By Amy Lillard

Past transgressions in the industry have been confessed, but there’s still much work to be done to represent minority communities in medical imaging. Could the answer lie in an Indianapolis magnet school?

Our country has been known to pride itself on our diverse makeup, our meeting place for a heady mix of cultures, ethnicities, and backgrounds. But when it comes to reflecting that diversity in industries like health care, we often fall short.

Should an imaging center reflect its community in order to provide excellent care? For a growing majority in and outside the field, the overwhelming answer is yes. But as diversity-in-medicine studies have consistently shown, women and ethnic and racial minorities remain underrepresented in the imaging and medical arena. And the disparity is growing larger.

A Dearth of Diversity

Radiology is somewhat unique in its barriers as a medical specialty requiring additional study and year of internship. According to figures from Meharry Medical College, Nashville, Tenn, 167 programs in diagnostic radiology nationwide offer 928 postgraduate year-two (PGY2) positions annually. Compare this to the total residency programs in medicine, where 3,475 programs exist offering more than 22,000 positions. Radiology, therefore, represents only 4% of the field, with restricted training opportunities and spots available.

Racial and ethnic minorities make up 25% of the United States population, but only 12% of students graduating from medical schools in the country. These students overwhelmingly choose primary care specialties and private practice for their work. From a small group of minority students, a microscopic opportunity for the specialty of radiology exists.

Research and data show that these statistics in our specialty and in general health care are not simply descriptions of a puzzling situation. Rather, they point to the lingering effects of a troubling history of disparity within the health care industry. Within the major organized community of the medical field, for example, lies a history of ingrained racism that has only recently been acknowledged. The American Medical Association, which required potential members of the national society to first be members of local and state societies, overlooked or implicitly accepted standards in certain states that prohibited entry to African-American and other minority physicians.

The American College of Radiology, charged with guiding the field to the future, seems a natural place to centralize efforts to boost diversity. But some leaders in the field believe they are not doing enough.

“The efforts by the ACR are far too remote and myopic,” said Anthony C. Disher, MD, chair of the radiology department at Meharry. “They need to be more aggressive. What the ACR should be doing is tapping into science programs in high schools, creating imaging center and school partnerships, and hosting more outreach programs. It’s essential that young people from all communities can see what we do and feel encouraged to be part of the field.”

Benefits of Diverse Health Centers

Studies show that for all racial and ethnic groups, patients are more likely to choose a physician of their own racial and ethnic background when presented the option. Patients are more likely to see their physician for longer office visits, to rate their care as excellent, and to declare themselves as satisfied, when they see physicians in their same racial, ethnic, or gender group. Increasingly, the industry recognizes that diversity helps health care by bringing patients closer and creating stronger bonds. That elusive yet necessary patient-physician relationship is more often possible when physicians come from the same place of understanding as the patients.

“Within imaging centers, it’s critical to have radiologists and staff who are from the community to help with communication and education,” said Elena Rios, MD, MSPH, president and CEO of the National Hispanic Medical Association. “It truly helps in all health care, enabling patients to feel more comfortable, open up more, and have the important discussions necessary for health. By having physicians and staff from the same backgrounds as people in the community, it breaks down barriers, creates understanding, and enables that critical respect and trust.”

Another reason diversity is important to radiology and general medicine is the effect on ideas and advances. Advances in medicine come from original perspectives and unique ideas. A workforce of people from the same ethnic, racial, and socioeconomic backgrounds may miss out on new thoughts and improvements evident to those with different experiences.

“Managing diversity is a challenge by definition, but it’s absolutely necessary,” said Richard Helsper, vice president of operations at Clarian Health Partners in Indianapolis. His organization keeps close tabs on workforce representation of the community, through concentrated HR efforts and a formal diversity officer. “Diversity is complex, and that very richness provides avenues for new thoughts, innovations, and solutions to long-standing problems. A diversity of ideas, backgrounds, and experiences results in the richest outcomes and solutions for everyone. Otherwise, commonality may result in a condition called group-think in which people all think alike and may share a common blind spot.”

Efforts and Initiatives

“Radiology, of course, wants to be open to women and men of all races, ethnicities, and religions,” said Shawn Farley, public relations manager at the American College of Radiology, Reston, Va. “The ACR has worked to increase the number of total radiology residency slots by 300, in an effort to not only alleviate the shortage of radiologists, but to gain more minority and female applicants to the process.”

According to Farley, additional efforts by the ACR include resident functions at major radiological meetings such as the Radiological Society of North America, where organizers ensure that a number of the physicians attending are female and/or minority. The ACR continues to provide socioeconomic research regarding the radiology workplace. Finally, via the ACR Foundation, the college is considering funding for an initiative to “ensure the future workforce of the profession and attract the best and brightest in the field to radiology.” This initiative would include outreach to medical students, residents, and promising high school and college students, including minority and underserved populations, to promote radiology as a profession.

Looking broader, the AMA made news July 10 when the organization formally apologized “for its past history of racial inequality toward African-American physicians.”

“The apology was necessary to heal,” said Disher. “We can see this as the leadership at AMA coming to terms with this issue and history, instead of sweeping it under the rug. This is something the medical community can use to build from.”

Indeed, the AMA has funded $10,000 scholarships for minority students and visited schools, from elementary to undergraduate institutions, to generate interest in medical careers.

“The AMA is committed to improving its relationship with minority physicians and to increasing the ranks of minority physicians so that the workforce accurately represents the diversity of America’s patients,” said Immediate-Past President Ronald M. Davis, MD.

For many, this is indeed a crucial step forward in rectifying the past but also ensuring a more diverse future.

The National Hispanic Medical Association has also sought to bolster the ranks of minority students in health professions through programs like Health Careers Opportunity Program.

Medical schools are actively recruiting minority candidates starting in primary schools.

“Unless we focus on the pipeline, we won’t have a diverse physician base,” said Laura Castillo-Page, PhD, director of research in diversity policy programs at the Association of American Medical Colleges (AAMC). “Students of all backgrounds must be interested in medicine, get admitted, be successful, and graduate in order to have diversity in the physician workforce.”

Doctors in Indianapolis mentor minority high school students to generate interest in health care careers.

The AAMC conducts extensive research on diversity in the medical workforce and student pool. A new report, “Diversity in Medical Education: Facts and Figures 2008,” will be released later this year with updated figures that reflect increasing numbers of women applicants and medical students, but relatively stagnant numbers of racial and ethnic minority students. To increase this pipeline, the AAMC has also created a Web initiative, AspiringDocs.org, which provides information on medical school application procedures and more.

“This campaign is about getting this information to anyone interested, and offering images of young diverse physicians who have been successful,” said Castillo-Page. “We conducted focus group sessions to develop the images for this campaign, and respondents said they needed to see people who look like them, to feel like this profession is open to everyone. We’ve taken that to heart.”

Historically, black medical schools have long been the only tangible evidence of diversifying the field, and continue to feed the industry with young doctors.

“There are definitely benefits to attending a historically African-American medical school,” said Disher, who attended Drew Medical College in Los Angeles, and now works at Meharry. “The curriculum stresses cultural competence, diversity, and attention to health care disparities in our communities, essential to the overall health of the industry.”

Many successful efforts at increasing diversity have come from the institutional or local levels, and focus on radiological and medical staff positions. While an administrator at Duke University School of Medicine, Durham, NC, Helsper spearheaded a partnership with an existing University of North Carolina, Chapel Hill, training program along with two other hospitals. The partnership aimed to fund an expansion of their training program with the intent to recruit students from three surrounding counties. Students from all backgrounds were able to pursue study part-time and find careers they may not have been aware of in radiology. People learned, worked, and lived in the same area, resulting in a truly local and loyal workforce.

Helsper is also a strong advocate of working within local schools. While at Clarian, he has led a partnership with an Indianapolis magnet school with a focus on health sciences. This student population has a strong minority student representation. Clarian also reaches out to a multitude of other schools and venues to bring students to their facilities for the opportunity to explore careers. Directors also go to a variety of places to speak about their fields.

“When students are exposed to new things, careers they didn’t know existed and that are deeply interesting, they get excited,” said Helsper. “When they learn that they have pathways to these professions, through grants, programs, and incentives, it opens up a whole new world. Programs like these give people exposure and help address disparities. It provides access and enables them to achieve new goals they were unaware even existed.”

The Future

Within this wide range of efforts to increase diversity in the radiology and medical realm have been small successes and bigger jumps forward.

“Diversity is managing differences, not going out and hiring five people to meet a quota,” said Helsper. “It means bringing people on board, into the organization, and embracing these differences. When an organization approaches diversity positively, by a person’s presence, the organization can be substantively influenced and changed in a positive manner.”

There is much to be done, but just as many examples and case studies to draw from. With awareness of what is at stake, and understanding of how far we have to go, we can make great strides toward improving patient care through focusing on diversity.

Amy Lillard is a contributing writer for Axis Imaging News. For more information, contact .