Editor’s note: Dr. Hudis hosts the new ASCO in Action podcast series, which will focus on policy and practice issues affecting providers and patients. A short excerpt of the first podcast is shared below; it has been edited for length and clarity. Listen to the full podcast online or through iTunes or Google Play.
I’m serving as the host of the ASCO in Action podcast series. Each month I’m going to interview leaders and experts in oncology about policy and practice issues, and explore solutions to problems that we’re seeing. For our first guest I’m delighted to have Karen M. Winkfield, MD, PhD, a radiation oncologist at the Wake Forest Baptist Medical Center in North Carolina and immediate past chair of ASCO’s Health Disparities Committee. During her time as chair, Dr. Winkfield played an integral role in developing ASCO’s strategic plan for increasing racial and ethnic diversity in the oncology workforce.
CH: I would like to start this discussion with a really basic question: What is the current state of racial and ethnic diversity in the oncology workforce? What does our workforce actually look like now?
KW: The population of the United States has continued to become increasingly diverse, with some estimates suggesting that by the year 2040 the U.S. is going to be a majority minority country. Unfortunately, the racial and ethnic diversity of health care providers, in general, has not kept pace. For example, 13% of the U.S. population is black or African-American, and 18% identify as Hispanic or Latino. But only 9% of practicing physicians in the United States self-identify as either black or Hispanic. This gap is really pronounced in oncology, where only 2% of the physician workforce self-identifies as black or African-American, and 3% as Hispanic or Latino. So we have a little bit of work to do.
CH: Do we know what those barriers are? Do we know why more people from underrepresented communities don’t choose oncology?
KW: It is a very challenging question because it’s so multifactorial. When we look at oncology in particular, some of this may be related to the way the medical schools are set up for looking at specialties. Medical students might not get exposure to oncology until later in their course load. Those limited exposures oftentimes are focused on the inpatient setting. So if someone says that they really want to be in an outpatient clinician, they may be getting a skewed view of what oncology is. In fact, most of what we do is in the outpatient setting. So if we’re only exposing medical students to the inpatient setting it really is giving them an uneven view of the specialty.
The other issue that is really specific to the population of URM, and that means underrepresented in medicine, is that a lack of minority physician role models is really critical. That’s one of the things that we have to think about as a specialty—are there things that we could do to bring greater awareness to medical students, but also is there a really robust way to support the faculty members who are from your background, so that they can be there to be role models?
CH: One of the questions that listeners may have is a somewhat pragmatic one, and I can see some people shrugging their shoulders and saying, “I get why this is important on one hand, but can we explain why a lack of diversity has a negative impact on oncology patients?” Why do we need to care about this, exactly, just from a purely outcomes point of view?
KW: There’s been lots of data generated over the past few years—the past few decades in fact—that have shown that patients actually do better when they’re cared for by providers who look like them and come from similar backgrounds. And what I mean by “do better” is not necessarily saying, “Oh, their cancer is going to be cured at a higher rate if they’re seen by a physician who comes from that background.” It’s about how the patients feel, their quality of life, and how comfortable they feel in the clinical setting. Comfort levels lead to improved following of recommendations.
Having a comfort level with your provider, it builds trust. And having that trust between the patient and the care providers is essential. It’s really important to make sure that we understand that this issue of workforce diversity is indeed related to health equity, it’s about quality of care, and it should be a quality metric around how we look at practices and training programs.
CH: Are there other impacts that the lack of diversity would have that we need to be aware of?
KW: One of things that we see in business, more so than we see in medicine, is that diversity breeds innovation. Diversity of thought is important when you want to look at your bottom line, whether in terms of revenues but also in terms of thinking about innovative ways of approaching a problem.
So the more diverse the population around the table, the more innovative strategies we can have. The faster we can think about ways to improve cancer care and cancer delivery. And cancer is one of these problems that has so many different angles. So why not have diversity of thought, so that we can think about this problem in a way that really can move us lightyears ahead? That’s only going to come by having diversity at the table.
CH: Let’s talk for a few moments about something that I know has been a passionate effort of yours: what ASCO is actually going to do to increase diversity and cultural competency across the oncology workforce. You were instrumental in the development of our strategic plan to increase the racial and ethnic diversity in the oncology workforce. How was this plan created?
KW: ASCO has engaged in many efforts designed to support and promote diversity in the oncology workforce for years, primarily through its Diversity in Oncology initiative. But one of the things that we were tasked with is looking at whether there are things that we need to do that are more specific, that may actually help drive this issue of pipeline, if you will. How do we reach back and make sure that we’re opening up doors, and reducing some of those barriers? To think about this, we decided to have a strategic plan. We went to the Board and asked if this was something we could do, and ASCO completely jumped on and said that this was something we needed to do. We convened a working group composed of members from the ASCO Health Disparities Committee. We also included members of the Professional Development Committee of ASCO, and ASCO's Workforce Advisory Group. We also included in this group trainees who were from backgrounds that were underrepresented in medicine, and also other thought leaders. We put everyone in a room and we actually sat down, and we asked what some of the things were that we needed to do. Out of that roundtable came the bones of the strategic plan, and many of the steps that are outlined in the diversity statement.
CH: What does this plan call out to the front line? If I’m an individual ASCO member, what can I do personally to support the goals of this strategic plan?
KW: Hopefully the ASCO members will really join in on this effort. The biggest thing is being available. Think about becoming a mentor. You can mentor whether you’re in the academic setting, or if you’re in a community setting. Everyone needs a mentor. I met two students today who are applying for radiation oncology who said that they don’t have radiation oncology at their institution, but it was the kindness of a mentor, someone in the community, who allowed them to shadow that made the difference with them. Those simple things, particularly early in a medical student’s career, can really make the difference.