Thoracic oncologist on need for intentional inclusion practices to sustain diverse workforce
The U.S. has witnessed an uptick in the number of minority medical school matriculants in recent years, but actions to retain and grow a diverse medical workforce remains scarce.
“After 2020 and following the murder of George Floyd, there has been an even greater increase in diversity in the medical workforce overall. However, a key issue that remains is that we are preaching about diversity but not applying inclusion,” Narjust Florez, MD, associate director of the Cancer Equity Program and thoracic medical oncologist at Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute, and a Healio Women in Oncology Peer Perspective board member, told Healio.
“I was recruited into a residency program where no inclusion practices were in place, and at many other institutions, this has remained the same,” Florez said. “Individuals with diverse backgrounds are being recruited, but with the old white male practices still in place, it produces significant distress to the minority workforce. Diversity without inclusion equals trauma.”
Retention is key
Despite minority individuals being recruited across institutions, they are leaving because of the lack of inclusion practices, according to Florez.
“This is important to address because everybody deserves equal opportunity,” she said. “We improve cancer health disparities with a diverse workforce, and we advance science better when we have diversity of ideas.”
In a paper published in Journal of Clinical Oncology in 2022, Florez wrote about her experience as a female Latina starting out in medicine in the U.S. and how she suppressed her true self to fit in, which led to depression, “an overwhelming sense of not belonging,” and, ultimately, a prescription for antidepressants.
“For all minority medical students, residents, fellows and junior faculty, we belong in medicine even during those moments when our identity is tested,” Florez wrote in the paper. “Through my journey, I learned that we can and must challenge the status quo. I hope to inspire others to join me in this path of advocating for diversity, equity and inclusion because the time for change is now. I was finally free the moment I realized I could not be anyone else but myself, a proud Latina in medicine and oncology.”
Florez recommended the following actions to retain and grow a diverse oncology workforce:
- Listen and avoid tokenism.
- Understand the concept of intersectionality.
- Create a sense of community.
- Provide funding and support.
- Mentorship and sponsorship are key.
“Silence is a form of validation,” Florez said. “We need to make institutions accountable for tokenism and accountable for exclusionary practices. When we remain silent while our colleagues are being measured to a different standard, it feeds the inequalities. Purposely establishing inclusion practices keeps institutions accountable and, most importantly, provides role modeling and exampling for others to follow.”
‘Not alone’
Florez’s advice for underrepresented in medicine is to first and foremost “know that you belong and that you bring something to the table.”
“You are not alone in what you are feeling. That is the main issue that I had as an underrepresented minority in medicine. I thought it was just me,” she said. “Also know that speaking up about inequalities and speaking out about discrimination does not mean that you are complaining. Often because we are underrepresented minorities, our trainers may feel that they are doing us a favor — when, in fact, we are the bilingual resident who can communicate with a Spanish-speaking patient who is so grateful for us. So, we are here to improve care for all patients.”
Florez recalled a recent encounter with a patient who is from Egypt.
“We had more things in common than we didn’t. During a recent visit, I had decent news for her but not that great of news, and we were actually laughing together because of a cultural understanding that we had,” she said. “We discussed instances of our regular life and observations during our family interactions. My patient told me she had never had a doctor who she could connect with on that level. We also talked about the food she can eat while on cancer treatment and she had never had a doctor who knew the types of food she eats. It is that cultural concordance or cultural humility that is so important for patient care.”
Another piece of advice Florez offered is to “know that your ideas are valid, your research matters and your research makes a difference.
“I had another paper published in Journal of Clinical Oncology about 5 years ago on evaluating unconscious bias with speaker introductions at conferences that is still being talked about today,” she said. “The article has been reproduced in many other specialties and it started a movement. It has been used to create guidelines for many societies, including the Society of Medical Oncology, and Australia created guidelines for speakers so that speakers could have guidance to know how to introduce women speakers equally.
We are planning to eventually follow-up to see if there have been improvements.”
Offering a final piece of advice for the medical community, Florez added that “creating a sense of community for minority medical trainees is invaluable, and providing mentorship and sponsorship are significant in helping to retain our next generation of highly skilled individuals in the field of medicine.”
References:
- Duma N. J Clin Oncol. 2022;doi:10.1200/JCO.21.02601.
- Duma N, et al. J Clin Oncol. 2019;doi:10.1200/JCO.19.01608.
For more information:
Narjust Florez, MD, can be reached at narjust_florez@dfci.harvard.edu.
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