Daniel 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.
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