Hidden Figures

Although diversity and inclusion have improved in medicine overall, the radiology profession faces continuing challenges and special opportunities.

diversity 3Granville C. Coggs, MD, FACR, staff radiologist at Brooke Army Medical Center at Fort Sam Houston in Texas, evaluates an X-ray. (Image courtesy of Andricka Hammonds, U.S. Department of Defense.)

Marcus F. Wheatland, Sr., MD, was the first African-American radiology specialist and the 11th president of the National Medical Association, the largest and oldest national organization representing African-American physicians and their patients in the United States.

When William E. Allen, Jr., MD, FACR, arrived for his ABR examination in 1935, he was directed to take the freight elevator because the hotel manager said African-Americans could not share one with the white guests. Allen rode to the top floor, took the oral exam, diversity 1passed it, and became the first black diplomate of the ABR. He later became the first black member of the ACR, the first black fellow in 1945, and an ACR Gold Medalist in 1979. Leslie L. Alexander, MD, FACR, made medical history when he was elected as the first black vice president of the ACR BOC. Granville C. Coggs, MD, FACR, Tuskegee airman, inventor, and radiologist, was accepted to Harvard University and went on to receive the Congressional Gold Medal. Ivy O. Brooks, MD, followed her dream to become a physician at Meharry Medical College in Nashville, Tenn., and later served as secretary to the National Medical Association's Section on Radiology. She was the first woman appointed chief of radiology at the Tuskgee Veterans Administration Medical Center.

Despite trailblazing work done by these black pioneers in the field of radiology and radiation oncology, a shortfall remains in the number of African-Americans entering the medical profession, specifically the radiological sciences. In 1955, the Association of American Medical Colleges first acknowledged that a problem existed in the underrepresentation of blacks in medicine.1 The academic medicine community began studying and actively promoting the enrollment of more diverse and representative medical students, noting in 1968 that "medical schools must admit increased numbers of students from geographical areas, economic backgrounds, and ethnic groups that are now inadequately represented." At least in part as a result of this commitment, the representation of African-Americans in medical schools increased rapidly from 2.4 percent of all U.S. students in 1968 to 6.3 percent by 1974. However, representation has improved only marginally since then, standing at 6.9 percent in 2012 (the most recent year for which data are available).

"Emphasizing opportunities for patient contact and education in radiology may attract more minorities." – Sharon E. Byrd, MD, FACR

Barriers Start Early

Although many initiatives supported by foundations, medical schools, and government have contributed to increasing diversity in the physician pipeline, the number of applicants from one major demographic group — black men — has not increased since 1978. Despite an overall increase in the number of black male college graduates over the past three decades, the number of black male applicants to diversity 2medical school dropped to 1,337 in 2014 (from 1,410 in 1978). The number of enrollees also has declined, with 542 black male students enrolled in 1978, compared with 515 in 2014.2

"What we are seeing is the extinction of black men in medicine," says Raymond B. Wynn, MD, FACR, vice chair of network operations in the department of radiation oncology at Loyola Medicine in Maywood, Ill. "African-Americans are essentially becoming hidden in medical education."

Wynn is the only African-American academic radiation oncologist in the city of Chicago. He believes barriers occurring before medical school deter black students from applying for and being accepted to radiology programs.

"When you look at the science, technology, engineering, and mathematics (STEM) education system and who pursues STEM careers, you can see some implicit and explicit bias," says Wynn. "Institutional and systemic racism also exists. People tend to choose those with whom they are familiar and who have similar pedigrees to them. In highly-ranked universities, if you don't have black students already attending, then prospective black medical students are less likely to be selected when applications are reviewed. These factors make the pipeline tighter and smaller. It's the elephant in the room."

Blacks and Hispanics have a greater likelihood of attending medical schools affiliated with historically black colleges and universities, which, though quite diverse in student composition, still educate a higher proportion of underrepresented minorities (URMs) than do other medical schools. Typically, because these universities lack radiology and radiation oncology training programs, students are less likely to be exposed to those fields in clinical rotations and electives or to interact with radiologists and radiation oncologists as faculty and mentors.

According to Johnson B. Lightfoote, MD, FACR, a neuroradiologist at Pomona Valley Hospital Medical Center in California, another barrier to entry is the fact that radiology residencies look for participants who have publications, posters, and papers for meetings, and direct participation in radiology. Without mentors from within radiology, "these minority students may not be aware early as to what the preparation is to be accepted to radiology residencies," says Lightfoote. "And, therefore, they don't properly prepare for acceptance."

“ACR is making the house of radiology not only appear more diverse, but actually be more diverse in terms of gender, ethnicity, and culture.” – Raymond B. Wynn, MD, FACR

Perception Matters

Radiology and radiation oncology are two of the five subspecialties with the fewest URMs of all medical specialties. Lightfoote points out the misconception that radiology dose not have a direct impact on patient care in the way that obstetrics and gynecology or family diversity 4medicine does. With many minorities entering medicine wanting to have an effect on patients in their local communities, some medical students may not consider radiology, not understanding the patient-facing qualities and the direct impact the specialty has on all levels of disease.3

Sharon E. Byrd, MD, FACR, chair of the department of diagnostic radiology and nuclear medicine at Rush University Medical Center and College in Chicago, agrees with Lightfoote. She notes that studies suggest women and minorities often enter medicine wanting patient contact, and, therefore, the specialty could seem overly removed from the patient.

"I chose neuroradiology as my subspecialty because it allows me the patient contact through performing diagnostic procedures on patients," says Byrd. "Emphasizing opportunities for patient contact and education in radiology may attract more minorities."

According to Byrd, the ACR Commission for Women and Diversity is taking several steps to do just that, including founding the Pipeline Initiative for Enrichment of Radiology (PIER) mentoring program to increase minority medical student exposure and preparation for radiology postgraduate training. The PIER program, in collaboration with Nth Dimensions — an educational non-profit organization helping to increase diversity in orthopedics and other subspecialty fields — began in 2017 with an initial group of five rising second-year URM students who are being prepared to enter radiology residencies.

"The commission has been a major step forward in bridging the divide," says Wynn, who is one of ACR's two radiation oncology delegates to the AMA. "In fact, one of our white papers was referenced at the Minority Affairs Section meeting, during which the AMA resolved to address bias and inclusion in medical education."

While Wynn says that there remains a long way to go, he notes that the ACR is committed to literally changing the face of the organization.

"ACR is making the house of radiology not only appear more diverse, but actually be more diverse in terms of gender, ethnicity, and culture. A lot of groups create the perception but not truly the reality of diversity. I see other organizations stating that they value diversity, but the ACR is actually doing something about it. The rubber is meeting the road, and I've never seen it in all my days in medicine until now."

ENDNOTES
1. Cobb WM. Association of American Medical Colleges acknowledges problem. J Natl Med Assoc. 1955;47:73–4.
2. Lightfoote JB, Fielding JR, Deville C. Improving diversity, inclusion, and representation in radiology and radiation oncology part 1: why these matter. J Am Coll Radiol 2014;11:673–80. Available at
bit.ly/Diversity_Part1. Accessed Dec. 8, 2017.
3. American Association of Medical Colleges (AAMC). Altering the course: black males in medicine. Washington, D.C.: AAMC; 2015.
4. Lightfoote JB, Fielding JR, Deville C. Improving diversity, inclusion, and representation in radiology and radiation oncology part 2: challenges and recommendations. J Am Coll Radiol 2014;11:764–70. Available at
bit.ly/Diversity_PartTwo. Accessed Dec. 12, 2017.
5. Association of American Medical Colleges (AAMC). Minorities in medical education: facts & figures 2005. Washington, D.C.: AAMC; 2005.
6. Saha S. Taking diversity seriously: the merits of increasing minority representation in medicine. JAMA Int Med. 2014 Feb 1;174(2):291–2. Available at bit.ly/Minorities_Medicine. Accessed Dec. 13, 2017.

By Nicole B. Racadag, MSJ, managing editor, ACR Bulletin, and Dara L. Fox, freelance writer, ACR Press

Unless otherwise noted, all images are courtesy of A Centennial History of African Americans in Radiology, edited by Alan E. Oestreich, MD, with the assistance of and published by the Section on Radiology of the National Medical Association. ©1996 

 

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