Diversity among oncologists does not reflect US population

While the representation of women in academic radiation oncology and medical oncology faculties has increased over time, racial and ethnic minorities are still vastly underrepresented in these fields, according to a cross-sectional study of data from the Association of American Medical Colleges.

“Creating and sustaining a diverse healthcare workforce is a priority to help address societal inequities and health disparities, especially in light of the changing demographics of the general U.S. population. “, wrote authors led by Sophia C. Kamran, MD, a radiation oncologist at Massachusetts General Hospital in Boston.

the studywhich was published Dec. 9 in JAMA Oncology, surveyed full-time U.S. faculty in radiation therapy and medical oncology departments from 1970 to 2019.

Improved patient satisfaction, compliance, and outcomes have been documented when a healthcare workforce better reflects the demographics of those they serve, Kamran and associates wrote.

They point to recent increases in the number and urgency of calls for greater diversity in the healthcare workforce, also citing higher incidence and mortality of new cancer cases among Black, Indigenous and Hispanic populations, compared to their non-Hispanic white counterparts. Previous calls for diversity in the health workforce have led to the creation of opportunities and pathways for increased representation of women and racial and ethnic minority groups in medicine, and the overall diversity of medical school faculty has increased by race, ethnicity and gender.

The change, however, is less in magnitude than what has been observed among medical school applicants, students, and graduates, and medical school diversity gains have not kept pace with the growing diversity of medical schools. the American population. It remains unclear whether corresponding advances have taken place in the composition of radiation oncology and medical oncology departments over the past 5 decades.

Despite the lack of diversity, the total number of teachers has increased

Analysis by Kamran and associates found that the total number of faculty increased over time in radiation oncology and medical oncology, with faculty representation of underrepresented women in medicine (URM) increasing proportionally from 0, 1% per decade in radiation oncology (95% confidence interval, 0.005%-0.110%; P P = 0.06 for the trend), compared to female non-URM professors, who increased by 0.4% (95% CI, 0.25% to 0.80%) per decade in radiation oncology and by 0 .7% (95% CI, 0.47% to 0.87%) per decade in medical oncology (P P= 0.09 for trend) or for medical oncology (0.003% per decade [95% CI, −0.13% to 0.14%]; P = 0.94 for the trend).

In 2009 and 2019, the representation of women and URM people for both specialties was lower than their representation in the US population. The Faculty of Radiation Oncology had the lowest URM representation in 2019 at 5.1%. The total number of URM faculty represented in both medical oncology and radiation oncology remained low across all grades in 2019 (Medical oncology: instructor, 2 out of 44 [5%]; assistant professor, 18 of 274 [7%]; associate professor, 13 of 177 [7%]; tenured professor, 13 out of 276 [5%]. Radiation oncology: instructor, 9 out of 147 [6%]; assistant professor, 57 out of 927 [6%]; associate professor, 20 out of 510 [4%]; tenured professor, 18 out of 452 [4%]).

“Our results highlight significant diversity differences along the career ladder in both specialties, with women having lower academic rank than men throughout the study period and underrepresented [racial and ethnic groups] at all ranks,” the authors wrote.

And, although blacks, Hispanics and natives make up about 31% of the U.S. population, their inclusion in the health care workforce is lagging at all stages of the pipeline, investigators found.

Diversity among radiation oncologists and medical oncologists lags behind the diversity of medical schools in general, which has grown through the efforts of the Association of American Medical Colleges.

Despite some improvements, the authors suggest the need for more initiatives to retain racial and ethnic minorities in an effort to reflect the diversity of the cancer population in the United States.

“This is a multifactor problem, with a focus not only on increasing diversity in the upstream pipeline, but on maintaining diversity across the pipeline, requiring difficult but necessary conversations about systemic racial and ethnic bias, lack of exposure and opportunity, and financial toxicities and pressures, to name a few. Until these factors are better defined and better addressed, focused and targeted mentoring is essential,” the authors wrote.

Small steps can have a collective impact

In a commentary published with the study, Frederick Lansigan, MD, and Charles R. Thomas Jr, MD, both of Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH, called for systemic change in practices hiring.

“Any small step of change that helps support the issues highlighted by Kamran et al.’s study can have a collective positive impact. A holistic assessment of [underrepresented] applicants at all stages of education and training are paramount, and participation in selection committees is necessary to ensure fair processes. Mentoring programs, leadership courses, and addressing microaggressions and abuse can improve retention of [underrepresented] medical school graduates and oncology trainees. Cancer centers can build and lead visible and tangible efforts for diversity, equity, inclusion, justice and belonging as we do at our institution,” the physicians wrote.

Importantly, Lansigan and Thomas said the oncology community must agree that intentionally increasing the number of underrepresented physicians in the U.S. workforce is necessary to better address health care inequities.

“We need everyone on board to reduce structural barriers to early childhood education. We need STEM programs that start in elementary school and provide support through middle school. Oncologists can mentor these young learners to emphasize the positive aspects of a career in oncology, the importance of [underrepresented] oncology physicians and the resilience to care for people with critical illness, many of whom will come from underserved populations. “Physicians and public health experts themselves who want to tackle the gap between [underrepresented] and [non-underrepresented] medicine School [students] and oncology trainees must seek and be elected to positions that can begin to balance this equation. If more are willing to recognize the structural inequalities that exist in the oncology workforce pipeline, we can begin to solve the complex equation of structural inequalities.

Lansigan said he is the acting associate dean of diversity, equity and inclusion at the Geisel School of Medicine and the director of diversity, equity and inclusion for the department of medicine at Dartmouth. -Hitchcock Medical Center. No other disclosures were reported.

This story originally appeared on MDedge.comwhich is part of the Medscape professional network.

About Mark A. Tomlin

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