeconomics, geography, practice model, or any other factor, someone is always going to feel left out, which can often lead to accusations of cronyism, or start using labels that often end in “-ist,” which can be hypocrisy with its offenders pointing the fingers.

I would like to think that as a private practice and part time academic dermatologist from Wisconsin, raised by Indian immigrants and a victim of prejudice myself, that I might have broken some of that model, hopefully by my drive to make dermatology a better place, as I would say of many of my colleagues regardless of their background and how they got their starts. I would hope the drive for inclusion also means taking a chance on those who come from different origins not only in race and gender, but in geography, practice models, and training.

Once we take stock in what cronyism looks like in 2022, what today’s leaders are doing to open up circles to those who will one day walk in our shoes, and find balance in all aspects of inclusion, dermatology will be stronger and more cohesive, ready to stand together as we preserve our scope of expertise in the house of medicine, emphasize our image to patients and colleagues, and groom our future to be brighter than our past and present. I hope I have done my part, and if I haven’t, let me know and I will do better. Thank you for letting me serve as Vice President, as Meeting Planner, and as your friend. So now what? There’s nothing wrong with having a group to cackle with and spend time at the saloon with—we need cronies and friends; just be sure to give some newbies a chance, because every group needs a guy named Randy, someone to throw under the bus, and an emperor.