Diversity in radiology: One step forward, two steps back

By Amerigo Allegretto, AuntMinnie.com staff writer

August 10, 2022 -- Women are making slow but steady progress edging into leadership roles in radiology. But overall, the specialty is not attracting many more female radiology residents than it did a decade ago, and its efforts at racial diversity are also lagging, says a study published August 9 in Radiology.

A team led by Xiao Wu from Yale University in Connecticut found that while females have gained ground in some academic employment levels and medical schools see more diversity, females still make up a low proportion of radiology residency applicants. Along with that, representation for African American and Hispanic individuals in academic radiology remained mostly stagnant at all levels.

"Efforts to increase diversity may need to be focused toward the medical school and residency application levels," Wu and colleagues wrote.

Previous research suggests that improving the diversity, representation, and inclusion of the physician workforce can reduce healthcare disparities. This is represented by improving access to healthcare, especially among underrepresented minority and underserved populations.

Increased attention has been given in recent years toward addressing healthcare disparities in medical careers, radiology included, with the U.S. population becoming more diverse over time. While healthcare systems have employed initiatives to recruit and employ more women and people from underrepresented groups, the study authors noted a lack of data showing whether these have worked.

Wu et al wanted to explore diversity trends over the past decade (2010-2019) for the various levels of the U.S. physician workforce in academic radiology. These levels included instructors, assistant professors, associate professors, professors, and department chairs.

The team also looked at the available pipeline of medical students and trainees, obtaining trainee data from two time points, 2010-2011 and 2019-2020. The researchers obtained publicly available data from the Association of American Medical Colleges and the Electronic Residency Application Service.

They found that the number of women in some radiology leadership roles, such as department chairs, was edging up. But overall, the proportion of female radiology residents grew by only one percentage point in a decade.

Proportion of female faculty and residents in radiology for 2010 and 2019
  2010 2019
Instructors 36% 38%
Assistant professors 32% 31%
Associate professors 23% 28%
Professors 17% 22%
Department chairs 13% 17%
Residency applications 28% 29%

The group also found that the proportion of female medical school applicants increased from 47% in 2010 to 52% in 2019. However, female radiology residency applicants remained largely unchanged.

The team also found that the proportion of Black or African American department chairs was 5% in 2019, which they noted remained "largely unchanged" from 2010 numbers (4%). However, this was reportedly higher when compared with proportions of assistant professor (3%), associate professor (2%), and professor levels (2%) for Black or African American faculty.

Proportions of Hispanic department chairs, meanwhile, remained unchanged over the timespan at 3%. Proportions for other levels were between 3% and 5% and also remained unchanged, the study authors wrote.

Also, the proportion of underrepresented racial and ethnic groups among radiology trainees remains low with 4% for the Black or African American cohort and 6% for the Hispanic cohort.

The researchers suggested several reasons for the reduced proportion of female applicants to radiology residency, despite the increase of female medical school graduates. These include the competitive nature of radiology, lack of exposure to the field in medical school, and less patient contact in radiology than in other fields.

The authors also suggested that the increased Hispanic representation among radiology residents and similar representation among assistant professors may indicate a preference for practice in a nonacademic setting. Additionally, they found similar trends among Black or African American radiology professionals, and they wrote that greater representation at the "top" has not translated to greater recruitment into academic radiology ranks.

Wu and colleagues called for further analysis on efforts to increase representation in radiology, such as the Pipeline Initiative for the Enrichment of Radiology (PIER) program.

Dr. Pari Pandharipande and Dr. Zarine Shah from Ohio State University concurred in an accompanying editorial, calling for research to identify and target the programs that work best to affect these changes.

"Such research will be critical in identifying effective strategies that academic departments and professional organizations can use to rapidly and successfully improve the representation of women and underrepresented racial and ethnic groups at all levels in radiology," they wrote. "Put simply, the results of the study by Wu et al indicate that current efforts to improve the diversity of our academic radiology workforce are insufficient. We need to try harder and have more effective approaches."


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