On the Intersection of Race and Gender Diversity in Current Medical Research

Daniel Chonde Martinos Center ResearcherDaniel B. Chonde, MD, PhD, PGY-3 radiology resident and chair of the Radiology Diversity, Equity and Inclusion Committee’s Education Taskforce at Massachusetts General Hospital, contributed this post.

Allow me to preface this post: I’m a straight, half-black/half-white cis-gendered male who has been involved with diversity efforts for my entire adult life. The opinions and interpretation of the data expressed below are mine alone and do not reflect those of the American College of Radiology® (ACR®) or my home institution.

It’s incredibly difficult to have a nuanced conversation about gender and racial diversity, as it has been coopted and exploited to become one of the most divisive issues in our society; however, it’s imperative to confront implicit biases and our shortcomings/blind spots if we hope to address them.

There’s unfortunately no double-blind randomized controlled study that can definitively prove that it’s better for society to treat all people with respect and dignity, that women shouldn’t just be viewed through the lens of “mother” or “sister,” or that what is beneath our scrubs matters any more than the color of our lead aprons. As such, we will take it as a given that diversity is a noble goal we strive for as a professional society and as a country. This post will attempt to bring attention to the need of a multiaxial framework for diversity.

In 1989 philosopher Kimberlé Crenshaw coined the term “intersectionality” as a framework to understand the complex interplay between race and gender politics/theory in an effort to critique how both unintentionally marginalize black women. When we typically consider inclusion, we usually do so along a single axis, such as race or gender. Crenshaw argues there are multiple social identities, or axes, by which people can experience discrimination, including sexual orientation, age, socioeconomic status, place of origin, presence of disability or veteran status. Policies enacted along a single axis can have significant unintended consequences and lead to undermining the original goal of inclusion.

Intersectionality in Our Professional Organization

When creating structures to support and address diversity, equity and inclusion at the organizational and patient levels, it’s important to consider intersectionality and recognize that while one may never find someone who has faced discrimination along every axis, our goal should be to cultivate leaders who are aware and will remain cognizant of the multidimensional nature of diversity and how nuances like language can affect inclusion.

The ACR established the Commission for Women and Diversity in 2013. The divorce of binary gender from diversity may have been driven by a perception that solving the binary gender disparity is easier, or there is more data available. This inherent division between women and diversity (used as a surrogate for underrepresented minorities [URM]) is most apparent in part two of the commission’s original findings in the section on Challenges Particular to Women in Radiology and Radiation Oncology which states, “Unlike URMs, women have entered and exited the medical school pipeline in increasing numbers and now comprise 50% of medical school classes.”

In an intersectional framework, the use of the word “women” is somewhat redundant. This is not to diminish the importance of increasing the representation of women in radiology; instead it is to do the opposite, to affirm that the gender axis is just as important in diversity as race, and we should strive to increase the presence of women, especially women of color. As an aside, it is also somewhat antiquated, considering gender is no longer considered strictly binary.

Intersectionality in Our Departments

Additionally, as the stewards of the radiology department, we work alongside and make policies which affect our interdisciplinary staff which includes technologists, nurses and administrative staff. If our goal is to achieve a lasting culture of diversity and inclusion, it’s necessary to engage all stakeholders throughout the department and for diversity efforts to extend to, include and meet the needs of staff at all levels whenever possible.

Intersectionality in Radiology Research

Diversity research is typically either survey-based or demographics-based. Demographics-based research relies on publicly available information from the American Medical Association, American Association of Medical Colleges, U.S. Census registries and the ACR. Large, registry-based diversity research does not necessarily reflect or adequately capture the diversity of the radiology population at any given moment, as it requires evaluation over multiple years, and the release of registry information may be slow. While our ACR workforce survey is published regularly, the most recent ACR workforce survey does not collect racial demographics, though it does capture binary gender and age. As we strive to improve our efforts in regards to diversity, it’s important that we’re able to understand specific obstacles of women of color as well as gender diverse/non-binary representation.

While there are scant perspective-type articles on the barriers that women of color face in medicine, there are few, if any, substantial data-driven studies in radiology or broader medical literature. This is surprising given the recent increased attention on the topic of women in radiology among journals like the Journal of the American College of Radiology  and Academic Radiology. While more recent work in the American Journal of Roentgenology exploring participants decision to pursue a career in radiology does include racial demographics of survey participants, the only diversity-related question in the survey involved gender distribution.

For researchers who are engaging in radiology diversity research, I hope to make the case for broadening the scope of future projects exploring diversity in radiology. To this end, I believe it’s our responsibility to ensure all research be as broadly applicable as possible.

  • Is your research staff diverse enough, such to minimize blind spots in your research? If not, have you considered how you can minimize blind spots in your project?
  • What can you do to make your work more generalizable? The addition of a question or two in survey-based studies can have a broad impact on findings.

Let’s continue to work together to ensure we are approaching race and gender diversity as best as we can.

Please share your thoughts in the comments section below, and join the discussion on Engage (login required).

Moving Radiology Forward: A Look Ahead From ACR 2020

Headshot of Dr. Howard B. Fleishon with dark gray backgroundHoward B. Fleishon, MD, MMM, FACR, chair of the American College of Radiology® (ACR®) Board of Chancellors, contributed this post.

I am honored to serve as your new chair of the Board of Chancellors. As we continue to face unprecedented challenges battling COVID-19, it’s been incredible to experience the unwavering display of strength, compassion and wisdom by members of our radiology community. I want to assure you that, as we battle both shared and unique crises due to this pandemic, the ACR is working harder than ever to support our nearly 40,000 members across the country.

We are continually updating our radiology-specific COVID-19 resources. From clinical materials, well-being tools and leadership resources to the latest economic, regulatory and financial updates, we are committed to equipping our members with critical, up-to-date information needed to continue this fight. Most recently, we provided guidance on the safe resumption of routine radiology care.

Additionally, the ACR’s government relations team has advanced several member-driven legislative priorities. Together, we led the coalition that persuaded the Centers for Medicare and Medicaid to urge Medicare Advantage Plans to stop using prior authorization during COVID-19. We worked to gain more financial resources for radiologists through the Small Business Administration and the United States Department of Human and Health Services financial relief programs. We’re also working to educate Congress on why they should waive budget neutrality in the Medicare Physician Fee Schedule — a move that would prevent a devastating financial impact on already hard-hit practices.

As we look to the future, be assured that the ACR is devoted to aiding members like you in every step of your professional journey. We are proud to continue to offer access to our industry-leading publications such as the Journal of the American College of Radiology and the ACR Bulletin, free and discounted continuing medical education activities, online professional development and academic resources, and continued strong representation on Capitol Hill with federal agencies and in state legislatures.

As we keep the ACR moving forward through this pandemic and beyond, please reach out on Engage, in the comments section below, or on Twitter — you can find me at @FleishonMD.

I look forward to serving you over the next two years. I remain committed to empowering members to advance the practice, science and professions of radiological care. Remember, you are not alone — we are in this together, both now and beyond COVID-19.

Please share your thoughts in the comments section below, and join the discussion on Engage (login required).

It’s Time to Ditch the Disk: Critical Care

Koran_MaryEllen

Radiology residents Mary Ellen Koran, MD, PhD, and Audrey Verde, MD, PhD, from Stanford University, contributed this post.

Sometimes, hearing a patient’s personal experience is the call-to-action we need. Below is Amanda’s* story:

“In October 2014, I knew I had cancer again. It would be my third time with ovarian cancer, and I could just feel it. Unfortunately, my doctor had just moved to another state, so I needed a new specialist. I knew my new doctor would require CT images; however, their office wouldn’t order a new scan until they had the comparison in-hand. Because my previous scans were done in another state, the fastest way I could get my images was to fill out paperwork, have my parents print it out and then drive two hours to pick up a CD of my images and mail it to me overnight. I called my new physician’s office every day for a week while my pain grew steadily. They finally found the CD in their mailroom, but told me they still couldn’t order a new scan because the comparison CD they received was of the wrong body part.

Verde_Audrey

 After over a week of excruciating pain, I was very upset because I correctly feared my cancer had returned and I couldn’t get any help. After visiting the doctor’s office and looking at the CD, I noticed the label said, “Name, Patient ID, CT of Chest, A…” The label had cut off the full name, which should’ve been “ Chest, Abdomen and Pelvis” – exactly what they needed. My care was delayed because of a mislabeled CD.

 Following two terrible weeks of pain, fear and frustration, my new physicians finally ordered a CT scan. My cancer had dramatically grown. I had surgery immediately, which could have been even more immediate if I hadn’t dealt with the issues obtaining my physical CD, which is a major barrier to care.”

* This patient has consented to use her real name.

There are multiple examples here where a secure, cloud-based image sharing platform would have improved patient care. Will you join us on our journey to #DitchTheDisk and improve the standard of care for all patients?

The #DitchTheDisk Task Force actively seeks patient and practitioner advocates as we embark on a journey to change the method of imaging transfer. To get involved, please fill out this form or email ditchthedisk@acr.org.

If you or someone you know has been affected by access to medical images, share your stories using the hashtag #DitchTheDisk on social media, commenting below or by joining the discussion on Engage (login required).