Proposal Calls for Educating, Empowering Radiologists to Address Healthcare Disparity 

Racial disparities in health care have gained increased awareness and urgency, underscored by the inequitable effects of the COVID-19 pandemic along with a backlash to high-profile incidents of racial injustice.

A recent article, published in Clinical Imaging, proposes a solution to the current lack of an organized and nationally accepted educational program for practicing radiologists to address diversity and healthcare disparity.

The article, written by Miral M. Patel, MD, and Jay R. Parikh, MD, FSBI, FACR, of the Division of Diagnostic Imaging at the University of Texas MD Anderson Cancer Center, calls for a three-pronged education approach to address health care disparities in radiology -- individual education, institutional change and national cooperation.

“Our intention is to further increase awareness of healthcare disparities in order to ultimately empower radiologists to work both with their respective institutions and national organizations to incrementally reduce these disparities,” Patel told Diagnostic Imaging.

The article noted disparities specific to radiology. For example, a 2011 trial found that low dose computed tomography was associated with a 20% reduction in mortality specific to lung cancer compared with chest radiography, however, Black Americans may be less likely to meet eligibility criteria. Similarly, Black patients may be hindered from prostate MRI and breast cancer screening.

“As our primary daily practice is that of breast imaging, a subspecialty in radiology, it was eye-opening to see how widespread healthcare disparities are among all radiology subspecialties, which again reinforces the role we as radiologists can play in creating change,” Patel said.

The article pointed out disparities in the use of imaging to evaluate acute ischemic stroke related to whether patients were uninsured, on Medicaid or Medicare, or had private insurance. Also, race was found to be an independent predictor of imaging missed care opportunities

Efforts have been made to diversify the workforce in health care and to educate medical students and trainees about disparities. Miral and Parikh called for an educational curriculum for practicing radiologists with a consolidated web-based training program that is updated annually.

The components of diversity education include 1) acknowledge that disparity exists, 2) understanding one’s implicit bias, 3) cultural competency training specific to radiology, and 4) raising awareness of radiology political action committees.

“We would like to increase clinician and health care provider awareness of these issues, but also to increase institutional awareness as any attempt at change requires multiple layers of support, including institutional motivation to partner with radiologists to find solutions,” Patel said.

Miral and Parikh called for institutional change similar to that initiated by a 2002 report by the Institute of Medicine titled “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.”

They said institutional cultural change requires mandates from leaders along with support of health care professionals to alleviate cognitive overloading.

National cooperation is necessary to advance beyond current discussions to action. The article proposed a co-sponsored national meeting of radiologist from a variety of subspecialties, regions and backgrounds to brainstorm potential solutions. National support also could raise awareness of limitations of insurance coverage that contribute to disparities, empowering radiologists to advocate for change.

“The next steps are leveraging the influence of national radiology organizations to work together in educating, brainstorming, and empowering radiologists and the respective institutions in which they practice to create practice-specific changes at the local level,” Patel said.