ASCO’s 2022 State of the Oncology Workforce in America report presented a dismal picture of the representation of Hispanic/Latinx oncologists in the field. According to the report, despite initiatives aimed at increasing diversity in the nearly 13,400 oncology workforce, which includes about 36% female oncologists, just 4.7% of oncologists identify as Hispanic or Latinx; 3% are Black or African American; and 0.1% are Native American or Alaska Native.1
This lack of gender, racial, and ethnic diversity in the oncology workforce has serious implications for minority patients with cancer. Studies have shown that having providers with a shared ethnic/racial background improves patients’ interactions with their physician and results in a more positive health-care experience.2 There is also growing evidence that a gender-diverse oncology workforce may result in improved outcomes for patients.3
Although the consequences of gender inequity in the oncology workforce in the United States have been well documented, little is known about the experience of internationally trained female oncologists practicing in the United States.
Workplace Discrimination Among Minority Female Oncologists
Coral Olazagasti, MD
Acts of discrimination by her superiors and colleagues at an academic cancer center in New York City prompted Coral Olazagasti, MD, a native of Puerto Rico, to launch a study examining gender disparities among immigrant medical graduates and Puerto Rican medical graduates in oncology in the United States. Dr. Olazagasti, Assistant Professor of Clinical Medical Oncology at the Sylvester Comprehensive Cancer Center in Miami, and her colleagues developed an anonymous online survey of non–U.S. international medical graduates and Puerto Rican medical graduates in oncology in the United States that was distributed between September and December 2023.
Eligible survey participants included 97 immigrant and Puerto Rican medical graduates (49% women). The survey findings showed that women experienced significantly higher rates of gender discrimination during training than men (53.2% vs 4.5%, respectively) and in independent practice (57.6% vs 3.6%, respectively). Women also experienced higher rates of ethnic/racial discrimination during training than men (69.6% vs 38.1%, respectively); and another large majority of women, 65%, said they faced cultural challenges adapting to American traditions compared with 44% of men. The study results were presented during the 2024 ASCO Annual Meeting and simultaneously published in the Journal of Clinical Oncology.4
“This is the first cross-sectional study to assess gender disparities among international medical graduates and Puerto Rican medical graduates in oncology in the United States,” said Dr. -Olazagasti. “I knew there would be some degree of greater gender discrimination in women than men, but I didn’t expect it to be 13 times greater among minority women during independent practice and 10 times greater during training. These results are shocking to me.”
In a wide-ranging interview with The ASCO Post, Dr. Olazagasti discussed the discrimination and microaggressions she experienced at her cancer center; how she overcame workplace bullying; and what institutions can do to improve gender, racial, and ethnic equity in oncology.
Fitting Into a Medical Mold
Please share some of your experiences with discrimination and microaggressions from your superiors and colleagues during your residency and how these workplace practices were manifested.
Being from Puerto Rico and a U.S. citizen, I thought the transition from graduating medical school in Puerto Rico and moving to New York City to start my residency training in internal medicine would be relatively smooth. Unfortunately, a week into my residency, I started noticing aspects of discrimination from my superiors and colleagues. Initially, I thought I was imagining the slights and jokes at my expense, but they became so numerous and blatant that I knew what I was experiencing was not in my mind.
For example, I was working in the intensive care unit and during rounds, peers and colleagues would make fun of my accent when I pronounced the name of some medications. In medical school in Puerto Rico, even though our lectures and tests are in English, a lot of our didactics are in Spanish. There was one instance where I used the Spanish name for a drug, because that’s the way I learned how to pronounce it, and my colleagues laughed at me. That mispronounced word became a running joke.
Another example is once when I wore a dress instead of the extra-large scrubs I was given during rounds (I am just 5’2”), I again was made fun of and made to feel I had to change who I am to fit into a mold that wasn’t quite made for me. Being the center of the joke makes you feel insecure. Many of my friends from Puerto Rico who were also doing their medical training in New York experienced this same type of microaggression.
I also remember being chastised by a mentor, another minority woman, for being too excited about a fellowship program I was participating in. “I suggest you bottle your enthusiasm,” she said. I was often told I was too passionate and maybe a little bit too loud and colorful. These criticisms make you a shell of who you are, and you have to dig deep to overcome those feelings of being inadequate.
Experiencing Gender Bias in the Workplace
Did you feel you were discriminated against for your gender as well as your ethnicity?
Most of the discrimination I experienced I thought was related to my race and ethnicity, but what I gathered from the results of our study is that female physicians are more likely to experience gender bias in the workplace, and that also translates into racial discrimination. Many people are more comfortable discriminating against women than men, and I feel that gender bias and discrimination are tied together.
Finding Comfort in the Community
How did you respond to the gender and race/ethnicity-based discrimination at your institution? Was there a protocol in place to report your experiences?
There was no protocol at the institutional level to report and correct unconscious bias and outright discrimination. Also, having these encounters made me feel that maybe I was at fault. They eroded my confidence, so I kept quiet. When my peers made fun of my accent or the way I dressed, I tried to laugh along with them to soften the hurt feelings and blend in more with the culture.
How I coped with unconscious bias and discrimination was to seek comfort in my family, my faith, and through therapy. I came to understand that I was not the problem. What I was experiencing is a societal and institutional problem. What really helped me overcome my own feelings of inadequacy was finding a community that looks like me and talks like me. I learned to find a place within myself where I was accepted and celebrated, and that helped to build my confidence.
It was also comforting to know there is a movement toward reaching gender equity and to ending ethnic and racial discrimination. There are steps I can take to stand up for myself as well as for future generations of minority oncologists.
Celebrating Uniqueness
Because of the gender-based and racial/ethnic discrimination you experienced at your cancer center in New York City, you decided to take a position at the Sylvester Comprehensive Cancer Center in Miami. What is the workplace environment at your new institution?
It’s completely different. One of the main reasons I wanted to make the move from New York to Miami is because of the diverse population. Faculty here are from all backgrounds, races, and ethnicities. The Sylvester Comprehensive Cancer Center seemed like a place where I could be myself and celebrated for my uniqueness—and not be mocked—and I can’t say enough good things about being here.
The findings from our study revealed the gender and racial/ethnic discrimination that exists in oncology for women. To overcome these inequities and achieve gender equity pay transparency, diversity in selection committees is necessary. And efforts to end disparities need to happen across all settings, including academia, private practice, and industry. Improvement starts with diversifying the environment, diversifying the residency and fellowship programs, and increasing the representation of women in leadership roles. (See “ASCO Initiatives to Increase Gender, Racial, and Ethnic Diversity in the Oncology Workforce” below.)
Institutions also have to put practices in place that address sexual, gender, and racial/ethnic harassment and offer policies for reporting and investigating discrimination at every level. I’ll also add that institutions should make a point of sponsoring junior-level minority women for opportunities and creating mentorship programs. Minority women often fall prey to the imposter syndrome in which they doubt their intellect or accomplishments. It’s difficult for us to find a voice and confidence within ourselves, so it’s important to provide opportunities for minority women to succeed.
Finally, we need both female and male allies to achieve greater equity for all oncologists. Men need to be “action-standers,” not just bystanders, because there is power in numbers, and we all need to come together now.
ASCO Initiatives to Increase Gender, Racial, and Ethnic Diversity in the Oncology Workforce
In 2016, ASCO released its strategic plan for increasing racial and ethnic diversity in the oncology workforce. The ultimate goal is to develop a workforce that provides high-quality cancer care to racial and ethnic patient populations to improve health outcomes. To accomplish that goal, ASCO’s initiative includes specific objectives, such as improving and expanding mentoring opportunities and career development for oncologists and trainees from underrepresented populations in medicine; assessing policy solutions that may increase the number of underrepresented oncologists; and increasing racial/ethnic diversity among ASCO leadership.
Here are some ASCO programs intended to help build a diverse oncology workforce:
Diversity Mentoring Program (https://society.asco.org/career-development/mentoring/diversity-mentoring-program). This program helps United States–based underrepresented medical students and residents interested in pursuing a career in oncology foster relationships with mentors who can provide career and educational guidance and serve as a professional resource. The mentoring term is up to 12 months, with a 6-month minimum commitment. Check the website for details on when applications for the 2025–2026 Diversity Mentoring Program will be accepted.
Medical Student Rotation for Underrepresented Populations Award (https://society.asco.org/career-development/grants-awards/funding-opportunities/medical-student-rotation-underrepresented). This award provides financial support for U.S. medical students from populations underrepresented in medicine who are interested in a career in oncology to experience a minimum 4-week clinical or clinical research rotation. Eligible applicants can apply through ASCO’s application portal (https://asco.smapply.org) from October 25, 2024, through January 27, 2025.
Oncology Summer Internship Program (https://society.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/oncology-summer-internship). This partnership program between ASCO and U.S. medical schools introduces medical students from populations underrepresented in medicine to key concepts and career options in oncology. In the program’s first and second years, ASCO collaborated with 11 medical schools to support a total of 81 second-year medical students through daily clinical shadowing and weekly social events at their school, as well as virtual ASCO educational sessions with oncologists from across the United States. Applications for institutions to be considered as a host site usually open in the fall of each year. Eligible students at current Oncology Summer Internship host sites will receive application details from their school administration. Eligible students should apply through ASCO’s application portal (https://asco.smapply.org/) between October and January in their first year of medical school.
ASCO Annual Meeting Research Award (AMRA) for Underrepresented Populations (https://society.asco.org/career-development/grants-awards/funding-opportunities/annual-meeting-research-award). This is a supplemental merit award for ASCO’s Medical Student and Resident Abstract Forum presenters who are underrepresented in medicine. Applicants must be medical students or residents who are submitting oncology research to the Abstract Forum, which is an intimate poster presentation designed for students and residents to practice their research skills and have an opportunity to network at the ASCO Annual Meeting. Awardees will be required to attend the 2025 ASCO Annual Meeting in Chicago to present their work at the Abstract Forum on May 31, 2025. The AMRA includes a $1,500 award to support meeting attendance and complimentary ASCO Annual Meeting registration.
DISCLOSURE: Dr. Olazagasti is on the advisory boards of Novocure, AstraZeneca, and MJH Life Science.
REFERENCES
1. 2022 Snapshot: State of the Oncology Workforce in America. JCO Oncol Pract 18:396, 2022.
2. Artiga S, Hamel L, Gonzalez-Barrera A, et al: Survey on racism, discrimination and health: Experiences and impacts across racial and ethnic groups. KFF, December 5, 2023. Available at www.kff.org/report-section/survey-on-racism-discrimination-and-health-findings. Accessed September 11, 2024.
3. Gender equality in medicine: Change is coming. Editorial. Lancet Gastroenterol Hepatol 4:893, 2019.
4. Olazagasti C, Villa Celi C, Velazquez A, et al: Assessing gender disparities in oncology: Less talk, more action. J Clin Oncol 42(16 suppl):9011, 2024.
