In the workplace of the future, according to some experts, how you think will be more important to an organization’s success than what you think (“Why ‘thought diversity’ is the future of the workplace.” businessinsider.com). For example, diversity of thought will be key—fostering innovative problem solving and avoiding “groupthink” (in which a group of people strive for conformity to a degree that results in dysfunctional decision-making). It shouldn’t be surprising that thought diversity hinges on having a diverse population—a concept that should certainly be embraced within our specialty. After all, how can we claim to be the most innovative specialty in medicine today without embracing the most fundamental rule of innovation?
Why now?
Diversity itself incorporates a wide range of categories: gender, race, socioeconomic status and many other characteristics. However, some of those categories, such as women and minorities, are distinctly underrepresented in IR. While interventional radiology has the largest number of fellowships in radiology, our specialty represents the least amount of gender or ethnic diversity when compared to gender and ethnic percentages of AAMC-certified medical schools, all ACGME-certified residencies and ACGME-certified medical fellowships, and ACGME-certified radiology fellowships.
These numbers are disappointing. In several ways, IR is not benefiting from the contributions of a significant population. Practices fail to reap the benefits of a diverse workforce, while patients may not have the option to see an IR physician with whom they may feel more comfortable because of their gender or race. Medical students are denied role models and mentors.
Studies show gender diversity’s value
In examining gender diversity, our business colleagues demonstrate that more women in IR will likely be good for the field. A 2007 Catalyst report shows that Fortune 500 companies with at least three female directors on the board outperform companies with the lowest representation of women. Financial outcome measures were significantly greater in companies with demonstrated gender diversity at the board level.
This trend held true across most industries, including health care. It follows that more women in IR will likely be good for the field. McKinsey found that companies with gender-diverse leadership demonstrate higher profits and greater return on equity. Although no direct causation was proven with these findings, they suggest that companies that invite more women to serve on their boards are also investing in improved company performance. At the medical practice and national societal levels, women in leadership roles will bring their unique perspective and style to effect positive change.
Researchers in Spain at the University of Castilla-La Mancha showed that gender-diverse teams at R&D technology companies were significantly more likely to develop radical innovations. They hypothesized that radical innovation requires, among other things, a high level of communication, coordination and mutual support among team members. This was enhanced through gender diversity. Other research has shown that including women on a team improves the soft management skills and decision-making processes that leads to increased creativity and innovation. Creativity and innovation are hallmarks of interventional radiology. Would increasing our gender diversity lead to even more radical innovations in IR?
Patients value diversity
Patients also will benefit from more ethnic and gender diversity in IR. Recent studies have shown convincing evidence of the need for ethnic diversity within health care professionals to deliver high-value medical education, advancements in research and health care access to under-represented minorities (URMs)1. For example, physicians from URMs are more likely to work in URM communities. Further, URM patients perceive higher contentment with medical care received when the care is provided by URM physicians.
Studies have also shown that women prefer female physicians for conditions that are perceived to be more intimate in nature. There are many interventions available for women’s health, including uterine artery embolization, ovarian vein embolization and varicose vein treatment. This could be an innovative marketing strategy for IR practices.
Health care tackles diversity
Gender and ethnic diversity is considered to be a key for long-term success in any organization or industry, making it an imperative in business and medicine today. In 1986, Congress established the Council on Graduate Medical Education (COGME) to assess physician workforce trends and training issues. In 1993 and again in 2005, the COGME reported on the advancement of goals to increase URMs in the medical profession. The reports emphasized that “increasing the number of URM physicians is an important step for improving health care for minorities and underserved populations” and that “more research is needed to evaluate obstacles or motivations for minority entry into primary care or specialty residency programs.”
As a specialty, radiology has begun this process. In 2014, Chapman et al published a seminal article titled, “Current status of diversity by race, Hispanic ethnicity, and sex” in Radiology. Using data available from the American Medical Association, this article demonstrated a statistically significant difference between the percentage of women and under-represented minorities in the U.S. census population and all levels of training in radiology.
Our diagnostic radiology colleagues have already begun addressing diversity issues within radiology. In 2014, Lightfoote et al published a two-part article, “Improving diversity, inclusion, and representation in radiology and radiation oncology …,” which examined ways to improve diversity and inclusion within radiology, on behalf of the American College of Radiology.
Other medical subspecialties are taking steps to increase the number of women in their ranks. Orthopedic surgery, neurosurgery and vascular surgery have published their goals for recruiting more URMs and women. Today, medical school populations are 50 percent female. To attract the best candidates to their specialties, academic institutions realize that they have to attract more women. Orthopedic surgery has developed a robust pipeline—a medical school summer training program geared to increase the number of competitive URM applicants, which has subsequently led to an increase in URMs entering the specialty. Vascular surgery has been successful; the percentage of women entering integrated vascular surgery residencies is almost double the percentage of women in vascular surgery fellowships. The IR Residency coming online represents an opportunity for us as well.
Diversity in IR
A 2012 article in the Journal of Business Ethics emphasized that achieving sustainable diversity will only be possible when the workplace is inclusive, which leads to worker engagement, decreased turnover, improved recruitment and better decision-making. Doing more in interventional radiology to support underrepresented groups would markedly increase the innovation in thought at every level in the IR suite.
To effect this change, we must begin by understanding the arc of behavior that includes conscious bias, unconscious bias, microaggression and civility. We have many examples of conscious bias. It can be seen everywhere from the workplace to
national conference settings.
At the same time, each one of us is subject to our unconscious bias— attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner, affecting our interactions with those around us. How many times, when working with a member of our own IR team, have we built the entire story of their lives in our heads, without getting to know them first? Whether we admit it or not, the stories in our head, the preconceived notions, can negatively impact how we function in that team setting. As the team leader, the IR physician must be in touch with his or her own biases.
Most people believe they do not hold any biases. Research indicates that is simply not true. From the Kirwan Institute for the Study of Race and Ethnicity booklet on Unconscious Bias titled “State of the science: Implicit bias review 2014,” there are a few research-proven truths. These include:
- Implicit biases are pervasive and robust.
- Everyone possesses them, even people with avowed commitments to impartiality.
- Implicit biases have real-world effects on behavior.
- Implicit biases are malleable; therefore they can be gradually unlearned.
Key steps to overcoming our biases include understanding what bias is, identifying and addressing them, asking deep, uncomfortable questions and finally being patient with ourselves. Biases cannot be corrected overnight.
We most often express unconscious bias through “microaggression,” the ”everyday verbal, nonverbal and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory or negative messages to target persons based solely upon their marginalized group membership.”
Research has shown that mindfulness and compassion exercises increase our empathy and our sense of wellbeing. Just as with unconscious bias, we cannot address our own microaggressive behavior without understanding that it exists and then exploring solutions with an open mind.
Next steps
We can all take steps to help create a respectful, inclusive work environment. First, it is important to acknowledge personal biases. For example, we often judge which medical students and residents seem interested in IR and we tend to focus our attentions on these individuals. It is easy to assume that a woman or a student of color on the rotation is just taking a look and is not seriously considering a career in IR. After all, there are such a small number of women and minorities in IR, odds are that we would be correct. It is possible that this becomes a self-fulfilling prophecy.
Second, including more female and minority speakers and presenters at national and regional meetings will give those speaking an opportunity that can lead to other opportunities, while members of the audience will see the women or minority speakers as productive members of the specialty. This inclusion and exposure may lead some to accept women and minorities as colleagues. For others, it will create role models and a feeling of inclusion. We encourage meeting organizers to evaluate their speaker rosters and consider how to include more women and minorities.
The small number of women and minorities in IR is a problem that SIR wishes to address. Beyond decisions made at a committee level, it is incumbent on the members to also recognize and act on the imperative to increase women and minority representation in our field—not just for the benefit of the affected individuals but to ensure a successful future for interventional radiology.
References
- 1. AAMC. “2014 Physician Specialty Data Book,” November 2014.
- 2. Catalyst. “The bottom line: Corporate performance and women’s representation on boards,” Oct. 15, 2007.
- 3. Diaz-Garcia C, Gonzalez-Moreno F. “Gender diversity within R&D teams: Its impact on radicalness of innovation.” Innovation: Management, Policy & Practice 2013; 15(2) 149.
- 4. McKinsey & Company. “Lessons from the leading edge of gender diversity,” April 2013.
- 5. Turner C. “Why you need to retain women: The business case for gender diversity,” J. Business Ethics; March 2012.
Notes
1. According to the U.S. Department of Health and Human Services, URMs are defined as “racial and ethnic populations who are underrepresented in a designated health profession discipline relative to the percentage of that racial or ethnic group in the total population.”
Note: The authors thank Derek L. West, MD, for his assistance with this article.
