Improving workforce equity, addressing racism will require ‘transparency across the board’
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True progress in achieving a diverse and equitable rheumatology workforce will require honest conversations regarding the impacts of racism and bias, according to a presenter at the 2023 AWIR annual conference.
“Equity is what I am going to focus on in this talk,” Anisha Dua, MD, MPH, of Northwestern University Medical Center, told attendees in the meeting’s keynote address. “And that is giving everybody what they really need to access this ‘game.’”
Currently, the workforce in medicine as a whole — and in rheumatology specifically — are not representative of the overall population. For example, Black individuals make up 12% of the U.S. population, but only 5% of physicians. Hispanic people, meanwhile, account for 18% of the U.S. population, but only 6% of physicians, while Indigenous people represent 1.3% of the population but only 0.3% of physicians, according to Dua. In addition, just 37% of physicians in the country are women. However, the figure for residents and fellows is more encouraging — 47% are women.
“There are more women entering the workforce and becoming physicians, and that is true of white and Black physicians,” Dua said. “So, we do see more women entering the workforce.”
However, the problem regarding gender equity is that many new female physicians are entering specialties that tend to pay less on average, she added. In surgical specialties and subspecialties that enjoy higher compensation levels, representation is much more lopsided.
“A 2021 report from the Rand Corporation found that female physicians earn $2 million less over the course of their career,” Dua said. “The largest gaps are in male-dominated specialties.”
In rheumatology, data suggest that male physicians earn an average of 16% more than female physicians, she said.
Altering the paradigm to make medicine in general and rheumatology specifically more diverse and equitable will require immense work and effort, but there are a few places to start, according to Dua.
First among those suggestions is to redefine metrics and allow for more women to achieve regular promotions and positions of leadership.
“We need to increase access to prestigious, compensated and visible roles for women and underrepresented minorities,” Dua said. “Some folks are being asked to be on diversity councils or women’s councils, and some of these roles are compensated, but many of them are not.”
The next step for improving equity is transparency.
“There needs to be transparency across the board — through promotion criteria, payment structures and application reviews,” Dua said. “Selection committees really need to define what is outstanding performance, and then use that definition to clarify merit.”
Using a transparent and standardized merit system would not only benefit those hoping to advance in their career, but also help improve the health care system as a whole, Dua argued.
Conscientious recruiting efforts are also imperative.
“Selection committees and admission leaders need to actively recruit diverse applicants from every prior stage of training,” Dua said. “Create recruitment pathways — this has been shown to work.”
Finally, Dua recommended interventions that begin capturing potential physicians even before they graduate high school.
“When you can see your path to becoming a physician, that will just make it much more likely that it can happen,” she said. “These types of programs need to be expanded, supported and replicated. Initiatives like this should be considered an essential community service for medical schools and for teaching hospitals.”
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Dua A. Equity and diversity in the rheumatology workforce and pipeline. Presented at: Association of Women in Rheumatology annual conference; Aug. 10-13, 2023; Orlando, Florida (hybrid meeting).
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