The Culture of Radiology
Does your reading room look like your waiting room?
There’s a lot of talk about what the future of radiology will look like. Usually that discussion revolves around the role technology will play as machine learning and artificial intelligence enter practice.
But the diversity of a radiology practice, some say, may prove to be the best indicator of its ability to keep pace with the needs of a changing patient population.
“You can always say, ‘I have been successful so far.’ But how much more success might you enjoy if you had more diversity and different ways of thinking in your practice?” says Andrea Borondy Kitts, a patient advocate, JACR associate editor, and retired aerospace engineer. Diversity in the workforce includes age, race, ethnicity, gender, religious affiliation, sexual orientation, and disabilities. And when it’s time to hire new staff, it may even apply to personality and thinking styles.
Many groups are underrepresented in radiology. For instance, while women represent nearly 51 percent of the U.S. population, they account for just over 20 percent of the country’s radiology workforce.1 The overall makeup of the nation’s health care workforce, in fact, doesn’t reflect the diversity of the population. While people of color make up more than one third of the U.S. population, they account for only about 10 percent of the health care workforce. Fewer than 10 percent of radiologists are people of color.2 The National Academies of Sciences, Engineering, and Medicine notes that increasing diversity among health professionals is critical because it leads to improved access to care, greater patient choice and satisfaction, and a better educational experience for health professionals.3
“There is an expectation on the part of consumers of all products and services that businesses will provide professionals and staff that at least reflect the range of diversity that exists in the geographical area in which the business operates,” says Bettina Deynes, vice president of human resources and diversity and inclusion at the Society for Human Resource Management. “Medical practices are not in any way exempt from this expectation.”
Many HR leaders agree that ensuring diversity in the workplace will dominate hiring trends in the next decade.4 That’s important because hiring managers must ensure that they’re hiring the best candidates — not necessarily the ones who look or think the same as senior staff.
“If in a radiology practice, all of the senior staff are straight white men, it’s going to be harder for women, younger radiologists, people of color, or members of the LGBTQ community to feel welcome as part of the practice,” says Borondy Kitts. At the same time, radiologists must consider their patients’ comfort zone. Studies have shown that many patients are more comfortable with doctors who they perceive to be more like themselves. Women, for instance, may feel more comfortable seeing female doctors.5
Studies show that shared race or ethnicity between patients and physicians enhances communication, patient satisfaction, compliance with medical recommendations, and overall health care outcomes.6 When considering the broader health system, minority physicians are more likely to practice in underserved communities, which often include rural areas and communities made up of people of color. For example, African-American physicians are more likely to practice in areas with a high proportion of African-American residents. Likewise, Hispanic physicians tend to work in communities with twice the proportion of Hispanic residents when compared to their non-Hispanic colleagues. The contributions of physicians in these communities is expected to go a long way in meeting the pending health care needs of a growing, diverse society.7
For those in charge of hiring the best and brightest new radiologists, the time is now to be mindful of diversity. Close to a quarter of practicing radiologists are approaching retirement age, and newly available jobs for radiologists increased by around 16 percent last year compared to 2015.8 These shifts in the workforce present radiology practices with an opportunity to re-examine the makeup of their staff and adjust their hiring practices.
“Everyone has a tendency to hire people that most resemble themselves,” Deynes says. “No one is suggesting that businesses hire people who are not the best qualified. But if you don’t attract a pool of candidates that is reflective of the desired culture, then you’ve not fully explored your recruitment possibilities.”
Increasing numbers of women and underrepresented minorities are already in the medical school pipeline — offering imminent opportunities for practices eager to foster a more diverse staff. Borondy Kitts points out, “If you hire people with different thinking and different experiences of the world, you are more likely to create a system of solutions.” Hiring staff with different backgrounds for a radiology team, she suggests, could be helpful in building relationships across specialties. “You may be able to branch out into areas you’ve never touched upon,” she says.
In contrast, the consequences of not considering diversity when hiring, Deynes says, could be severe. “Practices whose employee composition continues to reflect only the cultural characteristics of their founders or management will likely start to see an erosion of their customers,” she warns. “Over time, they will be forced to adopt diversity in their workforce as a matter of survival.”
For radiologists who may not have a lot of face time with patients, it can be challenging to keep a critical eye on hiring within their practice. They may find it difficult to identify with the culturally specific needs of patients or the barriers patients may face when seeking care. Being mindful of achieving the goal of a more diverse workforce can become onerous when hiring managers think of diversity as an additional task instead of as a way to improve their business.9
Becoming more familiar with your client-patient base can make the task more manageable. “When recruiting employees at all levels, make a concerted effort to attract candidates from the culturally diverse pools that reflect the demographics of your patient population,” says Deynes. “Then try to hire to complete the cultural profile that best reflects that community.”
“If you continue hiring the way you have in the past, what kind of team are you going to have moving forward?” asks Borondy Kitts. A more diverse group of physicians can share cross-cultural life experiences, bridge language barriers, and sharpen interpersonal skills, she says. Diverse experiences foster providers’ ability to deliver care that answers the social, cultural, and linguistic needs of their patients. This, in turn, can create a positive experience for patients during face-to-face interactions.
Employees with diverse backgrounds can bring fresh ideas to the table and challenge unexamined processes and ways of doing business. “Drawing upon wide-ranging backgrounds and experiences, members of our specialty may develop better solutions to the many issues and challenges facing radiologic practice and science,” says James A. Brink, MD, FACR, chair of the ACR BOC. “Understanding and respecting the many features that make each person unique enables us to provide more effective and equitable care.”
Any business, including a medical practice, will face challenges in establishing and maintaining an organizational culture that reflects the communities it serves, says Deynes. But it’s important to remember not to go at it alone. Radiologists need to look across specialties to see what other doctors are doing, says Borondy Kitts. “If radiologists aren’t part of a multidisciplinary team, they aren’t going to perform as well,” says Borondy Kitts. “Having diversity across a team makes it possible to capitalize on different ways of thinking using different approaches for a common goal.”
When hiring a new staff member, there may be situations in which there are only one or two underrepresented minorities in a practice. If they join a hiring committee, these staff members should not become the “representatives for diversity,” caution researchers from University of California, Berkeley.10 Everyone on staff should be cognizant and accountable for considering issues related to equity, inclusion, and diversity when tasked with hiring.
The ACR’s Commission for Women and General Diversity has provided ways to promote inclusion and diversity within radiology practices. “Unique talents and diverse needs can be utilized to great advantage when it comes to working hours, working locations, fractional employment, specialty differentiation, and customer service,” says the commission’s Johnson B. Lightfoote, MD, FACR, medical director of radiology at Pomona Valley Hospital Medical Center in Calif. “Welcome, leverage, and creatively employ the diverse professional capacities of your team — and enjoy the resulting return to your bottom line.”
Chad Hudnall, ACR Press managing editor
- Ruth E, Bansal S. The 2016 ACR Commission on Human Resources Workforce Survey. J of Am Coll Radiol. 2016;13(10):1227–1232.
- Hansen M. Racial and ethnic health disparities: workforce diversity. NCSL; August 2014. http://www.ncsl.org/documents/health/workforcediversity814.pdf.
- National Academies of Sciences, Engineering, and Medicine. In the nation’s compelling interest: ensuring diversity in the health care workforce. Available at bit.ly/Ensure_Diversity. Feb. 5, 2004.
- Entelo Recruiting Trends Report reveals significant developments in recruitment marketing, diversity hiring and candidate engagement. HR.com, Aurora, Ontario. November 16, 2016. Available at bit.ly/Recruiting_Trends.
- Edwards M. What Diversity Can Do for You. ACR Bulletin. 2015 ;70(5). Available at bit.ly/Having_Diversity.
- Lightfoote JB, Fielding JR, Deville C, et al. Improving Diversity, Inclusion, and Representation in Radiology and Radiation Oncology Part 1: Why These Matter. J Am Coll Radiol. 2014 Jul;11(7):673–680.
- Figueroa O. The significance of recruiting underrepresented minorities in medicine: an examination of the need for effective approaches used in admissions by higher education institutions. Med Educ Online. 2014;19(10). Available at bit.ly/Minority_Medicine.
- Kaplan DA. Radiology Job Market Update: 2016. Diagnostic Imaging. Available at bit.ly/Rad_Demand.
- Goldberg C; SHRM Enterprise Solutions. Recruiting and retaining a more diverse workforce. Available at bit.ly/Recruit_Retain.
- Taing E. A toolkit for recruiting and hiring a more diverse workforce. University Health Services, University of California, Berkeley. April 2013.