in these fields, according to a cross-sectional study of data from the Association of American Medical Colleges.
“Creating and maintaining a diverse health care workforce is a priority to help combat societal inequities and health disparities, particularly in light of the evolving demographic characteristics of the general U.S. population,” wrote authors who were led by Sophia C. Kamran, MD, a radiation oncologist with Massachusetts General Hospital, Boston.
The study, which was published Dec. 9 in JAMA Oncology, surveyed full-time U.S.-based faculty in radiation and medical oncology departments from 1970 through 2019.
Improved patient satisfaction, compliance, and outcomes have been documented when a health care workforce better reflects the demographic traits of those whom it serves, Dr. Kamran and associates wrote.
They point to recent increases in the number and urgency of calls for improved diversity in the health care workforce, citing also higher incidence and mortality of new cancer cases among Black, indigenous, and Hispanic populations, compared with their non-Hispanic White counterparts. Prior calls for health care work force diversity have led to some 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 been increasing by race and ethnicity and sex.
The change, however, is of lesser magnitude than what has been seen among medical school applicants, students, and graduates, and the gains in medical school faculty diversity have not kept pace with increasing diversity of the U.S. population. It has remained unclear whether corresponding progress has occurred in the composition of radiation oncology and medical oncology departments during the last 5 decades.
Despite lack of diversity, total faculty numbers have increased
Dr. Kamran and associates’ analysis revealed that total faculty numbers increased over time in both radiation oncology and medical oncology, with faculty representation of underrepresented-in-medicine (URM) women proportionally increased by 0.1% per decade in both radiation oncology (95% confidence interval, 0.005%-0.110%; P < . 001 for trend) and medical oncology (95% CI, −0.03% to 0.16%; P = .06 for trend), compared with non–URM women faculty, which increased by 0.4% (95% CI, 0.25%-0.80%) per decade in radiation oncology and 0.7% (95% CI, 0.47%-0.87%) per decade in medical oncology (P < .001 for trend for both). Faculty representation of URM men did not significantly change for radiation oncology (0.03% per decade [95% CI, −0.008% to 0.065%]; P = .09 for trend) or for medical oncology (0.003% per decade [95% CI, −0.13% to 0.14%]; P = .94 for trend).
In both 2009 and 2019, representation of both women and URM individuals for both specialties was less than their representation in the U.S. population. Radiation oncology faculty had the lowest URM representation in 2019 at 5.1%. The number of total URM faculty represented among both medical oncology and radiation oncology remained low for every rank in 2019 (Medical oncology: instructor, 2 of 44 [5%]; assistant professor, 18 of 274 [7%]; associate professor, 13 of 177 [7%]; full professor, 13 of 276 [5%]. Radiation oncology: instructor, 9 of 147 [6%]; assistant professor, 57 of 927 [6%]; associate professor, 20 of 510 [4%]; full professor, 18 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 every rank,” the authors wrote.
And, although Black, Hispanic, and indigenous people make up about 31% of the U.S. population, their inclusion in the health care workforce trails at all stages in the pipeline, the investigators found.
Diversity among radiation and medical oncologists lags behind that of medical school diversity in general, which has grown through efforts by 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 U.S. cancer population.
“This is a multifactorial issue, with focus not only on increasing diversity of the upstream pipeline but maintaining diversity throughout the entire pipeline, requiring difficult but necessary conversations about racial and ethnic systemic bias, lack of exposure and opportunities, and financial toxicities and pressures, to name a few. Until these factors are further delineated and better addressed, focused and targeted mentorship is key,” the authors wrote.