In the summer of 2020, the ongoing COVID-19 pandemic and multiple incidents of police brutality against African Americans converged to shift the national narrative on racial justice. Included in this conversation was a new look at how health care disparities based on race and ethnicity affect population health.
Gibbs
“Although Black or African American and American Indian or Alaskan native populations have the poorest overall health status among all U.S. population groups, Black people experience the worst cancer outcomes of all races and ethnicities,” said Iris Gibbs, MD, associate dean of MD Admissions and professor of Radiation Oncology at Stanford Medicine.
Speaking at a Wednesday plenary session, Dr. Gibbs noted that these disparities in health care can, in part, be traced to the disparities found within the physician workforce. For instance, according to a study co-authored by Dr. Gibbs and published in the International Journal of Radiation Oncology, despite a diverse pipeline of residents, Black physicians remain disproportionately underrepresented in certain medical specialties, particularly radiation oncology (RadOnc).
“Although the student pipeline to the Black RadOnc residency applicant pool is representative of the U.S. resident applicant pool, the number of Black RadOnc residents selected for training is not representative of the Black overall resident pool,” Dr. Gibbs explained.
Furthermore, even though the number of RadOncs doubled between 1974 and 2016 (from 374 to 720), the number of Black RadOnc residents dropped from 31 to 23 during that same time (across 91 ACGME programs).
A similarly bleak picture is seen on the faculty side of the equation, where Black RadOnc faculty representation is less than half of their representation in the U.S. faculty pool. “The most depressing trend is that the rate of decrease for Black faculty has been steady, at a rate of 0.16% annually, from a peak of 3.1% in 2006 to 1.5% in 2016,” Dr. Gibbs said.
Change is Possible
According to Dr. Gibbs, these disparities in physician workforce have a direct, negative impact on patient care. For example, Black academic faculty are more likely to conduct research on health disparities than their white counterparts. Likewise, minority physicians are more likely to practice in underserved communities and treat uninsured patients than white physicians.
“Our absence or underrepresentation in the RadOnc specialty means that much of this work isn’t getting done — and minority patients are the ones who suffer for it,” Dr. Gibbs said.
Yet Dr. Gibbs is adamant that change is possible — and that it needs to start in radiology. “Start by educating yourself about the historical context of current health disparities and challenge yourself to recognize your own contributions to inequities in patient care,” she said.
She also recommended that radiologists advocate for inclusive and equitable health care policies that improve health access for marginalized communities. “We need to interrupt bias by speaking up within our own spheres of influence and volunteer our time and talent toward building a diverse pipeline of trainees,” she added.
Embracing a Vision of Health Equity
Not since the Civil Rights era has there been such a notable and vociferous call to address the structures of racism — structures that continue to fuel inequities and effectively exclude minority physicians and deny patients appropriate care.
“Improving physician workforce diversity to be more reflective of the changing diversity of patient populations is an important step toward eliminating health disparities — and this has to start with us,” Dr. Gibbs concluded.
Access the presentation, Plenary Session: Addressing the Continued Exclusion of Black Physicians in the US Radiation Oncology Workforce," (W5-PL05) on demand at Meeting.RSNA.org.
