Lack of Diversity in Radiation Oncology is Not Simply a 'Pipeline Problem'

By Tammy McCaudland

Lack of Diversity in Radiation Oncology is Not Simply a ‘Pipeline Problem’

This blog post sources its content from “Diversity Matters,” an article published in April 2020 in SROA’s quarterly news publication Radiation Oncology News for Administrators.

“If you look at the top 20 specialties, radiation oncology ranks at the bottom with respect to women and minorities, so we need to figure out what we are not doing a good enough job at, recruiting these folks that are going into other specialties,” said Dr. Curtiland Deville, clinical director of Radiation Oncology at Sibley Memorial Hospital and associate professor at Johns Hopkins University School of Medicine. “We can’t just say we need to increase the pipeline because even if we increase the pipeline, history has shown us that we’re not attracting them into radiation oncology.”

Discussions about the “pipeline problem”—that is, the underrepresentation of certain minority groups—in radiation oncology often miss the fact that there is greater representation of women and minorities in other areas of medicine, Dr. Deville said. While radiation oncology is one of the most competitive specialties, he suggested the scope of entrants needs to be broadened so it’s more reflective of the patient population.

Administrators can focus on diversity in physician hiring and in residency and training programs They can also provide staff with bias training. Dr. Deville offered four suggestions:

1. Inventory: Leaders can examine their data and make comparisons with peers, whether it’s an internal comparison with other departments or with external radiation oncology departments. Comparisons can be local or regional. Some demographic limitations or particularities may exist depending on the location, but close analysis can reveal opportunities to make improvements.
    
2. Prioritize: Leadership needs to make diversity a priority by putting human and financial resources behind it. For example, invest in bias training and allocate time for staff to participate.
    
3. Engage: The responsibility for diversity shouldn’t fall on only a few individuals, especially minorities within the department, because it perpetuates the ongoing problem. “We talk about ‘the minority tax’ and how we are potentially overburdening the few minorities in the department with working on these issues, and very often, it may not be to their benefit either, in terms of direct compensation. It may take away from their clinic time, their research time, and their efforts may not be valued in their promotion,” said Dr. Deville. He suggested staff working on diversity initiatives be assigned value that is factored into their promotion package and compensation package.
    
4. Educate: To ensure staff from underrepresented groups feel encouraged and supported, invest in bias training for all staff, have diversity search advisors on search committees and develop specific mentorship programs for trainees, residents and fellows. “We’re just not talking about counting numbers or representation for representation sake, so inclusion is that active part, which is the harder piece. How do you create a culture that’s welcoming, inviting, but that also wants to retain and keep people? There’s definitely a need to make it deliberate,” he said.

Administrators can inventory what practices they use at their institutions to recruit, engage and welcome students from underrepresented groups. They can hold talks in course curriculum and oncology curriculum, invite students to their department, make use of the ASTRO Minority Summer Fellowship or the ASCO Medical Student Summer Rotation for Underrepresented Students, and create opportunities within their own departments.

Because radiation oncology is such a small field, administrators may need to look within their institution overall to ensure they’re creating an inclusive culture. There may also be opportunities within the broader campus to create an inclusive culture. For example, at the University of Pennsylvania where Dr. Deville completed his residency, there was a minority faculty development cohort program, grouped by academic tracks. There were regular meetings where participants could present their research, ideas or issues, and also offer support, information and resources.

Diversity is about more than having a cultural day, a diversity committee or doing diversity rounds—it’s about trying to have a deeper experience or impact. “There’s an analogy that I heard a speaker from the AAMC [Association of American Medical Colleges] use. . . diversity is being invited to the party, and inclusion is being asked to dance,” he said. “I’ve always liked that. Sure, it’s great to be invited to the party, but you want to make sure that once you’re there, you’re still welcoming, you’re still inviting people in.”

We want to hear from you!

What are some practices that you use to recruit, engage and welcome underrepresented groups? Let us know in a comment below!

Related content

Strategies for Diversifying the Radiation Oncologist Workforce

Managing a Multigenerational Workforce in the Radiation Oncology Department

References:

1. Cavallo J. “Increasing Racial and Ethnics Diversity in the Oncology Workforce.” The ASCO Post. October 10, 2017.

2. University of Pennsylvania Perelman School of Medicine. Diversity Search Advisor Best Practices. 2020.

• Diversity, Leadership, Staffing