The ACR committed to advancing the practice of radiology and supporting patients from the time of its inception 100 years ago, but a noticeable lack of diversity plagued the specialty and its leading professional organizations. A group of committed ACR leaders and members have spent the past decade seeking to change that through the Commission for Women and Diversity, established in 2013 and aimed at measurably improving diversity, equity and inclusion at the College and within radiology.
The College showed an early appreciation for the accomplishments of women by awarding Madame Marie Curie with the Gold Medal in 1931 for her co-discovery of radium and polonium. Despite recognizing the value of diverse contributions, the ACR lacked a formalized approach to attract diverse physicians to the field for the rest of the 20th century.
The U.S. population has increasingly grown more racially diverse, and medical schools now graduate women at nearly the same pace as men. Yet women and people of color remain under-represented as physicians and resident trainees. Even more troubling is the fact that although people of color account for at least 15% of medical school graduates, they make up only 6.5% of diagnostic radiologists and 7% of radiation oncologists, according to a 2014 study published in Radiology.1
In 2012, Paul H. Ellenbogen, MD, FACR, then the ACR’s BOC chair, resolved to make diversity part of the College’s mission to ensure a bright future for radiology. The idea was that in addition to the moral value diversity represents, a diverse specialty simply performs better.
Launching the Commission
Ellenbogen consulted with the American Association for Women in Radiology (AAWR) to recruit some of its members to create the new Commission for Women and Diversity. Ellenbogen tapped Katarzyna J. Macura, MD, PhD, FACR, past president of AAWR, to head up the Commission. “Nothing like the Commission for Women and Diversity existed in the house of radiology,” Macura says. “I was really honored to have this opportunity to build the new Commission and extend the College’s work beyond just gender diversity to all the axes of diversity.”
From the beginning, one of the Commission’s overarching goals was to gather and share data about diversity and inclusion in radiology. The Commission was coming together when the 2014 Radiology report was released analyzing the U.S. diagnostic radiology physician workforce. The paper’s authors, Christina Chapman, MD, and Curtiland Deville Jr., MD, also a member of the Commission, found that as of 2010, there had been no change in the number of women and people of color in diagnostic radiology residency programs for the previous eight years, despite the diverse available pipeline of medical school graduates. In 2010, almost half of all medical school graduates in the U.S. were women, but that number dipped to only 28% in diagnostic radiology. Among physicians already in diagnostic radiology, women made up only 24% of the workforce. The authors uncovered a similar trend in radiation oncology.2
“With these publications in existence, we looked at the numbers through a retrospective lens and thought about what would need to happen to build a diverse and inclusive house of radiology,” Macura says. “We knew there was a lot of talent in our specialty already, and there were many talented medical students we weren’t able to recruit, and we needed to do something about it.”
To that end, the Commission published research and commentary in the JACR® shortly after the group launched. The first two articles explored the current state of the specialty and why diversity, inclusion and representation mattered in the first place. Chief among the arguments was the fact that healthcare disparities and inequitable access to advanced imaging and interventional care among America’s diverse population require a professional radiological workforce that reflects the diverse patient population it serves.3,4
The top-down approach to supporting, championing and funding diversity efforts has continued since Ellenbogen’s tenure as chair. Geraldine B. McGinty, MD, MBA, FACR, became the first female chair of the BOC in 2018, bringing her own lived experience to the role.
Recruiting the Next Generation
The Commission also focused on identifying barriers to creating a diverse radiology workforce, which included exposure to, interest in and mentorship access within the specialty. Macura appointed Johnson B. Lightfoote, MD, MBA, FACR, to lead the Commission’s Committee on Diversity and Inclusion. In 2016, the College launched the ACR Pipeline Initiative for the Enrichment of Radiology (PIER) program.5
The PIER program exposes women medical students and those from nontraditional backgrounds to radiology and equips them to be competitive applicants to radiology residency programs. It was initially an in-person program, with five PIER scholars working side by side with experienced radiologists in academic and private practices.
In 2020, the COVID-19 pandemic forced program leaders to pivot and “rebuild the plane while it was flying,” says Lightfoote, who serves as current chair of the Commission. With the support of McGinty, then-chair of the BOC, who committed to “moving mountains to make this program happen,” Lightfoote recalls, the program was able to continue virtually in a safe, cost-effective setting. Under the leadership of PIER program chair Michele H. Johnson, MD, FACR, who introduced a revised program’s curriculum and engaged an even larger group of PIER mentors, scholars receive stipends for the eight weeks they dedicate to the program, hearing lectures from top radiologists across the globe, including notable specialists from as far away as Europe and Africa.
The program has shifted to an all-virtual format because of the cost savings and the additional opportunities it provides. “We’re able to accept more students, and the students get to meet all the preceptors,” Lightfoote says. “In the past, the student would spend their time with one radiologist — now they get to talk with 40 different senior, world-class radiologists.” The number of students accepted into the program has grown steadily — the 2020 class admitted 10 participants, while the 2023 class has accepted 43 PIER scholars.
Building Upon the Movement
The ACR has established that diversity is central to its mission, adopting a resolution in 2015 that affirms diversity of the radiological professions as a central objective, and that opportunities to continually measure and assess membership diversity should be promoted. To that end, the Commission is expanding its focus to support radiologists with disabilities, and to emphasize the importance of a healthy workplace culture to prevent burnout and support physician well-being. Addressing gender-based needs, which extends to gender-diverse professionals and patients, is another priority.
“It’s important to strategize about accommodating the Family and Medical Leave policies being recognized as a necessity for our practices, and letting new parents, especially women, recover from childbirth,” Macura says.6
Additional priorities for the Commission include ensuring transparency surrounding equitable pay, fostering mutual respect and supporting work-life balance. These kinds of initiatives contribute to an environment that attracts a talented and diverse workforce that benefits the profession and its diverse patient populations, McGinty says.
“When I was in medical school, women were only 8% of the (radiology) profession,” McGinty says.7 “Women held no seats on any of the professional (radiology) organization boards, and there were no female journal editors. We’ve come a long way, but it’s very important to think about how we advance diverse leadership in the profession, because we need visible diversity of leadership to make women and under-represented minorities feel that the profession is welcoming.”