SHE Initiative Shines Light on Gender Disparities in Oncology Workforce

Nick Smith-Stanley, MBA

The Association of Community Cancer Centers (ACCC) National Oncology Conference each year helps community oncologists approach both unique and typical challenges with innovative strategies. This year, one of the challenges addressed that has been increasingly raised throughout the year was the topic of disparities in the medical field.

To close out the ACCC 37th (Virtual) National Oncology Conference, keynote speaker Nick Smith-Stanley, MBA, addressed the topic of diversity and inclusion for women in medicine, and specifically in the field of oncology.

Smith-Stanley, associate director of finance and administration, Livestrong Cancer Institutes, Dell Medical School, associate director of administration and strategic planning, Department of Oncology, Dell Medical School, The University of Texas at Austin, explained the challenges faced by women in the oncology workplace and quantified the divide seen between the number of men and women in oncology and in positions of leadership in the medical field.

By discussing the lack of women in the field of oncology, he said, it will hopefully lead to developing strategies that address such challenges, which can then lead to real change.

He also presented how the Livestrong Cancer Institutes’ Dell Medical School has created a program that seeks to address this gap and give the future generation of women in medicine the tools they need to succeed.

The Growing Gender Divide Across a Medical Career Span

Oncology is known to be a male-dominated field in the healthcare space. Although the number of female students and physicians in the field has grown over the past few years, the proportion of women compared to men in medicine is still less than half. Further, the numbers get lower throughout the continuum of a medical career from medical student to physician to professor and then dean.

Smith-Stanley said that, encouragingly, for the first time in history, the number of female medical students is higher than the number of male students, but the difference is marginal. The rates decrease, however, over the course of a medical career. The number of female residents and fellows is below 50% and has not changed much in the last 10 years, and specific to oncology and hematology, the proportion of female residents and fellows is below about 45%.

Among practicing physicians, only 35% are female, and within the oncology/hematology field specifically, the rate is closer to one-third. However, this is increased from 10 years ago when the rate of female physicians was only about 28% overall and about 25% in the oncology field.

Within research in general, as of 2018, 50% of STEM (science, technology, engineering, and mathematics) positions were held by women, but specifically to science and engineering, only 28% of women hold positions in these fields.

“Across all disciplines in science and oncology, we see women struggling to be considered for opportunities for promotion and leadership,” Smith-Stanley said. “One faculty member at Dell Medical School told us that throughout her career she has seen male colleagues with fewer accomplishments get promoted at the same time. In addition, she shared that at previous institutions, rules were not as rigid for promotion and tenure for men as they were for women, they were willing to bend the rules for men, but not for women. This shows that this is not only a personal or organizational issue, it is by far a systemic issue.”

He pointed out that as a result, women hold fewer positions of leadership than men. Only 19% of department chairs were held by women in the year 2019 and only 21% of full professors are female.

“This poses a greater problem…because of the lack of mentorship opportunities. If our students and junior faculty are unable to identify women in positions of leadership and mentorship to help guide their career then they are less likely to progress in their career as well,” he commented.

He suggested that these rates reduce across the span of a medical career due to a lack of tools, mentorship, and support given to women in medicine.

Smith-Stanley offered some strategies to bridge the gender divide through organizational changes. Starting with culture, organizational leaders must embrace and promote an all-inclusive environment. Training on diversity and bias is one way to overcome these barriers and allow for change. Providing opportunities for professional development, including mentorship and networking, can also help to retain the women in the medical workforce.

Livestrong Cancer Institutes, he said, is one of the few cancer centers across the country that is led by a woman, S. Gail Eckhardt, MD, who is the director and associate dean of cancer programs at the company. As such, Dell Medical School is focused on addressing such healthcare disparities and leaders at the Livestrong Cancer Institutes feel that they have a responsibility to address the role that women play in cancer, research, and academics.

SHE Takes a Step Towards Overcoming Gender Disparities

The Livestrong Cancer Institute stressed the use of early education and mentorship to bridge the gender gap, which ultimately led to the development of the Summer Healthcare Experience (SHE) program in oncology. SHE is a free, immersive week-long program for introducing female-identifying high school juniors and seniors to a range of career opportunities in the cancer field. The program was launched in the summer of 2019 when 8 young women from Austin were selected with health program teachers and brought to the Dell Medical School to learn more about the various careers involved with cancer care.

The SHE program sought to empower young women to take control of their education and future careers by giving them tools to overcome challenges in the workplace. The high school students were given the opportunity to participate in research and interact with the clinical teams. Participating students also came away with a general knowledge of cancer, how it is treated, and the challenges that patients with cancer and their caregivers face. Additionally, the program promoted leadership skills and professionalism that could be used throughout their career, no matter the field.

During the week, the students worked with women in the cancer center to learn about cancer anatomy and how physicians work together for the care of patients with cancer. In the wet research lab, the students were able to see cell cultures and tumor slides and they also investigated different brain tumors in the neuro-oncology lab. The students were also able to join in on the molecular tumor boards to see the interaction between various departments for deciding on optimal care for a patient. In a survivorship session, the students were also able to meet with cancer survivors and their families and learn about their cancer journeys. Additionally, the students learned about health services research in the community and how health services researchers are investigating healthcare disparities in patients with cancer.

Throughout the week, the students were able to interact with female leaders from the cancer center, including center director Eckhardt, to hear about and learn from their experiences and the challenges they faced in their careers. They also met with a number of community organizations, from American Cancer Society to the Austin Center for Grief and Loss, to hear about how these organizations are assisting patients with cancer in the city.

“It’s not enough to just talk about equity and inclusion. You need to have people who are invested in the conversation and the desire to make a difference. That’s exactly what we saw in the first year of SHE,” Smith-Stanley said.

The students were tasked with coming up with a comprehensive care plan for a cancer case based on all they learned during the week. These plans were then presented at the end of the week to faculty from Livestrong Cancer Institutes, Dell Medical Center, the students’ high school teachers, and their families.

“We could not have been more thrilled with the results. They were confident, they were thoughtful, they were knowledgeable, they were compassionate. The transformation that we witnessed from Monday to Friday was remarkable,” Smith-Stanley commented.

Moving forward, the Livestrong Cancer Institutes hopes to expand the SHE program to more students and extend the program to 2 weeks. The program also hopes to add in more biomedical research, entrepreneurship education, a college prep day, and even a post-program internship. Livestrong Cancer Institutes is also partnering with other organizations to spread the SHE program to 4 other cancer centers, and hopefully nationwide, although this expansion has been delayed by the coronavirus disease 2019.

_Reference

_{Smith-Stanley N. Addressing the Disparities of Women in Oncology. Presented at: ACCC National Oncology Conference; September 14-18, 2020; Virtual.}