Recognizing Racial Bias and Promoting Diversity in the Rheumatology Workforce

Abstract

Our rheumatology workforce is facing a moment of reckoning with the stark lack of racial and ethnic diversity. National events have called increasing attention to the multitude of barriers faced by people from groups who are underrepresented in medicine (URiM), defined as "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population," including women, people with disabilities, and self-identified Black, Latinx, Native Hawaiian, Pacific Islander, American Indian, and Alaska Native individuals (1).This article summarizes key concepts from a virtual forum hosted by Brigham and Women's Hospital with Drs. Kerr, Stone, and Blanco on "Diversity in the Rheumatology Research Workforce." The forum focused on diversity, equity, and inclusion (DEI) within race and ethnicity, recognizing that these categories are social constructs that do not exist in isolation. Rather, as outlined in the theory of intersectionality, a person's self-identified race and ethnicity will intersect with other aspects of identity, social position, and processes and policies in complex ways that deserve further dedicated research (2). Herein, we will explore some of the barriers and biases encountered by URiM rheumatology professionals and outline changes that are required to recruit and retain a more diverse workforce.We must work to diversify the rheumatology workforce not only because it is the only right and equitable approach, but also because it is critical to the patients we serve and to the improvement of our field. URiM physicians have been shown to provide higher quality care to patients identifying as racial or ethnic minorities, and racial concordance with providers can improve communication and therefore care (3). This makes increasing URiM provider representation an important and necessary component of working toward equity in patient care and health outcomes. However, it is also an independent goal that will bring essential perspectives and experiences, which will impact the quality of the research questions we ask and the clinical care we provide, and thus requires independent attention and strategies (4). While the responsibility to recognize and dismantle structural racism in rheumatology is our shared responsibility, we can only work toward this if URiM voices are heard and valued.Recognizing these important needs, we will outline 1) the striking shortage of URiM professionals in rheumatology, 2) barriers faced by URiM applicants and professionals, 3) actionable strategies to increase URiM professional recruitment and retention, and 4) methods for teaching bias, structural racism, and structural competency. We will use terminology for race and ethnicity that reflects the cited studies (5). THE CRITICAL SHORTAGE OF URiM PROFESSIONALS IN RHEUMATOLOGYThe field of medicine struggles with a lack of diversity in many ways, which is reflected in suboptimal care for vulnerable patientThe content of this article is solely the responsibility of the authors and does not...

Health Equity in Rheumatology: A Global Health Perspective

“…46 There is a need to increase diversity in the workforce and promote individuals from such backgrounds to leadership positions. 47,48 The lack of culturally competent training of healthcare providers can create health disparities in medicine. A recent study examining the use of images in training materials found a significant underrepresentation of images from dark-skinned patients, leading to a lack of adequate training and increased chances of misdiagnoses and improper management based on the patient's race.…”

“Rounding Third Base and Heading Home”: Arthritis & Rheumatology in 2024

“…Some of the concerns raised in the ACR comments included the cost to authors to publish manuscripts with immediate ("gold") OA, the potential for this requirement to hurt authors who are less well funded, and the downstream financial consequences of drastic reductions in subscription revenues to journals, such as A&R (and to their parent organizations, such as the ACR). Some journals will decide to publish a high volume of articles to make up for financial shortfalls; however, the Expert perspective: Immune checkpoint inhibitors and rheumatologic complications Simms, 2020 9 Expert perspectives on clinical challenges: expert perspectives: Challenges in scleroderma Arora and Rovin, 2022 10 Expert perspective: An approach to refractory lupus nephritis Nocturne and Mariette, 2023 11 Expert perspective: Challenges in Sjögren disease Patel and Stone, 2022 12 Expert perspective: Management of antineutrophil cytoplasmic antibody-associated vasculitis Case et al, 2022 13 Recognizing racial bias and promoting diversity in the rheumatology workforce Grayson et al, 2022 14 VEXAS syndrome and disease taxonomy in rheumatology Rome and Kesselheim, 2023 15 Biosimilar competition for Humira is here: Signs of hope despite early hiccups Dellaripa et al, 2023 16 The climate emergency and the health of our patients: The role of the rheumatologist Syversen et al, 2023 17 Therapeutic drug monitoring: A tool to optimize treatment of inflammatory joint diseases Calabrese et al, 2023 18 "Burnout" coupled with workforce shortages spells trouble: Innovative solutions are essential for more satisfying rheumatology practice Monach, 2024 19 Complement Taubmann et al, 2023 20 CAR-T cell treatment in systemic lupus erythematosus Crow et al, 2024 21 Standing on shoulders: Interferon research, from viral interference to lupus pathogenesis and treatment Hile and Werth, 2024 22 Understanding the role of type I IFN in cutaneous lupus and dermatomyositis: toward better therapeutics * CAR-T, chimeric antigen receptor T cell; IFN, interferon; VEXAS, vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome.…”

Rheum at the Table for Everyone: A Call to Expand Rheumatology Knowledge for Primary Care Providers

“…A variety of strategies have been proposed to help address the critical rheumatology workforce shortage, including increasing the number of rheumatology training fellowship positions, decreasing barriers for URiM and international medical graduates to practice, 3,6 increasing the number of nurse practitioners and physician assistants in rheumatology, and retaining rheumatologists in the workforce by reducing burnout. 7 However, most of these strategies will take years to make a meaningful impact on the severe rheumatology workforce shortage.…”

“…This problem is compounded by geographic maldistribution with a critical shortage of rheumatologists in rural areas, where the average service ratio is one rheumatologist per 200,000 people 2 . Additionally, there is a striking shortage of rheumatologists from groups who are underrepresented in medicine (URiM) 3 . The dramatic geographic and racial disparities in access to care, with only 10% of adult rheumatologists practicing outside of urban metropolitan areas 2 and only 11% of rheumatology fellows identifying as URiM, 3 makes access challenging for patients living in rural communities and achievement of race and ethnic‐group concordant care difficult for BIPOC communities.…”