Women’s Impact on the Business of Radiology: The Importance of Gender Diversity and How Many Modern Organizations Are Taking Action

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Lucy B. Spalluto, MD

Gender diversity matters. According to research from more than 350 global public companies by McKinsey & Company, companies in the top quartile for gender diversity were more likely to have financial returns above the national median. In the United States, the correlation between gender diversity and improved revenue performance is strongest once women constitute at least 22 percent of a senior executive team.1 Gender diversity within an organization can increase revenue by improving recruiting methods, customer orientation, employee satisfaction and decision making. Increasing gender diversity in radiology, a specialty in which women are currently grossly underrepresented, offers an opportunity to gain a competitive advantage in the healthcare marketplace.

As global changes have shifted healthcare to a consumer-driven model, overwhelmingly comprised of female consumers, gender diversity in radiology organizations is of paramount importance. Leveraging the insight of women in radiology can improve the relationship of women consumers with radiology service providers. Women healthcare consumers now make the majority of healthcare decisions in this country, with nearly all women making healthcare decisions for themselves and 59 percent making decisions for others. Of working women with children under the age of 18, an overwhelming 94 percent make healthcare decisions for themselves and others.2

Women healthcare consumers value clear communication, affordable preventive care and friendly, informative customer service. Women’s perspectives at all levels in radiology including staff, administrators, trainees and radiologists is integral in improving this influential consumer relationship. Strengthening the relationship with women healthcare consumers can improve overall population health and well-being. Efforts to improve gender diversity by recruiting and retaining qualified women at all levels in radiology are imperative.

As a specialty, radiology continues to struggle to attract, retain and promote women at all levels. While the number of women graduating from medical school now approaches that of men, a significantly smaller proportion of women medical students (27 percent in 2017) choose radiology as a career path.3 This percentage of women applying for radiology residency has remained stagnant for over a decade. According to a 2009 study by the Journal of the American College of Radiology (JACR), factors influencing women medical students’ decision whether or not to pursue radiology as a career may include limited availability of women role models, lack of mentorship and limited exposure to radiology early in medical school (J Am Coll Radiol. 2009 Apr;6(4):246-53).

As in corporate America, women radiologists continue to fall behind their male counterparts early in their careers. This gender gap persists and further widens at senior level leadership positions. In radiology, this disparity is exacerbated by the paucity of women medical students choosing to pursue radiology as a specialty. According to a 2015 JACR study, of all practicing radiologists, approximately 22 percent are women, with even fewer women radiologists in private practice. Women hold only 7 percent of all radiology leadership positions in both private and academic sectors (J Am Coll Radiol. 2015 Feb;12(2):155-7).

AAWR Awards Ceremony at RSNA 2016 in Chicago. From left to right: Linda Chen, MD; Rebecca Rakow-Penner, MD, PhD; Katarzyna Macura, MD, PhD; Melissa Rosado de Christenson, MD; Christina Chapman, MD, MS; and Feng-Ming Kong, MD, PhD. Source: Lucy B. Spalluto, MD
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Overall, according to a comprehensive study of the state of women in corporations developed by McKinsey & Company and LeanIn.Org, women have less access to opportunities for career development than men and less access to senior leaders, mentors and networking opportunities.4 To improve gender diversity, radiology organizations must address current issues with recruitment, retention and promotion to senior leadership positions. Without efforts at the national and institutional level to improve gender diversity, the gender disparity in radiology will persist.

Organizations Making a Difference

National radiology organizations have recognized the positive impact of gender diversity and significant efforts are being made to increase diversity and improve the status of women in radiology. Organizations including the American Association for Women in Radiology (AAWR), the American College of Radiology (ACR) and the Association for University Radiologists (AUR) promote the importance of gender diversity in radiology.

The AAWR was created in 1981 to address the problems women in radiology were experiencing in being subordinate to their male counterparts. When it began, the AAWR identified barriers to women’s success, including poor visibility at meetings, low acceptance rate for publications with female authors, lack of promotion, lack of guidance for work-life balance issues and lack of recruitment for jobs and leadership positions. The AAWR’s goals are to increase the visibility of women in radiology, identify and address issues unique to women in radiology and advance the professional and academic standing of women in radiology.

AAWR Refresher Course at RSNA 2016 in Chicago. Seated from left to right: Carol Rumack, MD; Elizabeth Oates, MD; Rebecca Leddy, MD; Meryle Eklund, MD. Moderator at podium: AAWR President Margaret Szabunio, MD. Source: RSNA Daily Bulletin.
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The AAWR continues to provide opportunities for career development and award recognition for women in radiology. Career development courses focus on providing women with the executive skills necessary for career success, including assuming leadership positions. The AAWR also offers a unique structure for mentoring and networking in an organization of predominantly women. AAWR influence can be seen in the presence of AAWR women in national leadership positions. The importance of the AAWR’s efforts in helping women radiologists to reach their potential was recognized by the American Association of Medical Colleges Women in Medicine Leadership Award in 2005.

The ACR created the Commission for Women and Diversity to increase the awareness and recognition of the value of diversity and improve professional opportunities for women and minorities in radiology. This commission emphasizes the importance of diversity and inclusion to the future success of radiology. The commission has even published recommendations for initiatives in advocacy and awareness, professional development support and institutional performance improvement (J Am Coll Radiol. 2014 Aug;11(8):764-70).

As a means to increase diversity in radiology, the Commission for Women and Diversity encouraged the ACR to partner with the Nth Dimensions program, which offers an opportunity for women and underrepresented minorities to gain early exposure to radiology through an 8-week summer research internship designed for medical students after the first year of medical school. This summer internship is followed by a longitudinal mentorship program designed to facilitate scholars’ match into radiology residency. For more than 13 years, Nth Dimensions has offered this mentorship program to women and underrepresented minorities to increase entry into orthopedic surgery. Evaluation of the program from 2005 to 2012 showed an increase in odds of women having completed the internship and applying to orthopedic surgery residency programs compared to national controls (Clin Orthop Relat Res. 2016 Sep;474(9):1979-85). Students will have the opportunity to partner with radiologists beginning in 2017, and a similar increase in application numbers for radiology is anticipated.

The AUR has demonstrated continued commitment to women in radiology. For example, the 2016 AUR Annual Meeting theme was “Diversity, Inclusion, and Cultural Competency in Academic Radiology.” Further, four of six AUR Executive Committee members are women. In the past 10 years, the AUR has reached gender parity in its distribution of AUR Gold Medals.

While necessary and quite successful, efforts at the national level to improve gender diversity in radiology will not be sufficient to drive the necessary organizational changes.

Addressing Diversity

While many individual institutions and practices are committed to gender diversity, they often struggle to implement diversity within their organization. Often, individuals within an organization do not see the benefit of gender diversity and do not view it as a personal priority. The authors of the McKinsey & Company/LeanIn.Org study offered four ways companies can advance gender diversity efforts and to create a more inclusive and fair workplace. Here is a look at the suggestions with an eye toward radiology.

  • Make a compelling case for diversity

Radiology organizations must fully communicate the importance of diversity and inclusion. The impact of improved organizational gender diversity on the individual, institutional and societal level should be clear to all individuals within the organization. Benefits include strengthened patient relationships, improved employee satisfaction and an enhanced organizational decision-making process.

  • Ensure that hiring, promotions and reviews are fair

Transparency in the hiring, promotional and review process is essential to ensuring gender equity. Organizational policy should be reviewed to ensure opportunities for bias are minimized. Hiring panels and promotional review panels should be composed of a diverse slate. Consideration should be given to blind resume reviews.

  • Invest more in employee training

Opportunities for employee training in diversity, equity, inclusion and bias should be readily available. In order to recognize bias and discrimination, individuals must first more fully understand these issues.

  • Focus on accountability and results

The success of an organization’s diversity and inclusion efforts lies with organizational leaders and upper level management. Goals for diversity and inclusion should be set and leadership should be held accountable for reaching these goals.

It’s clear that the current gender disparity in the radiology workforce must be addressed. Improvements in gender diversity offer an opportunity not only to enhance organizational operations, but to gain an advantage in today’s volatile healthcare market. Radiology organizations must recognize the value of the diverse and inclusive workplace and take action to change the current workplace environment.

 

Lucy B. Spalluto, MD, is an assistant professor and the associate director of diversity, equity and inclusion in the department of radiology and radiological sciences at Vanderbilt University Medical Center in Nashville, Tenn. She currently serves on the executive committee of the AAWR.

References:

1Hunt V, Layton D, Prince S. Diversity Matters. November 2014.

2Luce CB, Hewlett SA, Kennedy JT, LS. The Power of the Purse: Engaging Women Decision Makers for Healthy Outcomes. 2015.

3FACTS: Applicants, Matriculants, Enrollment, Graduates, MD/PhD, and Residency Applicants Data - Data and Analysis - AAMC. Association of American Medical Colleges. https://www.aamc.org/data/facts/. Accessed April 7, 2017.

4Yee L, Krivkovich A, Kutcher E, et al. Women in the Workplace 2016.