Shortage of Black Oncologists Is "Critical"

Roxanne Nelson, RN, BSN

September 25, 2015

Black medical school graduates are not choosing oncology as a career path, and this trend is unlikely to shift anytime soon, according to a report published online September 21 in the Journal of Clinical Oncology.

The Association of American Medical Colleges placed the rate of oncologists who were black in 2013 at only 2.3%, write lead author Lauren M. Hamel, PhD, from Wayne State University-Karmanos Cancer Institute in Detroit, and colleagues.

In addition, 2013 data released by the American Society of Clinical Oncology (ASCO) indicate that only 4.0% of hematology/oncology fellows in the country are black, and that this serious under-representation in medical oncology is likely to continue.

In contrast, the percentage of black resident physicians in other specialties, such as surgery, has increased. Since 1986, there has been a decrease in the proportion of black medical oncology fellows, and the rate is now 3.1%, compared with 5.6% for internal medicine residents.

This disparity might be related to economics, said Otis Brawley, MD, chief medical and scientific officer and executive vice president of the American Cancer Society.

"This is a major issue for some minorities who go into medicine," he explained. "Because of socioeconomic disparities, they end up with a great deal of debt. So while oncology pays well, they may seek out specialties where they can make money more quickly to pay down their debt."

One study has shown that given the racial and ethnic inequalities in access to financial resources, increases in the student debt burden might not be assumed equally (PLoS One. 2013;8:e74693). In a sample of 2355 medical students in 2010/11, 77.3% of black students anticipated that they would owe more than $150,000 when they completed their medical education, which is a higher perentage than any other group.

In general, the supply of oncologists is not keeping pace with demand. According to a report issued last year by ASCO, the number of new cancer cases in the United States is projected to increase 42% by 2025. During the same period, the number of oncologists will increase by only 28%, which will lead to a projected shortage of 1487 oncologists.

Overall, the percentage of black medical school graduates did not increase substantially from 1980 to 2011. During that period, the proportion of white medical school graduates declined from 84.6% to 62.1%, while the proportion of graduates of all racial minorities increased.

But the increase in black graduates was much smaller than the increases in other minorities.

Table. Increase in Medical School Graduates from 1980 to 2011

Medical School Graduates 1980, % 2011, %
Black 5.1 6.5
Asian 2.7 21.7
Hispanic/Latino 3.1 7.1

 

Getting an Early Start

"To get more black students into medical school, we have to catch them early — in second and third grade. The fall off begins in grade school," Dr. Brawley told Medscape Medical News.

Nationwide, the rate of high-school graduation in 2011/12 was 69% for black students, 73% for Hispanic students, and 86% for white students, although these numbers vary by state. In Georgia, for example, where Dr. Brawley resides, the rate of high-school graduation is only 59% for black students but 67% for students overall.

For students who go on to college, there are a number of reasons they might not pursue a career in medicine, Dr. Brawley explained. "If you've had a poor education that was weak in the sciences and math, you aren't going to be able to easily get through the premed courses," he said. "You're going to wash out in basic chemistry. That's where many students are weeded out, so to speak."

He noted that when he was an undergrad at the University of Chicago, about 250 students started out as premed taking basic chemistry, but by the end of the semester, half of them weren't going to proceed with that major.

"To get more blacks into medical school, we have to start early — in grade school," he reiterated.

Dr Hamel and her colleagues focus on "getting an early start" to stimulate student interest in oncology as a career. They note that there are clear racial trends in the location and types of practice that physicians seek after they finish medical school, but that "increasing all students' awareness of options earlier and then selecting and guiding interested students toward medical oncology are important steps toward improved diversity."

Recruiting and mentoring minority medical students at various points in the student's experience is important, as is presenting oncology as a career when students from all backgrounds are in high school and college and still exploring their career paths. "It is also critical to support minority medical school students and to introduce the possibility of oncology as a career choice early in the process," they explain.

Minorities Helping Minorities

An association between shortages of minority healthcare providers and poorer health outcomes for minority patients is supported by increasing evidence, including a 2002 report from the National Academy of Medicine (formerly the Institute of Medicine). In addition, research in primary care and oncology settings has found that racially concordant clinic visits (when patient and provider are of the same race/ethnicity) are of higher quality than discordant visits.

"Increasing the number of practicing African American physicians has been repeatedly identified as a strategy to reduce the impact of racial bias and disparities in healthcare," Dr Hamel and her colleagues write. "Indeed, diversifying the ranks of medical oncologists will enable clinicians to be more responsive to the increasingly diverse populations for which they provide care, partly because African American physicians tend to demonstrate less racial bias compared with white physicians."

But Dr. Brawley cautioned that although there is some truth to this premise, it is a common misperception that minority doctors are needed to care for minority patients. "Having a minority doctor doesn't necessarily mean that outcomes will be better," he said. "And some minority patients don't specifically want a minority doctor."

Aside from the social justice aspects of bringing more minorities into oncology and medicine in general, some data indicate that minority physicians might be more likely to work in underserved communities. "I would agree with that," Dr. Brawley said. "They may not feel as frightened or intimated working in that environment."

Black Americans experience a greater incidence of cancer and greater mortality from the disease, so there is no question that these disparities exist. "But bringing in more minority physicians is not the full answer to the problem of health disparities," he said.

Some of the study coauthors report relationships with industry, as noted in the publication.

J Clin Oncol. Published online September 21, 2015. Abstract

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