Dr. Charlotte Yong-Hing
All Canadians have a fundamental right to individual protection from discrimination and bias. Promoting equity and diversity within medicine fosters a just professional and learning culture that cultivates the diverse perspectives within it, reflects the communities physicians serve, and promotes professional excellence and social accountability. Evidence indicates that when equity and diversity in medicine is achieved patients experience improved care and a more responsive and adaptable health care system.
Given that CAIR is dedicated to improving Canadians’ health and quality of life we thought a discussion about equity, diversity and inclusion in (interventional) radiology was in order.
We reached out to Dr. Charlotte Yong-Hing, who is a Clinical Assistant Professor, UBC Radiology; the Medical Director of Breast Imaging at BC Cancer Vancouver; President Elect of the BC Radiological Society; and President Elect of the Canadian Society of Breast Imaging. Dr. Yong-Hing also co-chairs the UBC Radiology Equity Diversity and Inclusion Committee and chairs the Canadian Association of Radiologists Equity Diversity and Inclusion Working Group. She founded Canadian Radiology Women in 2018 to advocate for improved diversity in Canadian Radiology practices. Most importantly she is from Saskatchewan originally 🙂 We appreciate her taking the time to answer our questions.
CAIR: Can you describe why equity, diversity and inclusion groups are needed in (interventional) radiology?
CYH: Radiology has been identified as one of the medical specialties with the least diversity of gender and race. We know that patients receive better care when the physician population reflects the diversity of the population as a whole. Many studies in industry and medicine have shown that increased diversity drives innovation and improves outcomes.
Specifically in regards to gender, there are documented significant positive impacts of increasing the role of women in medicine on the medical culture and practice, the quality of care, and the organization of the healthcare system, with benefits for patients, learners and the system.
In Canada, women currently represent over half the medical student population, yet women remain underrepresented in Radiology. The proportion of women radiologists has changed minimally over decades and current application trends suggest the proportion of women in radiology could decrease.
In addition, there is a marked paucity of women in political, academic and departmental radiology leadership positions across the country. Women represent 36% of Radiology faculty members in Canada. The Radiology gender gap widens with increasing academic ranks, suggesting that women may not advance at the same academic or professional pace as men. Further, an established gender pay gap may result in retirement and lifetime wealth differences of up to $2.5 million.
In the last census in 2016, 1 Canadian out of 5 was a visible minority. We know that underrepresented minorities in medicine in Canada include first nations (4.4%) and black people (2.9%). There is however no data on ethnic diversity in radiology in Canada. This is important because racial/ethnic representation of medical faculties and residency programs should resemble that of the population served. Visible minorities are more likely to practice in areas with underserved and minority populations. When patients and physicians are the same race/ethnicity there is improved overall patient satisfaction and compliance with medical recommendations. Physicians’ race/ethnicity are the strongest predictors that a physician will care for more vulnerable and underserved communities, irrespective of socioeconomic status.
The Canadian Truth and Reconciliation Commission published a report in 2015 outlining a number of calls to action to increase the number of Indigenous healthcare workers. While at the undergraduate level, faculties are collecting data on the admission of Indigenous medical students, information on post-graduate residency programs or faculty positions is largely lacking and there are no data in the literature regarding radiology and Indigenous peoples in Canada. A necessary step in meaningful progress toward Indigenous representation and equity lies in the collection of data around Indigenous residents, faculty members, and community physicians.
CAIR: What can (interventional) radiologists do to support diversity and combat inequality in Canada?
CYH: An informal online survey of women radiologists and radiologists in training in Canada demonstrated there are many real and perceived barriers to achieving personal, professional, and academic success as a female radiologist in Canada. The reported barriers were lack of exposure early in training; observation of gender gap; lack of female radiology mentors, lack of female radiology leaders. While some of these are general and would apply to women and men as well as other underrepresented minorities, all barriers could be addressed by increasing the engagement and visibility of the women who are already in radiology.
By increasing visibility of minorities in radiology online and in real life we can improve medical student exposure to radiology. In particular, as has been documented repeatedly, the Covid 19 pandemic has had a disproportionate effect on women. There need to be proactive strategies to support, mentor and sponsor young female radiologists.
CAIR: How can (interventional) radiologists promote equity, diversity and inclusion in their practice?
CYH: As a radiologist, you can improve equity, diversity and inclusion in radiology. Acknowledge that radiology is not diverse and educate yourself about why this is and what can be done to improve it. Recognize and reduce unconscious bias in your daily life. Mentor, sponsor and champion your peers and trainees.
CAIR: How can systemic imbalances be identified in (interventional) radiology and what strategies can be introduced to rectify such imbalances?
CYH: While women are underrepresented within radiology overall, interventional radiology (IR) has the lowest representation of women among Canadian radiology subspecialties (10.6%). Although IR, like breast and pediatric imaging, where women are well represented, has a great deal of direct patient interaction, several other potential factors have been identified that may deter women from pursuing this subspecialty. These factors include lack of scheduling flexibility and increased radiation exposure. The risk of radiation exposure during pregnancy has been overstated and exaggerated. To our knowledge, no clear consensus, protocol or guidelines exist for pregnant women in IR.
CAIR: Why do you think diversity is extremely underrepresented in interventional radiology and what actions are being done and can be done by programs and societies to combat this underrepresentation?
CYH: Strategies to improve diversity in radiology in Canada are necessary at the national, institutional, departmental, and individual levels. National organizations can drive improvement through awareness and policy change. I’m proud of the BC Radiological society where we have more women than men on our executive. However, some provincial radiology organizations have no women leaders at all. Programs and societies should intentionally create diverse teams. Look for people who will see things differently. Support junior team members and allow them the chance to grow and develop their skills. Resist the urge to label people and check boxes.
In summary, diversity is good for patients. Women are underrepresented in Canadian Radiology, particularly in Interventional Radiology. There is no data regarding ethnic diversity or Indigenous representation in Canadian Radiology. Actionable strategies exist at each level to improve equity, diversity, and inclusion in Canadian Radiology.