Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Diversity: are we asking the right questions?

When it comes to diversity, seeing is believing, or is it?

I still remember watching "Schoolhouse Rock" every Saturday morning as a child. I can proudly recite many of the lyrics of the songs to my own kids (they wisely prefer not hearing me sing them). One of the videos, "The Great American Melting Pot," recalls the cultural assimilation of 19th century European immigrants to America. At its core, the video is a celebration of diversity. These lines from the video speak of the welcoming embrace of the United States and the promise of the American Dream.

Our heritage is mixed.
So any kid could be the president.
You simply melt right in,
It doesn't matter what your skin,
It doesn't matter where you're from,
Or your religion, you jump right in
To the great American melting pot.

In the United States, diversity is a defining feature of our pluralistic society. One of the ways we honor diversity is to consciously acknowledge its importance in all spheres of our society, including the medical profession. What does diversity look like? Dr. Benjamin Felson famously popularized the concept of Aunt Minnie, reportedly noting, 'I can't describe her, but I know her when I see her.' If we can't describe diversity, can we just assume we'll recognize it? Diversity is a chameleon, shifting in response to the times and the cultural climate striving to achieve it. So we must be relentlessly vigilant in our pursuit if we wish our handling of it to remain relevant to on-going discussions of our society's values. Diversity is a moving target, needing continual re-evaluation and re-defining. 

There has been a good deal of thoughtful attention paid to diversity recently in the pages of JACR®

Counterpoint: Diversity and Inclusion: Works in Progress. Lightfoote JB, et al. J Am Coll Radiol. 2015 Sep;12(9):975-7. 

Point: Introducing Diversity Into a Medical Group: How to Do It and Why. Hayes D. J Am Coll Radiol. 2015 Sep;12(9):972-4. 

Diversity matters: historical lessons. Dhami G, et al. J Am Coll Radiol. 2015 Jan;12(1):118-9.

Improving diversity, inclusion, and representation in radiology and radiation oncology part 1: why these matter. Lightfoote JB, et al. J Am Coll Radiol. 2014 Jul;11(7):673-80. 

Improving diversity, inclusion, and representation in radiology and radiation oncology part 2: challenges and recommendations. Lightfoote JB, et al. J Am Coll Radiol. 2014 Aug;11(8):764-70.

Based on your reading of one or more of these articles, or based on your own experiences and observations, how do you think radiology is doing with respect to diversity? How about other specialties? Must all specialties and subspecialties be equally diverse? For example, if we say that women are underrepresented in interventional radiology, can we also say women are overrepresented in pediatric radiology? Do both types of imbalances warrant correction? Is it legitimate to frame diversity questions this way? Who gets to define optimal or acceptable diversity? 

Since radiology residents are all medical school graduates, should we ask if medical school student bodies are sufficiently diverse? Should a medical practice pursue broad diversity, or should it just reflect the degree of diversity of the community the practice is located in?

Are we even asking the right questions? If not, how can we identify the best institutional behavioral and policy changes to achieve the diversity we seek? How granular must our questions be to get it "right"? Do we end up with extensive but not-particularly-helpful-or-meaningful diversity checklists? 

Does our current focus on visible diversity (gender, ethnic, racial) among medical professionals blind us to some other types of diversity? Take religious diversity, which is quasi-visible. For example, you may see your neighbors repeatedly entering a certain house of worship or notice a colleague observing holy days or wearing symbolic items. But if you don't see such outward signs, you may never know. 

How about socioeconomic diversity? If you meet me, you'll see a Caucasian female professional, but you may not be able to ascertain my socioeconomic background. Growing up in a lower middle/working class family of immigrant parents shaped my values and life choices. I put myself through school with a combination of merit scholarships, small loans, and working part-time in health care jobs. I made sacrifices and delayed gratification. Between my determination and my family's belief in me, I achieved the American Dream. You can't really see that part of me now, it's not visible, but it's how I see my place in the diversity spectrum. This is my contribution to our marvelous American melting pot. 

Conversations about diversity seem to be found everywhere you look today: at work, in social media, in professional publications. In a country with a proud history of diversity, no one should be surprised about this. On the contrary, what's surprising is how complacent we became for a while, resting on our diversity laurels, until confronted in more recent years with a sobering truth: we've come so far, yet we've still got a long way to go. 

What about you? What are your opinions on any aspect of diversity mentioned above? What is still missing in our understanding of what diversity means? What about our on-going diversity conversations do you think may be overlooked or, on the flip side, overemphasized? Do you have a diversity story to share?

The House That ACR Built
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Monday, 20 November 2017

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