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Putting Women on the Escalator: How to Address the Ongoing Leadership Disparity in Radiation Oncology

Advancing equity, diversity, and inclusion in the physician workforce is essential to providing high-quality and culturally responsive patient care and has been shown to improve patient outcomes. To better characterize equity in the field of radiation oncology, we sought to describe the current academic radiation oncology workforce, including any contemporary differences in compensation and rank by gender and race/ethnicity.

We conducted a retrospective cohort study using data from the Society of Chairs of Academic Radiation Oncology Programs (SCAROP) 2018 Financial Survey. Multivariable logistic regression models were used to identify factors associated with associate or full professor rank. Compensation was compared by gender and race/ethnicity overall and stratified by rank and was further analyzed using multivariable linear regression models.

Of the 858 academic radiation oncologists from 63 departments in the United States in the sample, 33.2% were female, 65.2% were White, 27.2% were Asian, and 7.6% were underrepresented in medicine (URiM). There were 44.0% assistant professors, 32.0% associate professors, and 22.8% full professors. Multivariable logistic regression analysis for factors associated with associate or full professor rank did not reveal statistically significant associations between gender or race/ethnicity with academic rank (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.56-1.32; P = .48 for gender; OR, 0.81; 95% CI, 0.5-1.30; P = .37 for Asian vs White; and OR, 0.69; 95% CI, 0.31-1.55; P = .37 for URiM vs White), but CIs were wide due to sample size, and point estimates were <1. Similarly, multivariable linear regression analysis modeling the log relative total compensation did not detect statistically significant differences between radiation oncologists by gender (–1.7%; 95% CI, –6.8% to 3.4%; P = .51 for female vs male) or race/ethnicity (–1.6%; 95% CI, –7.3% to 4.0%; P = .57 for Asian vs White and –3.0%; 95% CI, –12.1% to 6.0%; P = .51 for URiM vs White).

The low numbers of women and faculty with URiM race/ethnicity in this radiation oncology faculty sample limits the ability to compare career trajectory and compensation by those characteristics. Given that point estimates were <1, our findings do not contradict larger multispecialty studies that suggest an ongoing need to monitor equity.

While disparities in the inclusion and advancement of women and minorities in science, technology, engineering, mathematics, and medical fields have been well documented, less work has focused on medical physics specifically. In this study, we evaluate historical and current diversity within the medical physics workforce, in cohorts representative of professional advancement (PA) in the field, and within National Institutes of Health (NIH)–funded medical physics research activities.

The 2020 American Association of Physicists in Medicine (AAPM) membership was queried as surrogate for the medical physics workforce. Select subsets of the AAPM membership were queried as surrogate for PA and early career professional advancement (ECPA) in medical physics. Self-reported AAPM-member demographics data representative of study analysis groups were identified and analyzed. Demographic characteristics of the 2020 AAPM membership were compared with those of the PA and ECPA cohorts and United States (US) population. The AAPM-NIH Research Database was appended with principal investigator (PI) demographics data and analyzed to evaluate trends in grant allocation by PI demographic characteristics.

Women, Hispanic/Latinx/Spanish individuals, and individuals reporting a race other than White or Asian alone comprised 50.8%, 18.7%, and 32.4% of the US population, respectively, but only 23.9%, 9.1%, and 7.9% of the 2020 AAPM membership, respectively. In general, representation of women and minorities was further decreased in the PA cohort; however, significantly higher proportions of women (P < .001) and Hispanic/Latinx/Spanish members (P < .05) were observed in the ECPA cohort than the 2020 AAPM membership. Analysis of historical data revealed modest increases in diversity within the AAPM membership since 2002. Across NIH grants awarded to AAPM members between 1985 and 2020, only 9.4%, 5.3%, and 1.7% were awarded to women, Hispanic/Latinx/Spanish, and non-White, non-Asian PIs, respectively.

Diversity within medical physics is limited. Proactive policy should be implemented to ensure diverse, equitable, and inclusive representation within research activities, roles representative of PA, and the profession at large.

The specialty of radiation oncology's gender diversity is lagging other medical specialties. The lack of gender diversity in radiation oncology has been demonstrated at all stages of career, from medical schools to department chairs. Multiple articles have demonstrated literature-based benefits of inclusion of a diverse group of female colleagues. This editorial is intended to note areas of progress and highlight resources available to support gender equity in the field of radiation oncology.

Radiation oncologists need to have more than sound clinical and technical competencies. To optimize care for patients and advance all aspects of radiation oncology (RO), radiation oncologists must also be effective leaders. Embedding systematic leadership education into RO training programs is challenging. This study examined RO residents’ perspectives and preferences relating to leadership education. Such data inform the integration of universal leadership learning into RO training in Australia and New Zealand and identify priority areas to facilitate successful leadership development initiatives in RO training programs worldwide.

Semistructured telephone interviews were conducted with 13 RO residents across 8 Australian training departments and all stages of training. Data from transcriptions of taped interviews were coded by at least 2 researchers and collected to saturation. Qualitative thematic analysis was conducted using an iterative inductive process to develop codes into themes and subthemes. Representative quotes were collated to illustrate subthemes.

Four key themes related to leadership education were identified and labeled as follows: (1) recognition, credibility, and value of education; (2) logistics of formal learning; (3) real-world opportunities (“seeing and doing”); and (4) one size does not fit all. Residents unanimously reported that formal leadership education was important and that aspects of becoming a good leader could be learned. Organizational and cultural factors emerged as either barriers or facilitators to learning. There was strong support for interactive methods of learning, and role-modeling by senior colleagues was identified as having a major effect on junior learners.

This study offers insight into RO residents’ perspectives of and preferences for their own leadership development. The findings have practical implications for the design of effective RO leadership programs and bring the RO field one step closer to the ultimate goal of enhancing leadership capability for all RO professionals.

Gender inequity in medicine harms society, and often originates in the context of broader societal discrimination. This study explores the experiences of older women in the radiation oncology specialty in Japan and the United States, with an emphasis on understanding how broader gender inequity affects career trajectory. Radiation oncology is an ideal setting to investigate cross-cultural physician gender equity issues, because few women enter the field despite fewer barriers (eg, frequent emergencies, evening/weekend hours, long procedures) that are commonly cited by women as deterrents in specialty selection.

Between 2012 and 2016, the authors interviewed 14 older women in radiation oncology (department chairs or full professors), with 6 from Japan and 8 from the United States. Multiple analysts identified themes to explore the impact of societal gender inequity on female radiation oncologists’ careers.

Five themes were identified: (1) childhood gender constructs affect career aspirations, (2) persistent sexism and gender-based workplace challenges affect women's careers, (3) gender inequity in the home affects women's careers, (4) non–gender-related factors intersect to affect women's career satisfaction, and (5) attaining gender equity appears to be even more challenging in Japan compared with the United States.

Female radiation oncologists in 2 of the most technologically advanced countries report that gender discrimination across their lifespans substantially affects career success. Because gender inequality reflects societal injustice and negatively affects scientific progress and patient outcomes, future research should focus on global approaches to address professional and domestic gender constructs that impede women's career progress.