Underrepresentation in Oncology: Identifying and Addressing Structural Barriers

Abstract

Underrepresentation of minority groups in the oncology physician workforce is a pressing issue that may contribute to disparities in cancer research, clinical care, and patient outcomes. To address this, we highlight the role of medical culture and institutions in perpetuating a range of barriers that lead to the persistent underrepresentation of minority medical trainees and physicians. These barriers include an exclusionary medical culture, bias in measures of merit, financial barriers to medical subspecialty training, underrecognition of achievement, and poor representation and satisfaction among underrepresented faculty. Furthermore, we suggest a more intentional approach to diversity that values both recruitment of underrepresented undergraduates and early medical students and retention of internal medicine trainees, hematology-oncology fellows, and faculty. To counteract deeply embedded structural racism that hampers diversity efforts, this multifaceted approach will require cultural transformation of our medical institutions at all levels, including increased institutional transparency, mandatory evidence-based bias training, acknowledgment of varied achievements, changes in recruitment practices, and reinvigoration of pipeline development programs with a focus on financial support. Taken in combination, programs should recognize the scope of deterrents to representation and develop program-specific, longitudinal interventions to promote more successful diversity initiatives within the field of oncology. The Oncologist 2021;26:630-634 Implications for Practice: The medical profession recognizes the value of physician workforce diversity in improving the quality of both medical education and patient care. In return, medical schools and training programs invest in recruitment programs focused on candidates who are underrepresented in medicine. In the field of oncology, where stark racial and ethnic disparities in care and health outcomes are well-defined, measures of minority physician representation remain especially stagnant. This study clearly defines the barriers that limit the effectiveness of such programs and provides recommendations to achieve the necessary workforce diversity in oncology.

American Cancer Society's report on the status of cancer disparities in the United States, 2021

“…Increasing diversity in the primary care and oncology workforce could help reduce provider biases and discrimination in health care settings, 201 improve shared decision making, 202 and increase people of color's satisfaction and trust in health systems 203,204 . A diverse research workforce also broadens scientific inquiry and knowledge and can result in better science 134,205 .…”

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival

“…11 , 12 Mechanisms underlying these disparities include differences in access to care and follow-up, screening utilization, and health behaviors. 13 , 14 For specific malignancies, studies have also illustrated that the likelihood of receiving standard-of-care treatment may vary by patient race. 15 Therefore, disparities in oncologic outcomes are likely influenced by key sociodemographic variables.…”

“…Studies have consistently demonstrated decreased survival for solid tumors as well as hematologic malignancies among patients of certain racial and socioeconomic backgrounds 11,12 . Mechanisms underlying these disparities include differences in access to care and follow‐up, screening utilization, and health behaviors 13,14 . For specific malignancies, studies have also illustrated that the likelihood of receiving standard‐of‐care treatment may vary by patient race 15 .…”

Raising The Curtain On The “Equality Theatre” In Recruitment To The Healthcare Workforce

“…Racial discrimination is known to begin with the pipeline to professional training 15 , continue in applications and selection to the NHS 11 , through to inequalities in experiences and opportunities when employed 12 . Understanding of what actually works to support workforce diversity, at all career levels, is currently limited to certain elds or clinical specialisms, for example, emergency medicine 16 and oncology 17 , and more could be done to build upon learning in further and higher education about widening access and equality monitoring 18 .…”