Oct 27, 2022
By Fernando Diaz, MD, Regina Barragan-Carrillo, MD, and Ana I. Velazquez, MD, MSc
The Latino Oncology Workforce
Approximately 62.1 million Hispanic or Latino/a/e individuals (herein referred to as Latino) are living in the United States, with 110 million expected by the year 2060.1,2 Latinos are a heterogeneous group with a variety of countries of origin, traditions, languages, and risk factors for cancer. The Latino population is the largest minority group in the U.S., comprising 18.9% of the total population, with cancer as the leading cause of death.3 In contrast, fewer than 5% of practicing oncologists in the U.S. self-identify as Hispanic or Latino, and only 7% of matriculating medical school students self-identify as Hispanic or Latino, of which only a fraction will go on to pursue oncology training.4 Despite increasing diversity of medical school enrollees, medical school graduates, and internal medicine residents, there has been little to no change in the representation of Latino trainees in oncology specialties.5 The likelihood of increasing representation of this community in the oncology workforce for the foreseeable future remains questionable at best, and underscores the need for increased recruitment and development of a community where Latino students from U.S. medical schools and international medical schools from Latin America can find mentorship and support.
We share the stories of two Latino oncology fellows who discuss their motivations to impact the Hispanic/Latino population with cancer. By sharing our stories, we hope to illustrate to other students and trainees that the path to becoming a champion for your community is not linear and often requires overcoming obstacles, making sacrifices, centering in your values, and adapting to changes along the way.
Dr. Fernando Diaz: Contributing From the Outside
As an international medical graduate from Mexico, pursuing postgraduate training in the U.S. was the net result of multiple personal and professional factors. Like many others, the driving force to leave stemmed from a desire to train alongside world-renowned experts. The paucity of dedicated training programs for physician-researchers and limited funding opportunities for cancer research against the backdrop of regional violence from drug cartels supported my decision to leave, but left an unsettled feeling that I was actively contributing to a brain drain.
Brain drain is defined as the migration of skilled personnel from one country or region to another for social, economic, or political reasons. In Mexico, there are 473 oncologists, or approximately 3.7 oncologists per 1 million individuals, while in the U.S., there are about 13,146 oncologists, or approximately 39.9 per 1 million individuals.6 Similar statistics exist across Latin American countries and fail to include the significant contribution of advanced practice providers, a crucial asset to the U.S. workforce that is virtually non-existent in Latin American countries.
Emigrating from a low-resource country with a shortage of health professionals to a country with a higher proportion evoked a sense of abandonment that has since been assuaged by the weekly interactions with my Spanish-speaking patients desperate for culturally competent care, a passion for addressing the disparities in scientific advancement of the Latino cancer community, and a desire to serve as a mentor for future generations of Latino physicians. These efforts serve as a constant reminder that even as a fellow, I can continue to provide meaningful contributions to my community from abroad.
That is why I chose to migrate.
Dr. Regina Barragan-Carrillo: Contributing From the Inside
Mexico, my home country, is a land of paradoxes, and the epidemiologic landscape is no exception. The environmental exposure to carcinogens as well as an increasingly aging population have led to a disproportional growth in the cancer burden. In Mexico, over 90,000 deaths related to malignant neoplasms were registered in 2021, with a substantial increase in the last decade.7 That, in conjunction with a fractionated public health care system, an unstable political panorama, as well as critical economic inequities, have led to worse oncologic outcomes in the population when compared to high-income countries.8
It was clear from an early point during my medical education that I wanted to be involved in cancer medicine. The desire to train and join faculty at one of the highly renowned centers where FDA-approved drugs are developed is inevitable. But it was only until I witnessed firsthand the complexities faced by people with cancer in the land of paradoxes that I understood that it did not matter that I knew exactly the best treatment approved by the FDA for my patient’s cancer if my patient did not even have enough money to pay for the bus ride every three weeks for an intravenous infusion. The direct involvement with local communities has not only been an eye-opening experience but has brought me a sense of responsibility to tackle disparities in cancer care within my community.
I would like to highlight the invaluable contributions that some ASCO pioneers have played in addressing local disparities in Mexico. The capacity and resourcefulness of researchers to develop and implement research initiatives in low-resource settings have shed light in their communities by acknowledging their individual characteristics and bringing high-quality research to some historically disregarded areas. Finally, those researchers have inspired trainees like me by demonstrating that the setting should not be a limitation to strive for better cancer care.
That is why I chose to stay.
A Call to Arms: The Need for Mentorship, Sponsorship, and Community for Latinos in Oncology
There is truth in the saying that there’s strength in numbers. We rely on this principle from a statistical perspective when we talk about power. However, when the number is small, is there no strength? Not necessarily. Latino oncologists, while few in number, have found new hope in creating connections and community thanks to social media networks, particularly Twitter. Clinicians and researchers across the country and the world have felt empowered to connect, collaborate, and disseminate high-quality information with an immense network of clinicians and researchers via a shared medium. Twitter handles such as @LatinxOncology, which boasts over 800 members since its inception 4 months ago, has been a popular destination to stay current on opportunities for research, engage in career development, and develop professional friendships amongst Latino physicians and trainees who may otherwise find themselves as the only one or one of the few Latino oncologists in their institution. While social media is an effective conduit for academic engagement and can serve as a bridge to networking at venues such as the ASCO Annual Meeting, these opportunities remain underutilized as an interface for mentoring the next generation of oncologists in Latin America.
We, as Latino oncologists, and our larger oncology community of allies have the power to sponsor and mentor Latino students in and outside the U.S. across the education pipeline, ensuring they have access to equal opportunities and sponsorship as their majority-population peers. An example is international research mentorship relationships that have allowed trainees from around the globe to connect and interact with researchers from leading institutions worldwide, releasing trainees from geographic constraints. As faculty, even if you cannot provide direct mentorship due to time or resource limitations, by leveraging their networks oncologists can create social connections for Latino and other minority trainees that will allow them to achieve their educational and professional goals.
The importance of having Latino oncologists serve as role models for Latino students cannot be overstated. Literature has shown us that exposure to role models from one’s own culture can influence an individual’s sense of belonging and compatibility, thereby leading to increased interest in a particular medical field.9 The ASCO Oncology Student Interest Groups (OSIGs) play an important role in recruiting medical students and residents interested in pursuing a career in oncology. These groups are student-led and often operate outside of broader networking circles of oncologists and oncology trainees. Similarly, the ASCO Oncology Summer Internship program allows first-year U.S. medical students from underrepresented populations to explore careers in oncology and meet oncology faculty from similar backgrounds across the country.
Visibility matters. We therefore call on all oncologists to actively participate in local OSIG activities and attend the Medical Student & Resident Abstract Forum held each year at the ASCO Annual Meeting. In addition, reach out to Latino medical students and medicine residents to introduce them to the fascinating and diverse field of oncology. Invite them to participate in ASCO-related activities and the Latino oncology social media community, connect them with a mentor or role model, and encourage them to connect with members of the ASCO Trainee & Early Career Advisory Group.
To Latino oncologists and fellows, we encourage you to talk about your journey in becoming an oncologist with local OSIGs and pipeline programs (and across other medical institutions, too). Personal stories of trials and tribulations remind students that we face barriers at every stage of our career and that it takes a village to raise an oncologist. As a community, we cannot afford to lose potential future oncologists and future leaders in the field.
Dr. Diaz is a hematology-oncology fellow at Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. He is a member of the ASCO Trainee & Early Career Advisory Group. Follow Dr. Diaz on Twitter @FernandoDiazMD1. Disclosure.
Dr. Barragan-Carrillo is an oncology fellow at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City. She is a member of the ASCO Trainee & Early Career Advisory Group and the ASCO-SEP Item Writing Task Force, and serves as a peer reviewer for ASCO journals. Follow Dr. Barragan-Carrillo on Twitter @reginabarcar. Disclosure.
Dr. Velazquez is a thoracic oncologist and assistant director of Diversity, Equity, Inclusion, and Accessibility for Training at the Helen Diller Family Comprehensive Cancer Center and an assistant professor of medicine at the University of California, San Francisco Division of Hematology/Oncology at Zuckerberg San Francisco General. She is a member of the ASCO Trainee & Early Career Advisory Group and trainee liaison for the ASCO Digital Education Editorial Board. Follow Dr. Velazquez on Twitter @AnaVManana. Disclosure.
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