While diversity rates of radiation oncology (RO) and medical oncology (MO) faculty have increased over the past five decades—most notably for women—they have not kept pace with the changing demographics of the US population, particularly in groups considered underrepresented in medicine (URM).
The diversity of medical school applicants, matriculants and graduates has increased significantly during the past 10 years, presumably in large part because of high profile efforts by the AAMC to promote diversity, equity and inclusion among medical schools and the physician workforce.
But these increases are not translating to better representation at the faculty level, or at higher levels of leadership in medicine.
Women represent half of the US population but are still underrepresented at the faculty and leadership levels. Black, Hispanic and Indigenous individuals represent 31% of the population but only about 5% of faculty in RO and MO.
The findings highlight the need for more initiatives to ensure successful recruitment and retention of URM individuals throughout the academic promotional pipeline, say the authors of a new study in JAMA Oncology.
“We know that oncology faculty at academic medical centers are responsible for training the next generation of oncologists,” says Sophia Kamran, MD, a radiation oncologist at the Mass General Cancer Center and the lead author of the study.
“It’s important to make sure that we’re reflective of the population so that we can adequately train future oncologists to be able to go out into the world and care for a diversifying cancer population.”
Why Diversity is Important
It is estimated that 48% of all new cancer cases in 2022 will occur in women, and that new cancer cases among Black, Hispanic and Indigenous populations occur at a higher rate and with more mortality compared to their non-Hispanic White counterparts.
According to the study team, a healthcare workforce that better reflects the demographics of the patients it serves can lead to improved patient satisfaction, compliance and outcomes.
Patients have reported greater satisfaction with treatment from physicians of the same race and/or ethnicity, which leads to better adherence to treatment plans and improved outcomes.
“Workforce diversity ensures inclusion of more viewpoints and enhances innovation, creativity, problem solving, and productivity,” the researchers write. “Furthermore, a representative cancer workforce can make much-needed strides in ensuring that biomedical research is inclusive and extends to all sectors of the US population.”
Approach and Findings
To assess the diversity of the current RO and MO faculty and understand the trends over time, the team looked at data from the Association of American Medical Colleges’ full-time faculty rosters for RO and MO between 1970 and 2019.
They used the AAMC Facts and Electronic Residency Applicant Service tables to obtain data on medical school applicants, matriculants and graduates, RO residency applicants, hematology and oncology and oncology fellowship applicants and current trainees.
The researchers performed comparisons by sex (M/F) and by race or ethnicity, with a focus on representation from Black, Hispanic and Indigenous individuals, who are considered underrepresented in medicine per the AAMC definition.
Representation of women at the faculty level increased significantly over the past five decades from 8.4% in 1970 to 29.1% in 2019 for RO and from 12.8% to 38.1% in RO.
For individuals underrepresented in medicine (URM), faculty representation in RO increased from 1.7% in 1970 to 5.1% in 2019, while representation in MO decreased from 8.0% in 1970 to 5.7% in 2019.
Over the five decades studied by the researchers, URM representation remained below 10% of the total faculty for both RO and MO.
At the medical school level, representation of women in medical school has improved dramatically, with applicants and matriculants exceeding the representation of US women in the population, the team writes.
“However, we see lower representation of women among MO and RO faculty, RO residency applicants, and RO faculty, and the lowest representation of women among clinical academic chairs, consistent with prior studies.”
A higher proportion of women faculty members had lower academic rankings than men in both MO and RO, the researchers found.
Efforts to improve representation of URM groups among medical school applicants and matriculants have translated into gains over time.
However, a gap between URM representation among medical school applicants and matriculants (18%) and graduates (11%) has emerged.
The authors acknowledge a few limitations with their study, noting that the AAMC relies on data provided by medical schools, thus it is not known how race/ethnicity or sex data were obtained from faculty.
They were also unable to obtain similar data on faculty in the third pillar of cancer care–surgical oncology—as this information is not reported separately from surgery as a whole.
The team was also unable to further stratify mixed races and ethnicity which will arguably play a more important role as the US population further diversifies. They also acknowledge that sex can be nonbinary, but they were unable to capture the depth of that data in their analysis.
Discussion and Next Steps
Kamran hopes the team’s findings will lead to more aggressive strategies to recruit and retain URM individuals to the fields of RO and MO.
“The prior calls to action clearly haven’t been enough,” she says. “I think more research, more understanding into the limitations of our current approaches and more funding needs to be poured into this issue.”
She notes that oncologists already struggle to recruit diverse individuals into cancer clinical trials, and that cancer treatments behave differently in different patient populations, which makes it challenging to optimize patient care for diverse populations.
“We need to move the needle forward in a more aggressive way,” says Kamran. “A lot of people will say, ‘We have all these programs in place, we’re doing a good job.’ But I think this highlights that we clearly aren’t. We thought we were and we’re not.”
Citation: Kamran SC, Niemierko A, Deville C, Vapiwala N. Diversity Trends by Sex and Underrepresented in Medicine Status Among US Radiation and Medical Oncology Faculty Over 5 Decades. JAMA Oncol. Published online December 09, 2021. doi:10.1001/jamaoncol.2021.6011
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