Author + information
- Pamela S. Douglas, MD, MACC, Past President, American College of Cardiology; Chair, ACC Task Force on Diversity,
- Kim Allan Williams Sr., MD, MACC, Past President, American College of Cardiology; Vice-Chair, ACC Task Force on Diversity and
- Mary Norine Walsh, MD, FACC, President, American College of Cardiology∗ ()
- ↵∗Address for correspondence:
Dr. Mary Norine Walsh, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Diversity and inclusion are increasingly recognized as requirements for optimal organizational performance as they have proven to (1):
• Improve financial performance
• Leverage talent
• Reflect the marketplace and build reputation
• Increase innovation and group performance
In medicine, the case for diversity also includes: to better serve diverse patients, to promote health equity, to provide diverse mentors at all levels, to bring different points of view to debates and problem solving, to better engage our communities, and to include investigators with a broad range of perspectives in their scholarly activities.
Cardiology Is Not a Diverse Profession
In comparison to the U.S. population, cardiology is far less diverse (Figure 1). Data from the American Medical Association and the American Council on Graduate Medical Education show that 5.4% of cardiology trainees were African American and 6.8% were Hispanic, compared with 5.8% and 7.8%, respectively, in internal medicine in the 2015 to 2016 academic year (2). Overall, <10% of medical students and <3% of medical school faculty are African American (3). Although American College of Cardiology (ACC) member racial/ethnic demographic data are incomplete, and we do not have robust overall data on African-American and Hispanic representation, the ACC 2016 Professional Life Survey suggests that these groups each represent 3% to 6% of our membership (4). Specifically, extrapolating respondents’ data suggests that there are approximately 300 African-American men and 100 African-American women Fellows of the American College of Cardiology.
The ACC’s own data show that 9.8% of Fellows who are U.S. board certified in adult cardiovascular disease are women. American Association of Medical Colleges workforce reports show an improvement from 9.7% women in 2007 to 13.2% in 2015, but this is still far below the 37% of women in general internal medicine (Figure 2) (5,6). In fact, regarding the percentage of women in the specialty, cardiology ranks 36th out of 44 specialties tracked, and interventional cardiology ranks 42nd, followed only by thoracic and orthopedic surgery. The proportion of women in cardiology fellowships has held steady at 21% for the past 6 years, although internal medicine residents, our talent pool, are 43% female. This strongly suggests that the under-representation of women is not a pipeline issue, and may ultimately have a negative effect on our ability to attract and retain the best and brightest to our profession.
Improving Patient Care
Diversity is not just an issue for cardiologists; it is an issue for quality patient care. The Sullivan Report, Missing Persons: Minorities in the Health Professions: A Report of the Sullivan Commission on Diversity in the Healthcare Workforce (7), noted that diversity plays an important role in the nation’s health: “The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans.” Similarly, the American Association of Medical Colleges has called on policymakers to “prioritize research and initiatives for increasing diversity in the physician workforce” (8).
Essential to Our Mission
Diversity and inclusion are essential to the ACC’s mission, values, patients, and strategic business goals as a profession and as a professional society. The reasons for this include:
• Diversity drives better business decisions and financial performance, making it essential for ACC governance/leadership excellence.
• The ability to recruit from the entire available pool is critical to ensure continued excellence and maximize the talent in our profession.
• Diversity and inclusion are important elements of achieving the “Quadruple Aim” of clinician wellness, leading to enhanced job performance and work life, reduced harassment and burnout, and improved job satisfaction. This, in turn, improves care and patient satisfaction.
• A more diverse cardiovascular workforce will better address the health needs of our increasingly diverse patient populations, and make progress toward health equity.
• The movement toward team care requires clinician health, communication, and trust—qualities that are promoted by diversity and inclusion.
• Innovation requires diversity of background, ideas, and experience.
• Diversity and inclusion provide the ACC with a chance to lead among medical professional societies.
Moving Toward Solutions
To address these issues, the ACC Task Force on Diversity was formed in early 2017 and was charged with providing recommendations to the Board of Trustees to enable the achievement of the following goals:
1. To ensure that both cardiovascular medicine in general, as well as the ACC itself, attract and provide rewarding careers for the full range of talented individuals in medicine.
2. To ensure that both cardiovascular medicine in general, as well as ACC itself, benefit from a diversity of backgrounds, experiences, and perspectives in leadership, cardiovascular health care delivery, education, and science.
3. To ensure that the diverse needs of cardiovascular patients are met by cardiovascular clinicians sensitive to and respectful of their sex, cultural, racial, and ethnic diversity.
ACC Task Force on Diversity members (Table 1) were divided by preference into 5 work groups with the following objectives:
• Data and benchmarking: To provide the information required to fully assess the problem, benchmark the cardiology field and ACC, and devise solutions, as well as to create feasible and meaningful progress indicators/metrics.
• Deep pipeline: To increase the talent pool of under-represented minorities and women selecting medicine and cardiology as a career.
• Internal medicine residency to fellowship “cliff”: To ensure access to available talent: recruitment and retention among cardiologists.
• Cardiology field: To purposefully create a culture of inclusion in the cardiology community through advocacy and through championing and communicating diversity.
• Overarching concerns: To ensure that efforts to increase diversity and inclusivity are sustainable and implemented throughout the organization so that they will maximally benefit the ACC and the field of cardiology.
Each group has identified a series of strategic initiatives to address its goal, along with tactics, associated benchmarks and progress indicators/metrics, and enduring accountabilities. This includes identifying and recommending changes in policies, processes, education, structure, culture, and application of resources to foster a culture of inclusion and ensure the entry and advancement of women and under-represented minorities in the field of cardiology. The recommendations of each group were presented to the entire Task Force, after which, objectives and recommended strategic initiatives (including action items and progress/success metrics for each) were substantially revised and prioritized.
The ACC Task Force on Diversity presented an interim report to the Board of Trustees at its August Strategic Planning Retreat, including a detailed background document, draft Diversity and Inclusion Strategic Plan, and prioritized recommendations for activities to launch in 2018. The following 3 broad objectives were identified:
Objective 1: Enhance the culture within the cardiology profession and the perceptions of the field to be more inclusive, professional, equitable, and welcoming.
Objective 2: Realize and sustain the value of diversity over the long term by implementing structures and continuous improvement programs within the ACC for accountable execution.
Objective 3: Engage and leverage all available talent by providing value to under-represented groups in cardiology across the “career life-span,” from ensuring a deep pipeline to recruitment, retention, and leadership development.
These objectives are illustrated in Figure 3.
The ACC Diversity Task Force will continue to meet regularly throughout the summer and fall to further refine and prioritize its recommendations; add specific tactics; and derive more robust estimates of feasibility, impact, and expense. The final recommendations will be presented to the Board of Trustees in January 2018. With the extraordinary work of the Task Force, the ACC can envision a future College and specialty of cardiology that is more diverse and inclusive, and thus more able to serve our mission.
- 2017 American College of Cardiology Foundation
- ↵Catalyst. Why diversity matters. Available at: http://www.catalyst.org/system/files/why_diversity_matters_catalyst_0.pdf. Accessed August 3, 2017.
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- for the American College of Cardiology Women in Cardiology Leadership Council
- ↵Center for Workforce Studies, Association of American Medical Colleges. 2016 physician specialty data report. Available at: https://www.aamc.org/data/workforce/reports/458712/1-3-chart.html. Accessed August 3, 2017.
- ↵Center for Workforce Studies, Association of American Medical Colleges. 2008 physician specialty data. Available at: http://www.aamc.org/download/47352/data/specialtydata.pdf. Accessed August 7, 2017.
- ↵American Association of Colleges of Nursing. Missing persons: minorities in the health professions: a report of the Sullivan Commission on Diversity in the Healthcare Workforce. Available at: https://www.aamc.org/download/47352/data/specialtydata.pdf. Accessed August 23, 2017.
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