As children, most of us encountered the phenomenon of unicorns, an elusive creature that blends the normal with the extraordinary. Unicorns have become a symbol adopted by royalty, religions and organizations to signify boldness, strength, pride, hope and healing. They may be mythical but, even in our modern age, unicorns of a sort may still be glimpsed. In interventional radiology, where there are high disparities of representation among women (8.2%) and underrepresented minorities (1.8%), there are some “unicorn” practices where representation far exceeds the norm. 2,3
Breaking gender barriers
Memorial Sloan Kettering Cancer Center (MSKCC), the world’s oldest and largest private cancer center and a leader in cancer treatment and research, is also spearheading female representation. With an IR department of 22 physician providers, five of whom are women (23%), MSKCC has a female workforce that surpasses the national average.
Anne M. Covey, MD, FSIR, an attending at MSKCC, joined in 2000 and was surprised to find that the IR department was already rich in talented female IR providers. “It was really remarkable,” she says. Upon her arrival, there were four members of the IR department, three of whom were women including the chair of the department. When asked about whether this played into her decision to join, she says, “In retrospect I’d like to say it was a conscious decision. It probably did play into my decision, but I don’t think I was aware of it. I liked and felt comfortable with the group.”
“It’s well accepted by the entire staff that the women in the group are equally in a position of power and hold the same respect that men do.”
— Anne M. Covey, MD, FSIR
Female-dominated and -led spaces are often subjected to stereotypes and assumptions, however. For example, when a woman exhibits a behavior that is explicitly dominant, it may negatively impact both her “likeability” and “hireability.”1 According to Dr. Covey, Karen T. Brown, MD, FSIR, former attending at MSKCC and current chief of IR at the University of Utah School of Medicine, paved the way for future colleagues by defeating such prejudices at this practice. “She shouldered a lot of the negative associations with a woman in power and it made it much easier for the rest of us,” says Dr. Covey.
According to Amy R. Deipolyi, MD, an IR at MSKCC, her female colleagues were “such amazing doctors that those prejudices were all defeated. They already broke the glass ceiling, so I didn’t have one to break.”
Transcending these attitudes has enabled MSKCC to embody a sense of inclusion. “It’s well accepted by the entire staff that the women in the group are equally in a position of power and hold the same respect that men do,” says Dr. Covey.
Unicorn practices are not magically perfect, though. Like many other disciplines, even the MSKCC team is challenged in integrating and supporting providers with young families. “I think we have a lot of work to do,” says Dr. Covey. “Isabel G. Newton, MD, PhD, recently gave a talk about the new generation and how they are changing the way we think about work and life. Those of my generation often live to work. Everything is focused on employment and how to make life fit into it. Dr. Newton talked about how we’ve begun to ask if work fits into our lives, not vice versa. This shift will be good for all of us and changing the way we work and live can make us a little bit healthier and more open to those who have particular needs in their life. I don’t think we’ve always been as open and accommodating as we should have and could have been.”
Reflecting the community
While MSKCC’s gender diversity might have been the domino effect of strong leadership, organizational transformation demands deliberate effort. This is well-demonstrated by Emory University’s IR department.
Led by Janice M. Newsome, MD, FSIR, associate professor of radiology and imaging and division director and chief of IR and image-guided medicine, Emory’s IR team has intentionally cultivated a diverse team of providers. In a team of 27, there are seven (26%) women and four (15%) Black IRs.
As Dr. Newsome points out, Atlanta is the cradle of the civil rights movement, with a large Black population—and it seems obvious to her that Emory’s IR team should reflect the community they serve. Dr. Newsome asserts that central to this strategy is, “making it easier for underrepresented groups to find you. You want them to know that there are opportunities for them here.”
Emory has one of the biggest academic practices in the United States—a powerful platform for these efforts to be scaled and noticed—and cultivating a culture of respect and inclusion has impacted the performance of the Emory IR team.
“We have a very adaptable practice. Everyone is part of the discussion and it’s the reason we are so innovative,” says Dr. Newsome. “In IR there’s a ‘we can fix it!’ mentality. We’re just doing the same thing in the social dimensions of our work.”
Expanding the vision for workforce diversity is an inherent part of Emory’s IR culture. When a nonbinary radiologist joined the team, Dr. Newsome says that the department reflected on how to be more inclusive: “Bathroom signage was changed, and the entire IR team talked about the contemporary usage of pronouns and held each other accountable to change the workplace culture. Everybody did it.”
In a health care system where we are often burdened by diminishing reimbursements and an increased demand of work hours, diversity, equity and inclusion work requires a concerted and strategic effort, as well as a dedicated community and support from leadership.
Dr. Newsome recalls wearing a lanyard celebrating pride month during a recent Zoom call and receiving a follow-up email from a medical student thanking her. While it was not worn deliberately for the call, this symbol of inclusion and support encouraged the student to consider Emory for residency.
Conclusion
Symbols can be important in reminding us of our highest calling and tempering inequity. As we envision an impactful and sustainable future for IR rooted in excellence in patient care and superior outcomes, we behold the “unicorns” of MSKCC and Emory University as examples of what is possible.
Through metamorphosing more practices into unicorns, IR can serve as an emblem not only for using its technological prowess in delivering improved patient outcomes but also through unparalleled diversity and inclusion in its workforce.
References
- Williams MJ, Tiedens LZ. The subtle suspension of backlash: A meta-analysis of penalties for women’s implicit and explicit dominance behavior. Psychol Bull. 2016;142(2), 165–197.
- Rosenkrantz AB, Englander MJ, Deipolyi AR, Findeiss L., Duszak Jr. R. Clinical practice patterns of interventional radiologists by gender. Am J Roentgenol. 2019;213: 867–874
- Higgins MCSS, Hwang W, Richard C, Chapman CH, Laport A, Both S, Thomas, Jr. CR, Deville C. Underrepresentation of women and minorities in the United States IR academic physician workforce. J Vasc Interv Radiol. 2016 Dec;27(12):1837–1844.e2.
