How med school recruiters can help solve cardiology's diversity problem

One college dean is taking a new approach to attracting diverse talent to medical schools and fellowships across the country, and it’s one that involves taking a hard look at established prejudices and recognizing directors’ own biases.

Medicine has a diversity problem—there’s no question about that, Quinn Capers, MD, said at the American College of Cardiology’s annual conference in Orlando, this month. And as the dean of admissions at Ohio State University’s med school, he often witnesses implicit, complex biases that go hand-in-hand with the recruitment process.

“While the United States is becoming more and more diverse, our profession is not,” he said of cardiology. “We can either make it easy, or we can make it hard. It seems for many years we’ve made it a very difficult thing to do.”

In 2014, just 2.7 percent of American cardiologists were black, Capers said. Hispanic doctors made up 5 percent of the physician pool that year, while the remaining majority fell into another category: white.

It was quickly clear that the bulk of clinicians were not only white—they were overwhelmingly male, Capers said. While around half of internal medicine residents are women, only 21 percent of adult cardiology fellows are female. In 2015, just under 10 percent of FACCs who were U.S. board certified in adult CV were women.

Capers said the responsibility for correcting these diversity issues doesn’t fall squarely on any one group’s shoulders, but, as a higher-up at one of the country’s best-ranked primary care and research medical schools, he knows recruitment officers and cardiology program directors hold weight in these decisions.

A first step, he said, could be program directors simply asking themselves, frankly, why they’re considering certain applicants over others.

“Are we doing this for superficial reasons?” he asked. “Is it because the graduation photo looks a little bit better when there’s a little color in the photo? Or women in the photo?”

A 2017 ACC program director survey distributed to 137 cardiology specialists asked participants if they believed that more diversity among healthcare providers translated to better patient care. More than 70 percent said it did, but when asked if they could quote one or two references to support the statement, nearly 80 percent of surveyed physicians admitted they couldn’t.

Diversity isn’t a priority to program directors during recruitment, Capers said. In fact, data have shown it’s the tenth factor directors consider when making their rank lists, falling far behind clinical skills, ability to fit in, research productivity and USMLE scores. And some professionals might not even be aware of the gap—61.3 percent of ACC survey respondents said they believed their program was diverse enough already, while just 17.5 percent said they wanted to achieve greater diversity in their program and had a plan to succeed in that goal.

An unconscious bias likely contributes to this, Capers said. An Ohio State study using the Implicit Association Test found that even if the majority of program directors believed they were unbiased, 52 percent of women and 64 percent of men explicitly preferred white clinicians.

“When they see a black face, they automatically associate it with bad things,” Capers said. “But when they see a white face, they associate it with good things.”

It’s a step forward just to address these biases, he said, but program directors can also focus on familiarizing themselves with literature that documents the benefits of diverse healthcare, enhance their supply chain and put more energy into the recruitment process.

He said directors often fall back when it comes to recruitment—especially if they’re in a comfy position at a highly ranked school.

“They feel like, ‘We’re above recruitment,’” he said. “‘They know who we are.’”

But that’s not necessarily true, Capers said. Recruiting cardiology students in person, through social media and at national meetings can help attract a more diverse group of applicants to a director’s school, and that makes a big difference.

“Diversity in medicine saves lives,” he said. “But the lack of diversity in medicine costs lives.”