Diversity in the Cancer Care Workforce

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Significance: The racial and ethnic distribution of the cancer workforce contrasts starkly with that of the general population. Only 2-3% of oncologists identify as Black or Latinx, compared to 13% and 18% of the U.S. population, respectively. While evidence from the business literature suggests that diversity in teams impacts organizational performance, it is not known whether provider team diversity as well as patient-provider racial and ethnic concordance is associated with quality of cancer-related care and outcomes. If the diversity of teams (physician patient-sharing networks) does indeed improve cancer care, this benefit could improve care for all patients, regardless of the individual patient's race or ethnicity or the race or ethnicity of their provider. Objective: Our over-arching goal is to generate actionable evidence to inform efforts to improve cancer workforce diversity and increase equity in cancer care. Our hypothesis is that the racial and ethnic representation of the oncology workforce varies across regions and patient-sharing networks and that this variation is associated with clinical care. Previously, addressing this knowledge gap has not been possible due to a lack of available data combining physician race and ethnicity with patient clinical data. Specific Aims: We propose a retrospective study using a novel data linkage between the American Medical Association; Association of American Medical Colleges; Surveillance, Epidemiology and End Results population-based cancer registries; and Medicare data to address the following aims: (Aim 1) To ethnic and sharing and regions patient-sharing or assess changes in racial and diversity of the cancer physician and trainee workforce between 2015 and 2020, according to specialty regional healthcare market and ( Aim 1A ) to assess the racial and ethnic diversity of physician patient- networks providing cancer care during the period 2015 – 2020; ( Aim 2 ) To assess variation in racial ethnic representativeness of the oncology workforce across specialty, physician networks, and geographic and (Aim 2A) to identify whether underrepresented in medicine (URM) physicians, as well as physician networks containing a higher proportion of URM physicians, are more likely to care for Black Latinx patients with cancer; ( Aim 3 )To assess geographic and health system contextual factors (e.g. health system factors, area sociodemographics, and structural racism) associated with physician diversity within physician patient-sharing networks; (Aim 4) Among patients diagnosed with invasive lung, prostate, breast, or colorectal cancer during 2015-2019, to networks Receipt assess the association between the racial diversity of their physician , and ( Aim 4A) Early stage at diagnosis for patients with colorectal or breast cancer, ( Aim 4B ) of guideline-concordant cancer treatment, and ( Aim 4C) Quality of end of life care. Through this study, we will create a novel data linkage, and incorporate network science methods to further our understanding of the cancer physician workforce and to identify whether physician team diversity may serve as a previously unidentified mechanism of reducing racial and ethnic disparities in cancer outcomes.