From ASCO Daily News
Improving equity, diversity, and inclusion within the care delivery and biomedical research workforces is critical to reducing health disparities in cancer care.1 Black people are currently underrepresented at every level of the pipeline that supplies the medical oncology workforce, and their representation decreases at each stage in the pipeline. Specifically, Black people are 13.4% of the US population2 but only 11% of college graduates.3 They make up only 6.2% of recent medical school graduates,4 6.2% of internal medicine residents, and 3.9% of oncology fellows.5 Just 3% of medical oncologists are Black (Fig 1).6 Black representation in medical oncology fellowships has remained relatively flat between 2006 and 2018 and is lower than many other internal medicine subspecialties.7 Black physicians are also underrepresented in other oncology specialties, including radiation oncology, surgical oncology, and gynecologic oncology.8 Additionally, a similar problem exists in the health research workforce, with Black physicians being vastly underrepresented in research careers and on medical school faculty.9,10
Benefits of Diverse and Inclusive Workforce
There are many benefits to the healthcare delivery system of a more diverse and inclusive workforce that we are failing to realize. Benefits include improving awareness of health disparities by healthcare organizations and healthcare providers.11 Racial and ethnic concordance between patients and physicians is associated with patients reporting higher satisfaction with their care.12 A diverse workforce contributes to improved cultural competency and patient trust in the healthcare system, which is especially important for patients from communities that have traditionally been underserved or mistreated. It also helps reduce implicit racial bias by physicians, which can negatively affect patient-clinician communication and treatment decisions.13 Other potential advantages of diversity and inclusion in the workforce include expanded patient access to care, policies that better support the needs of all patients, and more research in minority populations.11 Additionally, the lack of Black physicians in research and academic careers may have the downstream effect of perpetuating racial disparities in recipients of research funding.1 It also disadvantages Black students by making it harder for them to identify role models and mentors who represent future versions of themselves as well as fails to ensure Black students feel like they belong in healthcare and research careers.14
ASCO’S Efforts to Improve the Workforce
ASCO has a long-standing commitment to health equity and diversity. In 1964, one of the seven founding members of the organization was Dr Jane Wright, a Black oncologist and surgeon known for her significant contributions to early chemotherapy research.15 Her work within ASCO engendered a lasting commitment by the organization to improve inclusivity and equity in cancer care. This is demonstrated today through the organization’s mission statement that includes promoting the highest quality and equitable patient care. ASCO has also adopted the guiding institutional principle that health equity applies to its entire portfolio of work, from advocacy to research to the development of learners and leaders.1
In 2009, ASCO prioritized programs that target improving the diversity of the cancer care workforce.11 ASCO has since developed several award programs focused on diversity, inclusion, and health disparities that are funded by Conquer Cancer, ASCO’s charitable foundation.16 These award programs focus across the pipeline of the workforce, including recruitment of medical school students into oncology careers. The Medical Student Rotation for Underrepresented Populations, for example, provides financial support for US medical students from populations underrepresented in medicine17 who are interested in oncology as a career. The award funds 4-week clinical or clinical research rotations in private practices, hospitals, or academic settings. Award recipients are paired with mentors who oversee the rotation and provide ongoing academic and career guidance following the rotation. Recipients also attend the ASCO Annual Meeting, giving them the opportunity to interact with oncology professionals and learn about the latest oncology research. Outcomes data on the program from 2009 to 2020 show that it has successfully reached Black students, with 52 of 90 (58%) recipients self-identifying as Black or African American. It has also shown success at achieving its objective of increasing the diversity of the oncology workforce. Of the 90 awards, 20 students (22%) have participated in oncology training or residency programs (ie, Medical Oncology; Medical Oncology, Hematology; Hematology Oncology; Gynecologic Oncology; and Radiation Oncology). Another 20 recipients (22%) are still in medical school so have not selected their specialization yet.
The Resident Travel Award is another program funded by Conquer Cancer that is focused on improving the diversity of the oncology workforce. This award covers the cost of attending ASCO’s Annual Meeting for residents from populations underrepresented in medicine who have an interest in oncology. It also gives recipients the opportunity to meet and network with leading oncologists and learn more about career options in oncology. This program has been successful at reaching Black residents, with 69 of 96 (72%) recipients self-identifying as Black or African American between 2009 and 2020. Many of the recipients have gone on to careers in oncology: 54 of 96 (56%) completed an oncology training fellowship (which includes Gynecologic Oncology; Hematology Oncology; Medical Oncology; Medical Oncology, Hematology; Neuro-Oncology; Pediatric Hematology-Oncology; and Surgical Oncology), suggesting a small but important role at increasing the diversity of the oncology workforce.
ASCO’s Larger Effort Moving Forward
To further expand its efforts to improve the diversity, inclusivity, and equity of the oncology workforce, ASCO recently launched its Oncology Talent and Diversity Program with funding from Conquer Cancer. The program encompasses the Medical Student Rotation for Underrepresented Populations and the Resident Travel Award for Underrepresented Populations plus several new programs. New awards include the Oncology Summer Internship program, which is launching in June 2021. This is a 4-week program targeting rising second-year medical students from populations underrepresented in medicine at select medical schools across the United States. The program is intended to expose recipients to the field of oncology and provide them with a strong network of local mentors. Activities include daily virtual education seminars; networking events to learn from local leaders in medicine, faculty, and other members of the oncology community; and daily opportunities to shadow and meet one-on-one with oncology professionals. Following the program, ASCO will continue to support the participants through quarterly interactive webinars, virtual mentoring, and a stipend to attend the ASCO Annual Meeting. The intended impact of the program includes both contributing to greater equity at the participating medical schools and promoting awareness of the need to increase the diversity of the oncology workforce. Additionally, ASCO has launched the Diversity Mentoring Program. This is a 6- to 12-month structured mentoring program that is intended to help students foster relationships with mentors who provide career and educational guidance.
ASCO recognizes the importance of providing longitudinal career support for all the students and trainees participating in its diversity and inclusion programs. ASCO is creating a pathway to encourage further engagement within ASCO and the oncology community. The Oncology Summer Internship and Medical Student Rotation recipients, for example, will have opportunities to apply for other Conquer Cancer awards and pursue ASCO volunteer opportunities.
Ultimately, creating a more diverse and inclusive workforce will require ongoing effort and prioritization by ASCO and other healthcare organizations. ASCO’s commitment to this ideal is demonstrated by the creation of these grant programs. Additionally, ASCO is seeking to educate the oncology community on ways to address health disparities, such as through its new educational series focused on the role of social determinants of health in cancer care, modifiable risk factors, and cancer outcomes.18 The larger objective of creating a more equitable healthcare system will necessitate educating and energizing the entire medical community on importance of this endeavor. Much work remains to be done to achieve ASCO’s mission of ensuring all patients with cancer have access to the highest quality of care.
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