Why should organizations request that retina specialists provide demographic data?
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Information needed to provide equitable health care
Disparities in eye care have been documented to exist in nearly all subspecialties of ophthalmology.
Racial and ethnic minoritized populations have a higher prevalence of vision-threatening diabetic retinopathy and diabetic macular edema but are less likely to undergo screening dilated fundus examinations than white patients and are underrepresented in clinical trials related to diabetic retinopathy and macular edema. Improving diversity in our workforce is a crucial step in combating these pervasive disparities.
Although groups from underrepresented in medicine backgrounds — Black, Hispanic, American Indian, Alaskan Native, Native Hawaiian and Pacific Islander — account for more than 30% of the U.S. population, they account for only 6% of practicing ophthalmologists in the United States. Studies have shown that physician-patient concordance in gender, race/ethnicity and language/culture is correlated with increased patient satisfaction and adherence. Nonwhite physicians are more likely to care for minority, medically indigent and sicker patients. Gender and racial/ethnic disparities are also pervasive in our workforce, with poor representation of women and ophthalmologists from underrepresented in medicine backgrounds in leadership roles and at the podium of national meetings.
Monitoring the diversity of medical students, residents, fellows, practicing ophthalmologists and leadership is crucial to ensure the diversity in our field is reflective of the diversity in the U.S. population. For the first time, the San Francisco Match released gender and race/ethnicity data on fellowship applicants in 2021. Overall, of those who matched into an ophthalmology fellowship, 2% were Black, 7% Hispanic, 3% mixed race and 7% declined to state their race. In order to improve diversity within retina, pipeline mentorship programs for residents have been established by the American Society of Retina Specialists and the Vit-Buckle Society. Monitoring the success of these programs and the diversification of our field with objective data is necessary to highlight progress as well as areas for improvement. Thus, ophthalmology organizations should allow for optional reporting of race/ethnicity, just as information on gender is collected. This information is critical to ensure that we are moving forward in our goal to provide equitable health care for all.
- References:
- Berkowitz ST, et al. JAMA Ophthalmol. 2021;doi:10.1001/jamaophthalmol.2021.0857.
- Bowe T, et al. Ophthalmol Retina. 2022;doi:10.1016/j.oret.2022.01.018.
- Coney JM, et al. J Natl Med Assoc. 2022;doi:10.1016/j.jnma.2021.12.011.
- Marrast LM, et al. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2013.12756.
- Xierali IM, et al. JAMA Ophthalmol. 2016;doi:10.1001/jamaophthalmol.2016.2257.
Fasika A. Woreta, MD, MPH, is an associate professor of ophthalmology and director of the eye trauma center at Johns Hopkins University School of Medicine.
Data could help increase diversity in workforce
Disclosure of race/ethnicity should be optional, not a requirement.
Disclosing demographic data on job applications, if used correctly, could be used as an opportunity to increase diversity in the workforce. And this is important because our understanding of the impact of discrimination based on race/ethnicity is becoming better understood, not only with regard to how it affects occupational mobility or immobility for minority health care providers, but also in terms of how it affects health outcomes and disparities among our patients. In a 2002 report from the Institute of Medicine, researchers directly acknowledge the existence of racial bias among health care providers and highlight its contribution to health care disparities at length. This is a pivotal report in that it outlined the direct role that physicians play in perpetuating health care disparities — that while the majority of physicians are not explicitly racist or prejudiced, they assume implicit biases that account for many of the gaps we see in health care access and outcomes today.
Over the years, many health care organizations, including the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges, have publicly announced efforts to mitigate sources of racial disparities. However, little has been done to actually close these gaps. Disclosing demographic data on job applications, if used correctly, could be used as part of the solution. While classically these disclosures might have been used to limit occupational mobility, and still could and possibly do, they may also serve as a way to actively seek out minority applicants to better address disparities and improve patient outcomes and experiences.
Further, having this information as an option rather than a requirement could be used to vet or hold accountable organizations that may otherwise claim a commitment to increasing workforce diversity but have fallen short in their efforts. In the past, I was worried about this type of disclosure for fear of discrimination, but now further in my career, I would rather “weed out” organizations that do not prioritize and address race/ethnicity as an institutional goal. I would not want to work in an environment of discrimination or lack of thoughtfulness around these issues.
Institutional racism, whereby there is differential access to academic/occupational opportunities by function of race, still exists. Disclosing demographic data on job applications, as an optional criterion, carries the opportunity to increase diversity in the workforce, thereby improving patient care. Further, remaining optional but not a requirement may act as a source of information about the organization itself for the applicants seeking employment. Organizations that do ask this information may be seen as having more commitment to diversity and inclusion efforts, while those that omit this may not.
- References:
- Nelson A. J Natl Med Assoc. 2002;94(8):666-668.
- Sabin J, et al. J Health Care Poor Underserved. 2009;doi:10.1353/hpu.0.0185.
- Sabin JA, et al. PLoS One. 2012;doi:10.1371/journal.pone.0048448.
- Teachman BA, et al. Int J Obes Relat Metab Disord. 2001;doi:10.1038/sj.ijo.0801745.
Nathan L. Scott, MD, is a fellow in the department of ophthalmology at Bascom Eye Institute at the University of Miami Miller School of Medicine.
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