Diversity strategies in cardiology are not working, study finds

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Pamela Douglas

Different strategies are needed to address the continuing lack of diversity in the US cardiology workforce, say the authors of a cross-sectional study which found that numbers of underrepresented minority (URM) individuals and women remain proportionately lower, and that progress is slow.

Writing in JAMA Cardiology, Laxmi S Mehta (Ohio State University, Columbus, USA) et al say: “Despite extensive efforts to increase URM representation, the slow rate of change suggests tactics beyond the current methods are needed.”

They point out that “despite a robust pipeline” of female medical students and internal medicine resident physicians, women remain underrepresented in adult cardiology. The same is true of paediatric cardiology, although numbers here are increasing. And, they add: “Members of several racial/ethnic minority groups remain underrepresented in adult and paediatric cardiology, and the percentages of trainees and medical students from these groups were also low.”

Researchers stratified medical students, resident physicians, fellows, and cardiologists by sex and race/ethnicity using data from the Association of American Medical Colleges, the American Medical Association, and the American Board of Internal Medicine. They also assessed proportional changes in adult and paediatric cardiology between 2006 and 2016. The data analysis was conducted from August 2018 to January 2019. The main outcomes and measures of the study were the percentage of cardiologists and trainees by sex and race/ethnicity in 2016, as well as changes in proportions between 2006 and 2016. Members of underrepresented minorities (URMs) were defined as individuals who self-reported being black or African American; Hispanic, Latino, or of Spanish origin; American Indian or Alaska Native; or Native Hawaiian or Pacific Islander, either alone or in combination with any other race.

Mehta and colleagues found that, despite a high percentage of female internal medicine resident physicians (42.6%, 10,765 of 25,252), only 21.5% were represented in adult general cardiology fellowships (584 of 2,720). In subspecialties, women make up 13.7% of electrophysiology fellowships (24 of 175) and 9.8% of interventional cardiology fellowships (30 of 305).

From 2006–2016, the proportion of female adult cardiologists increased slightly (from 8.9% to 12.6%, slope, 0.36, p<0.001), but it remained low overall. The percentage of female physicians in paediatric residency positions was disproportionately higher (72.9%, 6,439 of 8,832), with a trend towards an increase in female paediatric cardiology fellows (from 40.4% to 50.5%, slope 1.25, p<0.001). This resulted in an increase in the percentage of female paediatric cardiologists (from 27.1% to 34.0%, slope 0.64, p<0.001).

The percentages of members of underrepresented minority groups were low in both adult and paediatric cardiology fellowships and only increased slightly over the study period (from 11.1% to 12.4%, slope 0.15, p=0.01 in adult cardiology; and from 7.7% to 9.9%, slope 0.29, p=0.009 in paediatric cardiology). And, less than 8% of practising adult and paediatric cardiologists are from underrepresented minority groups.

Asian individuals make up 5.2% of the general population in the USA and 22.1% of US medical school graduates (4,202 of 18,999), 38.1% of internal medicine resident physicians (9,618 of 25,252), 40.4% of adult cardiology fellows (1,098 of 2,720), 19.9% of adult cardiologists (5,973 of 30,016), 22.6% of paediatric resident physicians (1,998 of 8,832), 28% of paediatric cardiology fellows (122 of 436), and 20.1% of paediatric cardiologists (574 of 2,860), and are therefore not considered underrepresented. However, the authors stress that “further differentiating Asian groups into regions (for example, East, South, and Southeast Asian) may be more representative and shed light on gaps within these communities”. And, they add: “Despite Asian individuals constituting a non-underrepresented minority group, they remain a minority in leadership within medicine.”

Mehta et al write that efforts to redress the balance should be targeted at individual groups within the collective URM category. Among the strategies they suggest are a holistic review of medical school applicants, and programmes aimed at children during early education, which they say are “are crucial to establish a deep pipeline of future medical students and cardiologists”.

They conclude: “Currently, the American College of Cardiology’s [ACC] TaskForce on Diversity and Inclusion has a multipronged approach that includes efforts to engage and leverage diverse talent via strategies affecting the deep pipeline, recruitment, retention, and leadership, to help create a culture of inclusion within the field of cardiology. Efforts to improve the culture, increase mentorship, and promote work-life balance may help attract a more diverse group of individuals to pursue training in cardiology. Further research is needed regarding potential solutions that may be effective in reducing barriers to diversity and improving the climate for diversity in the cardiology workforce.”

Pamela Douglas, senior author of the study and chair of the ACC Taskforce, told Cardiac Rhythm News: “The study provides critical information regarding the current and past demographic profile of the cardiology profession. It includes not only adult cardiologists, but also data on trainees and academics in both paediatric and adult cardiology. Further, the time trend and fellowship demographics data allow us to create a clear picture of the future and provide benchmarks for measuring the success of current diversity inclusion efforts.”


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