Trainee and workforce diversity in hematology and oncology: Ten years later what has changed?

Abstract

11000 Background: The diversification of the healthcare workforce has been identified as a strategy to address health disparities and increase patient-physician trust. A prior review of diversity among oncology fellows up to 2010, showed an increase in female representation over 17 years, but no change in underrepresented minorities (URM). We aim to assess the changes in hematology and oncology (HO) fellowship diversity over the last decade and how this compares to our workforce. Methods: Publicly available registries were used to assess differences among female and URM HO fellows, HO fellowship applicants, internal medicine (IM) academic faculty, IM residents, medical school graduates (MSG), and the US population in 2019. These were compared to the 2016 HO practicing physicians. Changes in URM and female HO fellow representation from 2009 to 2019 were assessed. Data was analyzed using binomial tests and simple linear regression models. Results: Female representation among HO fellows (43.8%) was increased when compared with HO practicing physicians (+11.8%, p < 0.0001) and IM faculty (+3.2%, p = 0.0079); no difference from IM residents or HO applicants. Female HO fellows were underrepresented when compared with MSG (-4.0%, p = 0.0014) and US population (P < 0.0001). Hispanic HO fellows (6.1%) had increased representation when compared to IM faculty (+2.7%, p < 0.0001), but were underrepresented when compared to IM residents (-2.2%, p = 0.0012) and US population (p < 0.0001). The proportion of Hispanic HO fellows was no different when compared to HO practicing physicians, HO applicants, and MSG. African American (AA) fellows (3.8%) were underrepresented when compared to IM residents (-2.0%, p = 0.0005), HO applicants (-1.7%, p = 0.0465), MSG (-2.4%, p = 0.0001), and US population (p < 0.0001). AA fellows were increased when compared to HO practicing physicians (+1.5%, p = 0.0002), but no different than IM faculty. Asian HO fellows were increased when compared to IM residents, MSG, and US population. Over the last 10 years there has been no significant change in the proportion of AA or female HO fellow representation, with a decreasing trend in Hispanics (-0.14% per year, p = 0.04).Conclusions: The current state of diversity in HO workforce still requires attention. Despite ongoing efforts, females, AA, and Hispanics continue to be underrepresented. The decreasing trend in Hispanic representation and clear differences in diversity between HO fellowships and IM residencies calls for action among fellowship programs and national societies to increase URM engagement and recruitment.