Diversity in the Gastroenterology Workforce and its Implications for Patients

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References
  1. Welch M. Required curricula in diversity and cross-cultural medicine: the time is now. J Am Med Womens Assoc (1972). 1998;53(3 Suppl):121-3, 130. PMID:17598289. 
  2. Carethers JM. Toward realizing diversity in academic medicine. J Clin Invest. 2020;130(11):5626-5628. doi:10.1172/JCI144527 
  3. Guevara JP, Adanga E, Avakame E, Carthon MB. Minority faculty development programs and underrepresented minority faculty representation at US medical schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116 
  4. Guevara JP, Wade R, Aysola J. Racial and ethnic diversity at medical schools – why aren’t we there yet? N Engl J Med. 2021;385(19):1732-1734. doi:10.1056/NEJMp2105578
  5. Dill J, Akosionu O, Karbeah JM, Henning-Smith C. Addressing systemic racial inequity in the health care workforce. Health Affairs. September 10, 2020. Accessed July 12, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20200908.133196/full/ 
  6. Carr RM, Quezada SM, Gangarosa LM, et al; Governing Board of the American Gastroenterological Association. From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology. Gastroenterology. 2020;159(5):1637-1647. doi:10.1053/j.gastro.2020.07.044 
  7. American Gastroenterological Association. AGA equity project. Accessed July 11, 2022. https://gastro.org/aga-leadership/initiatives-and-programs/aga-equity-project/ 
  8. Barnes EL, Loftus EV Jr, Kappelman MD. Effects of race and ethnicity on diagnosis and management of inflammatory bowel diseases. Gastroenterology. 2021;160(3):677-689. doi:10.1053/j.gastro.2020.08.064 
  9. White PM, Iroku U, Carr RM, May FP; Association of Black Gastroenterologists and Hepatologists Board of Directors. Advancing health equity: The Association of Black Gastroenterologists and Hepatologists. Nat Rev Gastroenterol Hepatol. 2021;18(7):449-450. doi: 10.1038/s41575-021-00464-y 
  10. Ogunyemi D, Okekpe CC, Barrientos DR, Bui T, Au MN, Lamba S. United States medical school academic faculty workforce diversity, institutional characteristics, and geographical distributions from 2014-2018. Cureus. 2022;14(2):e22292. doi:10.7759/cureus.22292 
  11. Weiss J, Balasuriya L, Cramer LD, et al. Medical students’ demographic characteristics and their perceptions of faculty role modeling of respect for diversity. JAMA Netw Open. 2021;4(6):e2112795. doi:10.1001/jamanetworkopen.2021.12795 
  12. Association of American Medical Colleges (AAMC). Medical school enrollment more diverse in 2021. December 8, 2021. Accessed June 29, 2022. https://www.aamc.org/news-insights/press-releases/medical-school-enrollment-more-diverse-2021 
  13. Silvernale C, Kuo B, Staller K. Racial disparity in healthcare utilization among patients with irritable bowel syndrome: results from a multicenter cohort. Neurogastroenterol Motil. 2020;33(5):e14039. doi: 10.1111/nmo.14039 
  14. Robinett K, Kareem R, Reavis K, Quezada S. A multi-pronged, antiracist approach to optimize equity in medical school admissions. Med Educ. 2021;55(12):1376-1382. doi:10.1111/medu.14589 
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References
  1. Welch M. Required curricula in diversity and cross-cultural medicine: the time is now. J Am Med Womens Assoc (1972). 1998;53(3 Suppl):121-3, 130. PMID:17598289. 
  2. Carethers JM. Toward realizing diversity in academic medicine. J Clin Invest. 2020;130(11):5626-5628. doi:10.1172/JCI144527 
  3. Guevara JP, Adanga E, Avakame E, Carthon MB. Minority faculty development programs and underrepresented minority faculty representation at US medical schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116 
  4. Guevara JP, Wade R, Aysola J. Racial and ethnic diversity at medical schools – why aren’t we there yet? N Engl J Med. 2021;385(19):1732-1734. doi:10.1056/NEJMp2105578
  5. Dill J, Akosionu O, Karbeah JM, Henning-Smith C. Addressing systemic racial inequity in the health care workforce. Health Affairs. September 10, 2020. Accessed July 12, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20200908.133196/full/ 
  6. Carr RM, Quezada SM, Gangarosa LM, et al; Governing Board of the American Gastroenterological Association. From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology. Gastroenterology. 2020;159(5):1637-1647. doi:10.1053/j.gastro.2020.07.044 
  7. American Gastroenterological Association. AGA equity project. Accessed July 11, 2022. https://gastro.org/aga-leadership/initiatives-and-programs/aga-equity-project/ 
  8. Barnes EL, Loftus EV Jr, Kappelman MD. Effects of race and ethnicity on diagnosis and management of inflammatory bowel diseases. Gastroenterology. 2021;160(3):677-689. doi:10.1053/j.gastro.2020.08.064 
  9. White PM, Iroku U, Carr RM, May FP; Association of Black Gastroenterologists and Hepatologists Board of Directors. Advancing health equity: The Association of Black Gastroenterologists and Hepatologists. Nat Rev Gastroenterol Hepatol. 2021;18(7):449-450. doi: 10.1038/s41575-021-00464-y 
  10. Ogunyemi D, Okekpe CC, Barrientos DR, Bui T, Au MN, Lamba S. United States medical school academic faculty workforce diversity, institutional characteristics, and geographical distributions from 2014-2018. Cureus. 2022;14(2):e22292. doi:10.7759/cureus.22292 
  11. Weiss J, Balasuriya L, Cramer LD, et al. Medical students’ demographic characteristics and their perceptions of faculty role modeling of respect for diversity. JAMA Netw Open. 2021;4(6):e2112795. doi:10.1001/jamanetworkopen.2021.12795 
  12. Association of American Medical Colleges (AAMC). Medical school enrollment more diverse in 2021. December 8, 2021. Accessed June 29, 2022. https://www.aamc.org/news-insights/press-releases/medical-school-enrollment-more-diverse-2021 
  13. Silvernale C, Kuo B, Staller K. Racial disparity in healthcare utilization among patients with irritable bowel syndrome: results from a multicenter cohort. Neurogastroenterol Motil. 2020;33(5):e14039. doi: 10.1111/nmo.14039 
  14. Robinett K, Kareem R, Reavis K, Quezada S. A multi-pronged, antiracist approach to optimize equity in medical school admissions. Med Educ. 2021;55(12):1376-1382. doi:10.1111/medu.14589 
References
  1. Welch M. Required curricula in diversity and cross-cultural medicine: the time is now. J Am Med Womens Assoc (1972). 1998;53(3 Suppl):121-3, 130. PMID:17598289. 
  2. Carethers JM. Toward realizing diversity in academic medicine. J Clin Invest. 2020;130(11):5626-5628. doi:10.1172/JCI144527 
  3. Guevara JP, Adanga E, Avakame E, Carthon MB. Minority faculty development programs and underrepresented minority faculty representation at US medical schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116 
  4. Guevara JP, Wade R, Aysola J. Racial and ethnic diversity at medical schools – why aren’t we there yet? N Engl J Med. 2021;385(19):1732-1734. doi:10.1056/NEJMp2105578
  5. Dill J, Akosionu O, Karbeah JM, Henning-Smith C. Addressing systemic racial inequity in the health care workforce. Health Affairs. September 10, 2020. Accessed July 12, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20200908.133196/full/ 
  6. Carr RM, Quezada SM, Gangarosa LM, et al; Governing Board of the American Gastroenterological Association. From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology. Gastroenterology. 2020;159(5):1637-1647. doi:10.1053/j.gastro.2020.07.044 
  7. American Gastroenterological Association. AGA equity project. Accessed July 11, 2022. https://gastro.org/aga-leadership/initiatives-and-programs/aga-equity-project/ 
  8. Barnes EL, Loftus EV Jr, Kappelman MD. Effects of race and ethnicity on diagnosis and management of inflammatory bowel diseases. Gastroenterology. 2021;160(3):677-689. doi:10.1053/j.gastro.2020.08.064 
  9. White PM, Iroku U, Carr RM, May FP; Association of Black Gastroenterologists and Hepatologists Board of Directors. Advancing health equity: The Association of Black Gastroenterologists and Hepatologists. Nat Rev Gastroenterol Hepatol. 2021;18(7):449-450. doi: 10.1038/s41575-021-00464-y 
  10. Ogunyemi D, Okekpe CC, Barrientos DR, Bui T, Au MN, Lamba S. United States medical school academic faculty workforce diversity, institutional characteristics, and geographical distributions from 2014-2018. Cureus. 2022;14(2):e22292. doi:10.7759/cureus.22292 
  11. Weiss J, Balasuriya L, Cramer LD, et al. Medical students’ demographic characteristics and their perceptions of faculty role modeling of respect for diversity. JAMA Netw Open. 2021;4(6):e2112795. doi:10.1001/jamanetworkopen.2021.12795 
  12. Association of American Medical Colleges (AAMC). Medical school enrollment more diverse in 2021. December 8, 2021. Accessed June 29, 2022. https://www.aamc.org/news-insights/press-releases/medical-school-enrollment-more-diverse-2021 
  13. Silvernale C, Kuo B, Staller K. Racial disparity in healthcare utilization among patients with irritable bowel syndrome: results from a multicenter cohort. Neurogastroenterol Motil. 2020;33(5):e14039. doi: 10.1111/nmo.14039 
  14. Robinett K, Kareem R, Reavis K, Quezada S. A multi-pronged, antiracist approach to optimize equity in medical school admissions. Med Educ. 2021;55(12):1376-1382. doi:10.1111/medu.14589 
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As the US population has become more diverse, the medical community has advocated for students, faculty, and curricula to reflect these changes. Understanding and addressing a patient’s culture and socioeconomic situation is vital to their well-being, and physicians who share in the cultural backgrounds and lived experiences of their patients are more likely to bring this insight and understanding to medicine.1 Yet over the last 2 decades, diversity among medical faculty is largely unchanged. One author recently wrote that students who are Black, Indigenous, and people of color (BIPOC) would be hard-pressed to find role models that look like them, as these populations are underrepresented among medical faculty.2-4

In 2020, the upsurge of the Black Lives Matter movement combined with the COVID-19 pandemic’s exposure of health disparities prompted society to better acknowledge socioeconomic inequalities and health organizations to revisit these issues.5,6 The AGA has introduced many crucial initiatives in collaboration with its Diversity Committee, including the AGA Equity  Project – a multiyear strategic plan designed to: eliminate health disparities and inequities in access, support GI research that aligns with the realities of multicultural patient populations, and educate AGA members and staff about unconscious bias.7

Further diversification of the gastroenterology workforce will ultimately benefit all patients – perhaps most notably patients from diverse backgrounds and lived experiences. Diagnosis and treatment outcomes in multiple digestive-tract diseases are disparate across different races and ethnicities. The literature has demonstrated that patients are more comfortable discussing sensitive health issues and undergoing procedures in the care of doctors with whom they share a similar  cultural background.8,9

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Progress of the AGA Equity Project

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In May 2022, the Digestive Disease Week (DDW) conference was held in person again for the first time in 3 years. Two years prior in July 2020 AGA launched the Equity Project, a six-point strategic plan to achieve equity and eradicate health disparities in digestive diseases.

President John Inadomi elected to focus his AGA Presidential Plenary session on updates in gastrointestinal and hepatic health disparities, and opened with a powerful testimony on his personal experiences encountering racism, and recognizing the need to translate spoken intentions into action.

Dr. Sandra Quezada, University of Maryland, Baltimore
Dr. Sandra Quezada

This served as the perfect segue to the second plenary presentation in which an update was given on the progress of the Equity Project by co-chairs Byron Cryer, MD, and Sandra Quezada, MD, MS. Dr. Cryer described the vision of the Equity Project, including: a just world, free of inequities in access and health care delivery; state-of-the-art and well-funded research of multicultural populations; a diverse physician and scientist workforce and leadership; recognition of achievements of people of color; membership and staff committed to self-awareness and eliminating unconscious bias; and an engaged, large, diverse, vocal, and culturally- and socially aware early career membership.

Dr. Byron Cryer, Baylor University Medical Center, Dallas
Dr. Byron Cryer

Concrete action items were identified by a coalition of AGA members with diverse representation across specialties, practice settings, and identities. AGA staff and constituency programs have been critical in the execution of each action item. Key performance indicators were selected to gauge progress and hold the organization accountable in implementation of project tactics. These metrics demonstrate that the first 2 years of the Equity Project have been very productive. Salient accomplishments include three congressional briefings on health disparities topics, increased education and dialogue on diversity, equity, and inclusion (DEI) through podcasts, career development workshops and DDW sessions, fundraising of over $300,000 to support health disparities research, dedicated DEI sections and section editors for Gastroenterology and Clinical Gastroenterology and Hepatology, and the creation of a guide for GI fellowship program directors to promote equity and mitigate bias in the fellowship selection process.

Although the Equity Project is entering its third and final implementation year, the spirit and values of the Equity Project will live on. Excellence in equity requires ongoing, focused dedication – AGA is committed to ensuring that equity, diversity, and inclusion are inherently embedded through the fabric of the organization, and continuously integrated and assessed in all of the organization’s future strategic initiatives.

Dr. Quezada is an associate professor of medicine in the division of gastroenterology and hepatology at the University of Maryland, Baltimore. She reports being on the People of Color Advisory Board for Janssen. Dr. Cryer is chief of internal medicine and the Ralph Tompsett Endowed Chair in Medicine at Baylor University Medical Center, Dallas, and a professor of internal medicine at Texas A&M School of Medicine. He has no relevant conflicts of interest. These remarks were made during the AGA Presidential Plenary at DDW 2022.

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In May 2022, the Digestive Disease Week (DDW) conference was held in person again for the first time in 3 years. Two years prior in July 2020 AGA launched the Equity Project, a six-point strategic plan to achieve equity and eradicate health disparities in digestive diseases.

President John Inadomi elected to focus his AGA Presidential Plenary session on updates in gastrointestinal and hepatic health disparities, and opened with a powerful testimony on his personal experiences encountering racism, and recognizing the need to translate spoken intentions into action.

Dr. Sandra Quezada, University of Maryland, Baltimore
Dr. Sandra Quezada

This served as the perfect segue to the second plenary presentation in which an update was given on the progress of the Equity Project by co-chairs Byron Cryer, MD, and Sandra Quezada, MD, MS. Dr. Cryer described the vision of the Equity Project, including: a just world, free of inequities in access and health care delivery; state-of-the-art and well-funded research of multicultural populations; a diverse physician and scientist workforce and leadership; recognition of achievements of people of color; membership and staff committed to self-awareness and eliminating unconscious bias; and an engaged, large, diverse, vocal, and culturally- and socially aware early career membership.

Dr. Byron Cryer, Baylor University Medical Center, Dallas
Dr. Byron Cryer

Concrete action items were identified by a coalition of AGA members with diverse representation across specialties, practice settings, and identities. AGA staff and constituency programs have been critical in the execution of each action item. Key performance indicators were selected to gauge progress and hold the organization accountable in implementation of project tactics. These metrics demonstrate that the first 2 years of the Equity Project have been very productive. Salient accomplishments include three congressional briefings on health disparities topics, increased education and dialogue on diversity, equity, and inclusion (DEI) through podcasts, career development workshops and DDW sessions, fundraising of over $300,000 to support health disparities research, dedicated DEI sections and section editors for Gastroenterology and Clinical Gastroenterology and Hepatology, and the creation of a guide for GI fellowship program directors to promote equity and mitigate bias in the fellowship selection process.

Although the Equity Project is entering its third and final implementation year, the spirit and values of the Equity Project will live on. Excellence in equity requires ongoing, focused dedication – AGA is committed to ensuring that equity, diversity, and inclusion are inherently embedded through the fabric of the organization, and continuously integrated and assessed in all of the organization’s future strategic initiatives.

Dr. Quezada is an associate professor of medicine in the division of gastroenterology and hepatology at the University of Maryland, Baltimore. She reports being on the People of Color Advisory Board for Janssen. Dr. Cryer is chief of internal medicine and the Ralph Tompsett Endowed Chair in Medicine at Baylor University Medical Center, Dallas, and a professor of internal medicine at Texas A&M School of Medicine. He has no relevant conflicts of interest. These remarks were made during the AGA Presidential Plenary at DDW 2022.

In May 2022, the Digestive Disease Week (DDW) conference was held in person again for the first time in 3 years. Two years prior in July 2020 AGA launched the Equity Project, a six-point strategic plan to achieve equity and eradicate health disparities in digestive diseases.

President John Inadomi elected to focus his AGA Presidential Plenary session on updates in gastrointestinal and hepatic health disparities, and opened with a powerful testimony on his personal experiences encountering racism, and recognizing the need to translate spoken intentions into action.

Dr. Sandra Quezada, University of Maryland, Baltimore
Dr. Sandra Quezada

This served as the perfect segue to the second plenary presentation in which an update was given on the progress of the Equity Project by co-chairs Byron Cryer, MD, and Sandra Quezada, MD, MS. Dr. Cryer described the vision of the Equity Project, including: a just world, free of inequities in access and health care delivery; state-of-the-art and well-funded research of multicultural populations; a diverse physician and scientist workforce and leadership; recognition of achievements of people of color; membership and staff committed to self-awareness and eliminating unconscious bias; and an engaged, large, diverse, vocal, and culturally- and socially aware early career membership.

Dr. Byron Cryer, Baylor University Medical Center, Dallas
Dr. Byron Cryer

Concrete action items were identified by a coalition of AGA members with diverse representation across specialties, practice settings, and identities. AGA staff and constituency programs have been critical in the execution of each action item. Key performance indicators were selected to gauge progress and hold the organization accountable in implementation of project tactics. These metrics demonstrate that the first 2 years of the Equity Project have been very productive. Salient accomplishments include three congressional briefings on health disparities topics, increased education and dialogue on diversity, equity, and inclusion (DEI) through podcasts, career development workshops and DDW sessions, fundraising of over $300,000 to support health disparities research, dedicated DEI sections and section editors for Gastroenterology and Clinical Gastroenterology and Hepatology, and the creation of a guide for GI fellowship program directors to promote equity and mitigate bias in the fellowship selection process.

Although the Equity Project is entering its third and final implementation year, the spirit and values of the Equity Project will live on. Excellence in equity requires ongoing, focused dedication – AGA is committed to ensuring that equity, diversity, and inclusion are inherently embedded through the fabric of the organization, and continuously integrated and assessed in all of the organization’s future strategic initiatives.

Dr. Quezada is an associate professor of medicine in the division of gastroenterology and hepatology at the University of Maryland, Baltimore. She reports being on the People of Color Advisory Board for Janssen. Dr. Cryer is chief of internal medicine and the Ralph Tompsett Endowed Chair in Medicine at Baylor University Medical Center, Dallas, and a professor of internal medicine at Texas A&M School of Medicine. He has no relevant conflicts of interest. These remarks were made during the AGA Presidential Plenary at DDW 2022.

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