Underrepresentation in Oncology: Identifying and Addressing Structural Barriers

Oncologist. 2021 Apr 1. doi: 10.1002/onco.13771. Online ahead of print.


Underrepresentation of minority groups in the oncology physician workforce is a pressing issue which may contribute to disparities in cancer research, clinical care, and patient outcomes. To address this, we highlight the role of medical culture and institutions in perpetuating a range of barriers that lead to the persistent underrepresentation of minority medical trainees and physicians. These barriers include an exclusionary medical culture, bias in measures of merit, financial barriers to medical subspecialty training, under-recognition of achievement, and poor representation and satisfaction among underrepresented faculty. Furthermore, we suggest a more intentional approach to diversity which values both recruitment of underrepresented undergraduates and early medical students as well as retention of internal medicine trainees, hematology-oncology fellows, and faculty. To counteract deeply embedded structural racism which hampers diversity efforts, this multi-faceted approach will require cultural transformation of our medical institutions at all levels, including increased institutional transparency, mandatory evidence-based bias training, acknowledgement of varied achievements, changes in recruitment practices, and reinvigoration of pipeline development programs with a focus on financial support. Taken in combination, programs should recognize the scope of deterrents to representation and develop program-specific longitudinal interventions to promote more successful diversity initiatives within the field of oncology. IMPLICATIONS FOR PRACTICE: The medical profession recognizes the value of physician workforce diversity in improving the quality of both medical education and patient care. In return, medical schools and training programs invest in recruitment programs focused on candidates who are underrepresented in medicine (UiM). In the field of oncology, where stark racial and ethnic disparities in care and health outcomes are well-defined, measures of minority physician representation remain especially stagnant. Here we clearly define the barriers that limit the effectiveness of such programs as well as provide recommendations to achieve the necessary workforce diversity in oncology.

Publication types

  • Review