Equity,Diversity,and Inclusion: Calling,Career,or Chore?

Blind eyes can perceive more than an ignorant mind.

― Faisal Khosa

The radiology workforce has a documented history of issues surrounding equity, diversity, and inclusion (EDI).^1,2 Although radiology as a medical specialty has struggled with equitable representation since its inception, disparities among physicians are a byproduct of societal attitudes. These are not interwoven into the fabric of our discipline, and therefore, EDI should be viewed as an attainable reality rather than an elusive dream.

There has been increasing support for EDI initiatives across Canadian academic radiology departments, ¹ all with the overarching goal of embracing diversity, fostering inclusivity, and promoting equity. As the national voice for radiologists in Canada, the Canadian Association of Radiologists (CAR) is championing EDI by creating an EDI working group and promoting EDI at Annual Scientific Meetings. The opening plenary lecture in 2021 was an introduction to EDI in Canadian Radiology. Under the banner of the Royal College McLaughlin-Gallie Visiting Professorship, an EDI workshop at the Annual Scientific Meeting in April of 2022 brought together colleagues in all stages of the radiology pipeline (residents, early career faculty, and department leaders).

The workshop prompted exploration of the degree to which the current pipeline, especially among radiology leadership, is discordant with the gains in diversity at the undergraduate levels. Improved equity and inclusivity in medical school matriculation has not permeated into the ranks of radiology leadership. Workshop attendees were divided into breakout rooms and led through introspective exercises exploring the ways that unearned disadvantage and privilege, social inequities, unconscious bias, mentorship, and de-mentorship had influenced the course of their careers.

Most notably, physicians reflected on whether they saw their profession as a calling, a career, or a chore. A calling is an impulse towards a distinguished path that could be regarded by some as spiritual or divine. A job, career, or title can be stripped from an individual, but no one can take away a calling. A career is a job that is performed with a variety of underlying motivations, such as passion, interest, or convenience. A chore is a simple transaction—effort and time in exchange for money. Throughout a physician’s career, the compounding impact of disparate treatment (e.g., discrimination) can lead to disengagement and disillusionment, such as when a calling becomes a chore.

The poll conducted during the workshop demonstrated the profession of medicine was a calling for 67% of participants during medical school and early training. None of the respondents saw it as a chore. However, when asked again about their current perception as a medical practitioner, only 40% continued to see it as a calling, and 30% regarded it as a chore. Issues surrounding EDI in the radiology workplace have the potential to eventually downgrade one’s commitment and passion for their profession. Only 17% of radiologists indicated that they were satisfied with the current levels of diversity in their own radiology practice and/or department.

While EDI has become a welcomed and frequently discussed concept in medicine, there is no room for complacency as the radiology community continues to grapple with lack of EDI. Even for colleagues who were drawn to medicine as their calling, there is only so much tolerance for disparate treatment. Attrition from academia is instigated through a vicious cycle in which underrepresented minority physicians are perpetually tasked with proving their ability and competence specifically in connection to their protected characteristic such as gender or race. As identified from respondent attitudes at our workshop, action must be taken to sever this ouroboros which continues to perpetuate a seemingly endless and detrimental cycle.

The sticky floor, broken ladder, and glass ceiling of academic radiology remain as persistent obstacles to EDI. The sticky floor is a metaphor for impediments within institutions which, by design, hinder the progress of the underrepresented. A broken ladder designates the inequitable process by which leadership positions are transferred among individuals that favors select demographics (i.e., a job is advertised in a way to suit certain individuals, or a candidate is chosen before the job is advertised). The glass ceiling refers to the ingrained self-perception of underrepresented groups (such as but not limited to women and people of color) that they are either underqualified or overqualified, but never appropriately qualified for opportunities.

These aforementioned obstacles are highly relevant to the discussion of the radiology workforce pipeline. In an age where medical school cohorts are increasingly diverse, each of these obstacles play a role in creating and perpetuating the leaky pipeline. From radiology residents, junior staff, senior faculty, and all the way to department leaders, each step up features a loss in diversity. Existing data from the literature suggest that gender distribution of Canadian radiology faculty is strongly correlated with their respective resident cohorts. ³ Although the cause of the correlation is yet to be confirmed, it has been speculated that resident gender equity may be more attainable in departments with visible female faculty representation. ³ This effectively highlights the importance of tackling EDI at all stages of the pipeline. While medical schools are producing more diverse cohorts, there remains a strong onus on departments and institutions to prioritize recruitment and retention of diverse radiology faculty to feed backwards and to attract diverse, prospective-radiologists.

Despite increasing attention and support for EDI within Canadian academic radiology, there is still much more work to be done.^1,2,4 A demographically representative and culturally competent radiology workforce will not arise simply by treating EDI as a checkbox item. EDI is a commitment that often requires adaptation, correction, and redirection in light of shifting population demographics. Accordingly, it is of paramount importance to recognize that diversity is a term that refers to more than just gender and race. It also encompasses other critical characteristics such as sexual orientation, religion, age, disability, and many more. Only once these differences are embraced can we effectively embody diversity, foster inclusivity, and promote equity.