Mentorship Key to Improving GI, Hepatology Workforce Diversity

Tara Haelle

October 13, 2022

UPDATED October 27, 2022 // Editor's note: This story has been updated with additional comments from Dr Aja McCutchen of Atlanta Gastroenterology Associates.

Increasing mentorship opportunities for gastroenterology and hepatology residents and medical students from populations underrepresented in medicine is essential to increase diversity in the specialty and improve health disparities among patients, according to a special report published simultaneously in Gastroenterology and three other journals.

“This study helps to establish priorities for diversity, equity and inclusion in our field and informs future interventions to improve workforce diversity and eliminate health care disparities among the patients we serve,” Folasade P. May, MD, PhD, MPhil, the study’s corresponding author and an associate professor of medicine at the University of California, Los Angeles, said in a prepared statement.

The report, the result of a partnership between researchers at UCLA and the Intersociety Group on Diversity, reveals the findings of a survey aimed at assessing current perspectives on individuals underrepresented in medicine and health equity within gastroenterology and hepatology. The collaboration involved five gastroenterology professional societies: the American Association for the Study of Liver Disease; American College of Gastroenterology; American Gastroenterological Association; American Society of Gastrointestinal Endoscopy; and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

“The current racial and ethnic composition of the GI and hepatology workforce does not reflect the population of patients served or the current matriculants in medicine,” Harman K. Rahal, MD, of UCLA and Cedars-Sinai Medical Center, Los Angeles, and James H. Tabibian, MD, PhD, of UCLA and Olive View–UCLA Medical Center, and colleagues wrote. “As there are several conditions in GI and hepatology with disparities in incidence, treatment, and outcomes, representation of UIM [underrepresented in medicine] individuals is critical to address health disparities.”

The term “underrepresented in medicine” is defined by the Association of American Medical Colleges as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” The authors explained that these groups “have traditionally included Latino (i.e., Latino/a/x), Black (or African American), Native American (namely, American Indian, Alaska Native, and Native Hawaiian), Pacific Islander, and mainland Puerto Rican individuals.”

The five gastroenterology and hepatology societies partnered with investigators at UCLA to develop a 33-question electronic survey “to determine perspectives of current racial, ethnic, and gender diversity within GI and hepatology; to assess current views on interventions needed to increase racial, ethnic, and gender diversity in the field; and to collect data on the experiences of UIM individuals and women in our field,” according to the report’s authors. The survey was then distributed to members of those societies, with 1,219 respondents.

The report found that inadequate representation of people from those underrepresented groups in the education and training pipeline was the most frequently reported barrier to improving racial and ethnic diversity in the field (35.4%), followed by insufficient racial and ethnic minority group representation in professional leadership (27.9%) and insufficient racial and ethnic minority group representation among practicing GI and hepatology professionals in the workplace (26.6%). Only 9% of fellows in GI and hepatology are from groups underrepresented in medicine, according to data from the Accreditation Council for Graduate Medical Education. Furthermore, one study has shown that the proportion of UIM in academic faculty has never exceeded 10% at each academic rank; there has even been a decline recently among junior academic faculty positions. That study also found that only 9% of academic gastroenterologists in the United states identify as underrepresented in medicine, with little change over the last decade.

Potential contributors to this low level of representation, the authors wrote, include “lack of racial and ethnic diversity in the medical training pipeline, nondiverse leadership, bias, racial discrimination, and the notion that UIM physicians may be less likely to promote themselves or be promoted.”

Another potential contributor, however, may be complacency within the field about the need to improve diversity and taking actions to do so.

A majority of White physicians (78%) were very or somewhat satisfied with current levels of workforce diversity, compared with a majority of Black physicians (63%) feeling very or somewhat unsatisfied.

This disconnect was not surprising to Aja McCutchen, MD, a partner at Atlanta Gastroenterology Associates who was not involved in the survey.

"One cannot discount the lived experience of a [person underrepresented in medicine] as it relates to recognizing conscious and unconscious biases, microaggression recognition, and absence of [underrepresented clinicians] in key positions. This is a reality that I do see on a daily basis," McCutchen said in an interview.

Only 35% of respondents felt there is “insufficient racial and ethnic representation in education and training,” and just over a quarter (28%) felt the same about representation in leadership.

Although McCutchen appreciated the broad recognition from respondents, regardless of background, to improve diversity in the pipeline, she noted that "retention of current talent and future talent would also require cultural shifts in understanding the challenges of the [underrepresented] members."

In fact, most respondents (59.7%) thought that racial and ethnic diversity had increased over the past 5 years even though data show no change, the authors noted.

Again, however, the majority of the respondents (64.6%) were themselves not members of underrepresented groups. Nearly half the respondents (48.7%) were non-Hispanic White, and one in five (22.5%) were Asian, Native Hawaiian, or Pacific Islander. The remaining respondents, making up less than a third of the total, were Hispanic (10.6%), Black (9.1%), American Indian or Alaskan Native (0.2%), another race/ethnicity (3.3%), or preferred not to answer (5.7%).

McCutchen said that she had mixed feelings about the survey overall.  

"On the one hand, I was eager to read the perceptions of survey respondents as it relates to diversity, equity, and inclusion in the GI space, as very little cross-organizational data exists," said McCutchen, who was not involved in the research. "On the other hand, the responses reminded me that there is a lot of work to be done, as I expected more dissatisfaction with the current GI workforce in both academia and private practice respondents."

She was surprised, for example, that nearly three quarters of the respondents were somewhat or very satisfied, and that a majority thought racial and ethnic diversity had increased.

Studies on provider-patient concordance have shown that patients feel it’s important to share common ground with their physicians particularly in terms of race, ethnicity and language, the authors noted.

“This patient preference underscores the need to recruit and train a more diverse cohort of trainees into GI and hepatology fellowships if the desired goal is to optimize patient care and combat health disparities,” they wrote. They pointed out that cultural understanding can influence how patients perceive their health, symptoms, and concerns, which can then affect providers’ diagnostic accuracy and treatment recommendations. In turn, patients may have better adherence to treatment recommendations when they share a similar background as their clinician.

"Diversity in medicine also leads to greater diversity in thoughts, better returns on investments, increased scholarly activities related to health equity to name a few," McCutchen said.

The top recommendations from respondents for improving representation of currently underrepresented individuals in GI and hepatology were to increase mentorship opportunities for residents (45%) and medical students (43%) from these groups and to increase representation of professionals from these backgrounds in program and professional society leadership (39%). A third of respondents also recommended increasing shadowing opportunities for undergraduate students from these underrepresented populations.

McCutchen expressed optimism regarding the initiatives to improve diversity, equity, and inclusion across the gastroenterology spectrum.

“It is incumbent upon all of us to continue to be the driving force of change, which will be a journey and not a destination," McCutchen said. "In the future, diversity, equity, and inclusion will be the expectation, and we will ultimately move closer to the goal of completely eliminating healthcare inequities."

The research was funded by the National Cancer Institute, the UCLA Jonsson Comprehensive Cancer Center, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research Ablon Scholars Program. The authors reported no conflicts of interest. McCutchen disclosed relationships with Bristol-Myers Squibb and Redhill Biopharmaceuticals.

This story originally appeared on MDedge.com, part of the Medscape Professional Network.

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