Health Equity Blueprint: Dr. O’Connor’s Tools to Dismantle Disparities and Build Community
Women make up just over 7% of all orthopedic surgeons in the United States, making it the lowest percentage of any major specialty. Mary O’Connor, MD is a female pioneer in orthopedics and health equity, who – through her own success – has consistently perforated myths about women in medicine for 4 decades.
Her decades-long quest to improve health equity began early in her career, when she witnessed the ways in which her patients’ experiences were also being gendered; typically by a male, orthopedic surgeon.
“I just got tired of all the women I was seeing coming in who were not listened to by their orthopedic surgeon – predominantly white males,” O’Connor told me. “They’d come to me and I’d wonder why no one was listening to them? And I realized there were lots of issues here which were basically unintentional on the part of my male colleagues, like differences in communication style and unconscious bias.”
A study done in 2018 verifies what O’Connor had been witnessing. It found that men were considered “brave” and women “emotional” when it came to determining treatment for pain.
O’Connor saw the difference was even more pronounced when it came to non-white women, who’d seen a white, male orthopedic surgeon. This seemingly leads to a deeper issue: Not only is the specialty predominantly male but Black orthopedic surgeons make up just 1.9% of all orthos and only 5% of residents, while just 2.2% of orthopedic surgeons are Hispanic and 0.4% are Native American.
“I can’t fix all the biases in medicine. How do I help you, as an individual, have more tools and feel more comfortable voicing questions?
O’Connor, who in 2023 was awarded both the American Association of Orthopedic Surgeons Diversity Award and the American Association of Hip and Knee Surgeons Diversity Award, has made it her life’s work to improve diversity and health equity within medicine. Since 2010, she has been an active chair for Movement is Life; a multi-disciplinary coalition whose goal is eliminating health disparities in musculoskeletal (MSK) health. And in 2021, she launched Vori Health, along with Ryan Grant, MD — a neurosurgeon who specializes in spine care. Vori Health is a virtual healthcare team that takes a multidisciplinary approach to MSK care, with MSK-trained doctors, nurses, physical therapists, health coaches and dietitians available. O’Connor sees Vori as a way to democratize healthcare by making it more accessible to all, particularly those in underserved communities by preventing inappropriate, invasive care.
Throughout O’Connor’s work, the throughline has been putting tools in the hands of individuals to gain more agency over their health.
“I can’t fix all these societal problems,” she said. “I can’t fix all the biases in medicine. How do I help you, as an individual, have more tools and feel more comfortable voicing questions?”
Rx Community
Through Movement is Life, O’Connor has increased her impact and become a nationally recognized health equity leader. The non-profit has four primary vehicles through which it works to improve health equity:
- An annual summit
- The Health Disparities Podcast (which I highly recommend checking out)
- Educational publications
- Operation Change – A community-based program
The latter is where O’Connor sees heart work being done. The 18-week program is for underserved women who have knee pain and comorbidities such as obesity, diabetes and hypertension. The idea was inspired by O’Connor’s experience treating joint pain and the patient demographics that consistently needed surgery: Women in underserved communities lacking the support and resources to improve their health.
The programs are aligned around race and ethnicity with programs for Black, Latina, and rural women. Each week, 40 women come together for 3 hours. The first hour is educational, covering topics such as diabetes, nutrition and arthritis, among others. The second hour is for movement; yoga, line dancing, etc. The third hour is “motivational interviewing” in smaller groups to help women understand what their personal barriers are to adopting change (she breaks it down in her TEDx Talk). According to O’Connor, the women’s feelings of hopelessness decreased by 40%, and walking speed increased by 18%, all without drugs, injections or medical interventions.
“It was because our program created the opportunity for these women to make emotional connections with other women that would support their journey towards better health,” she said on her TEDx Talk. “Instead of treating these women as individuals, we treated them as a community. We gave them the tools to support each other as a community.”
Democratizing Healthcare
Vori Health, O’Connor’s new company, is a completely separate venture from Movement is Life, but in many ways, the fingerprints of O’Connor’s life work are scattered across the operation.
O’Connor believes Vori’s healthcare model democratizes healthcare. Like other telehealth models, it’s more accessible, but what makes Vori Health unique is its biopsychosocial approach to MSK conditions. Vori’s team recognizes the importance of psychological and social factors in recovery. In the words of O’Connor, the Vori care team focuses on “what matters to you,” and not just “what is the matter with you.” Further, they work with insurers to eliminate copays to make care more affordable to patients. If patients don’t have to choose between paying for groceries or the copay on their follow-up treatment (like physical therapy) they’re much more likely to attend, significantly reducing the chances they would need surgery, the logic goes.
“To me, this matters from a health equity standpoint because we need to empower patients at the individual level to make healthy behavioral changes.”
For those who say MSK care can’t be done in a virtual setting, O’Connor disagrees.
“Not all MSK care can be done virtually,” she said. “But you would be surprised at just how much can be done virtually, and done well. Every physician knows the most important part of the evaluation is the patient’s story and nearly all physical examination testing can be adequately performed in a virtual setting.”
By providing convenient, virtual and high-quality care, O’Connor believes that Vori Health can reduce the rate of inappropriate medical tests and surgeries. These numbers are not insignificant with over 50% of low back surgeries and 34% of total knee replacements determined inappropriate.
“People fail to understand how complex it is to run a hospital, or health system, from a financial standpoint. Many hospital services, like pediatrics, lose money, and free care is given to so many. Hospitals essentially function as the medical safety net for the country,” Dr. O’Connor said. “So, I do not crucify the hospitals – I don’t – but we still have to find a better way.”
O’Connor is quick to point out the complexity of the issue of inappropriate surgeries.
“I do not think my surgical colleagues are bad people,” she said. “I think they are trying to help their patients. But we all have biases, and surgeons tend to have a bias towards surgery.”
Furthermore, O’Connor notes that financial margins for hospitals are driven by surgical revenue.
“People fail to understand how complex it is to run a hospital, or health system, from a financial standpoint. Many hospital services, like pediatrics, lose money, and free care is given to so many. Hospitals essentially function as the medical safety net for the country,” Dr. O’Connor said. “So, I do not crucify the hospitals – I don’t – but we still have to find a better way.”
Vori Health has seemingly found that better way – a lot better, as their referral rate for low-back surgery sits at 3%. The irony in the model is that both O’Connor and Grant are surgeons.
Or perhaps that’s the beauty.
“We aren’t anti-surgery, just anti-inappropriate surgery,” O’Connor said.
The Vori Health Care team is an extension of the same heart work that made Operation Change so dynamic. O’Connor recognized the power of community in providing emotional infrastructure to support better choices.
“Our goal (at Vori) is for our patients to feel the love we have for them; that they truly matter to us, and to provide that holistic support they need in their wellness journey,” she said.
O’Connor hopes to further improve that support network by creating similar community groups as part of the Vori Health offering. It’s not offered yet but O’Connor said it’s “on the roadmap.”
Beyond the Bikini
Finally (as if she wasn’t busy enough), O’Connor co-authored the 2022 book, Taking Care of You: The Empowered Woman’s Guide to Better Health (Mayo Clinic Press) with medical anthropologist, Kanwal L Haq, MS. The book focuses on common non-reproductive clinical conditions and how they can impact women differently than men.
“There are plenty of books for women that focus on the ‘bikini’ conditions related to breast or reproductive health,” she said. “But there was nothing out there to help women with these common conditions. We empower our readers by giving them practical information and, my favorite section of each chapter, ‘Questions to ask your healthcare team.’ ”
The book is an extension of her lifelong work to advance healthcare for women and address women’s voices not being heard.
O’Connor won’t be able to reach all who may feel unheard or discriminated against by traditional medicine, but she’ll continue producing tools and resources, hoping to reach those wanting agency over their own health.
Stephen Norris is a digital health leader and health equity advocate with over 10 years of experience building successful provider partnerships. Based in Seattle, WA, he's currently seeking new opportunities to leverage his expertise in a progressive, digital health setting.
His most recent role saw him leading strategic provider partnerships for a mission-driven, digital health startup in the workers' comp space. There, he built a robust west region provider network, fostering provider adoption of the company's SaaS platform. In doing so, he helped secure several Fortune 500 payers and spearheaded initiatives that expanded and retained key regional and national provider groups. Notably, he piloted the company's DEIJ initiatives, resulting in improved employee morale and engagement.
Norris brings a well-rounded background in journalism and experiential marketing, which, when coupled with his provider partnership expertise and dedication to health equity, allows him to develop unique strategies for building and growing successful partnerships.
To contact Norris, you can email him at snorris32@gmail.com or reach out via Linkedin.
