Diversity in the Cancer Care Workforce

重要性：癌症劳动力的种族和民族分布与癌症劳动力的种族和民族分布形成鲜明对比。 一般人口。只有2-3%的肿瘤学家认为自己是黑人或拉丁裔，而在美国，这一比例分别为13%和18%。 人口分别。虽然商业文献中的证据表明，团队的多样性 组织绩效，尚不清楚提供者团队的多样性以及患者-提供者的种族 种族一致性与癌症相关护理的质量和结果相关。如果团队的多样性 （医生和病人共享网络）确实改善了癌症护理，这一好处可以改善所有人的护理 患者，无论个体患者的种族或民族或其提供者的种族或民族。 目标：我们的总体目标是提供可采取行动的证据，为改善癌症的努力提供信息 劳动力多样性和增加癌症护理的公平性。我们的假设是，种族和民族 肿瘤学工作人员的代表性在不同地区和患者共享网络中各不相同， 变异与临床护理有关。在此之前，解决这一知识差距是不可能的， 缺乏将医生种族和民族与患者临床数据相结合的可用数据。具体目标： 我们提出了一项回顾性研究，使用美国医学协会之间的新数据链接; 美国医学院协会;基于人群的监测、流行病学和最终结果 癌症登记处;和医疗保险数据，以实现以下目标：（目标1） 民族 和 共享 和 区域 病人分享 或 评估种族和 2015年至2020年期间癌症医生和实习生劳动力的多样性，根据专业 区域医疗保健市场和（目标1A）评估医生和患者的种族和民族多样性- 2015 - 2020年期间提供癌症护理的网络;（目标2）评估 跨专业、医生网络和地理区域的肿瘤学工作人员的种族代表性 和（目标2A），以确定是否在医学（URM）医生代表不足，以及医生 网络包含更高比例的URM医生，更有可能照顾黑人 拉丁裔癌症患者;（目的3）评估地理和卫生系统背景因素（例如健康 系统因素，地区社会人口统计学和结构性种族主义）与内部医生多样性相关 医生患者共享网络;（目的4）在诊断为浸润性肺、前列腺、乳腺或 2015年至2019年期间， 网络 收据 评估他们的医生的种族多样性 （目标4A）结直肠癌或乳腺癌患者的早期诊断（目标4 B） 与指南一致的癌症治疗，以及（目标4C）生命终末护理的质量。通过这个 研究，我们将创建一个新的数据链接，并结合网络科学的方法，以进一步我们的 了解癌症医生队伍，并确定医生团队的多样性是否可以作为 一种以前未确定的减少癌症结果中种族和民族差异的机制。

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.