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Physics Contribution| Volume 8, ISSUE 1, 101057, January 2023

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Diversity and Professional Advancement in Medical Physics

Open AccessPublished:August 28, 2022DOI:https://doi.org/10.1016/j.adro.2022.101057
Diversity and Professional Advancement in Medical Physics
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      Abstract

      Purpose

      While disparities in the inclusion and advancement of women and minorities in science, technology, engineering, mathematics, and medical fields have been well documented, less work has focused on medical physics specifically. In this study, we evaluate historical and current diversity within the medical physics workforce, in cohorts representative of professional advancement (PA) in the field, and within National Institutes of Health (NIH)–funded medical physics research activities.

      Methods and Materials

      The 2020 American Association of Physicists in Medicine (AAPM) membership was queried as surrogate for the medical physics workforce. Select subsets of the AAPM membership were queried as surrogate for PA and early career professional advancement (ECPA) in medical physics. Self-reported AAPM-member demographics data representative of study analysis groups were identified and analyzed. Demographic characteristics of the 2020 AAPM membership were compared with those of the PA and ECPA cohorts and United States (US) population. The AAPM-NIH Research Database was appended with principal investigator (PI) demographics data and analyzed to evaluate trends in grant allocation by PI demographic characteristics.

      Results

      Women, Hispanic/Latinx/Spanish individuals, and individuals reporting a race other than White or Asian alone comprised 50.8%, 18.7%, and 32.4% of the US population, respectively, but only 23.9%, 9.1%, and 7.9% of the 2020 AAPM membership, respectively. In general, representation of women and minorities was further decreased in the PA cohort; however, significantly higher proportions of women (P < .001) and Hispanic/Latinx/Spanish members (P < .05) were observed in the ECPA cohort than the 2020 AAPM membership. Analysis of historical data revealed modest increases in diversity within the AAPM membership since 2002. Across NIH grants awarded to AAPM members between 1985 and 2020, only 9.4%, 5.3%, and 1.7% were awarded to women, Hispanic/Latinx/Spanish, and non-White, non-Asian PIs, respectively.

      Conclusions

      Diversity within medical physics is limited. Proactive policy should be implemented to ensure diverse, equitable, and inclusive representation within research activities, roles representative of PA, and the profession at large.

      Introduction

      Limited diversity in science, technology, engineering, mathematics, and medicine (STEMM) is a long-standing issue.

      Matthews CM. Underrepresented minorities and women in science, mathematics, and engineering: Problems and issues for the 1990s. CRS Report for Congress. Available at: https://files.eric.ed.gov/fulltext/ED337525.pdf. Accessed February 8, 2022.

      ,

      Landivar LC. Disparities in STEM employment by sex, race, and Hispanic origin. American Community Survey Reports. Available at: https://www2.census.gov/library/publications/2013/acs/acs-24.pdf. Accessed February 8, 2022.

      Despite improvements in the inclusion of women and underrepresented minorities
      In the context of STEMM higher education and workforce, ‘underrepresented minorities’ refers to individuals reporting Black or African American race, American Indian or Alaska Native race, or Hispanic or Latino ethnicity.
      at the undergraduate level,

      National Science Foundation, National Center for Science and Engineering Statistics. Women, minorities, and persons with disabilities in science and engineering. Available at: https://ncses.nsf.gov/pubs/nsf21321/. Accessed February 8, 2022.

      disparities persist in higher educational attainment

      National Science Foundation, National Center for Science and Engineering Statistics. Women, minorities, and persons with disabilities in science and engineering. Available at: https://ncses.nsf.gov/pubs/nsf21321/. Accessed February 8, 2022.

      ,

      Association of American Medical Colleges. Diversity in medicine: Facts and figures 2019. Available at: https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Accessed February 8, 2022.

      and in activities classically representative of professional advancement (PA), including scientific authorship
      • Marschke G
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      and among award and grant recipients.
      • Ma Y
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      Women who win prizes get less money and prestige.
      Nature. 2019; 565: 287-288
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      • Chaudhary AMD
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      Gender differences in research project grants and R01 grants at the National Institutes of Health.
      Cureus. 2021; 13: e14930
      , 

      National Institutes of Health. Racial disparities in NIH funding. Available at: https://diversity.nih.gov/building-evidence/racial-disparities-nih-funding. Accessed February 8, 2022.

      Within academia, diversity tends to be more limited at the faculty level than among students, a trend that is exacerbated with increasing academic rank.

      National Science Foundation, National Center for Science and Engineering Statistics. Women, minorities, and persons with disabilities in science and engineering. Available at: https://ncses.nsf.gov/pubs/nsf21321/. Accessed February 8, 2022.

      ,

      Association of American Medical Colleges. Diversity in medicine: Facts and figures 2019. Available at: https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Accessed February 8, 2022.

      ,
      • Rissler LJ
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      Gender differences in grant submissions across science and engineering fields at the NSF.
      Bioscience. 2020; 70: 814-820
      Collectively, these findings reveal a progressive decline in the representation of women and minorities in roles associated with increased seniority, specialization, or qualification—a leaky pipeline through which there is a disproportionate loss of diversity along academic and career trajectories (eg, Pell,
      • Pell AN.
      Fixing the leaky pipeline: Women scientists in academia.
      J Anim Sci. 1996; 74: 2843-2848
      Buckles,
      • Buckles K.
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      J Econ Perspect. 2019; 33: 43-60
      and Liu et al
      • Liu SC
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      Patching the “leaky pipeline”: Interventions for women of color faculty in STEM academia.
      Arch Sci Psychol. 2019; 7: 32-39
      ). Rather than representing a lack of talent, ability, or motivation among those exiting the pipeline, pipeline leaks have been attributed to a number of interrelated, systemic factors, including limited networking and mentorship opportunities, social isolation within the workplace, disproportionate service and administrative burdens, work-life integration challenges, implicit bias, and experiences of harassment and discrimination, among others.
      • Pell AN.
      Fixing the leaky pipeline: Women scientists in academia.
      J Anim Sci. 1996; 74: 2843-2848
      , 
      • Buckles K.
      Fixing the leaky pipeline: Strategies for making economics work for women at every stage.
      J Econ Perspect. 2019; 33: 43-60
      , 
      • Liu SC
      • Brown SEV
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      Patching the “leaky pipeline”: Interventions for women of color faculty in STEM academia.
      Arch Sci Psychol. 2019; 7: 32-39
      , 
      • Beeler WH
      • Griffith KA
      • Jones RD
      • et al.
      Gender, professional experiences, and personal characteristics of academic radiation oncology chairs: Data to inform the pipeline for the 21st century.
      Int J Radiat Oncol. 2019; 104: 979-986
      Fortunately, improved understanding of these issues has led to development of ameliorating interventions and avenues for support within various fields (eg, Buckles,
      • Buckles K.
      Fixing the leaky pipeline: Strategies for making economics work for women at every stage.
      J Econ Perspect. 2019; 33: 43-60
      Liu et al,
      • Liu SC
      • Brown SEV
      • Sabat IE.
      Patching the “leaky pipeline”: Interventions for women of color faculty in STEM academia.
      Arch Sci Psychol. 2019; 7: 32-39
      and Allen-Ramdial and Campbell
      • Allen-Ramdial SA
      • Campbell AG.
      Reimagining the pipeline: Advancing STEM diversity, persistence, and success.
      Bioscience. 2014; 64: 612-618
      ).
      While work regarding diversity and PA in medical physics is limited, existing scholarship suggests similar issues within the field. Recent analysis of the historical and current American Association of Physicists in Medicine (AAPM) membership revealed that women have remained underrepresented for over 5 decades, at maximum comprising 23.3% of AAPM members in 2019.
      • Covington EL
      • Moran JM
      • Paradis KC.
      The state of gender diversity in medical physics.
      Med Phys. 2020; 47: 2038-2043
      Additionally, women were found to be underrepresented in a variety of clinical and AAPM leadership positions, including as Commission on Accreditation of Medical Physics Education Programs (CAMPEP) program directors and AAPM council chairs, within AAPM executive committee roles, and as award recipients. Development and analysis of the AAPM–National Institutes of Health (NIH) Research Database has also revealed gender disparities in the allocation of research funding.
      • Whelan B
      • Moros EG
      • Fahrig R
      • et al.
      Development and testing of a database of NIH research funding of AAPM members: A report from the AAPM Working Group for the Development of a Research Database (WGDRD).
      Med Phys. 2017; 44: 1590-1601
      Amongst AAPM members, men are more than twice as likely to hold NIH funding than are women,
      • Whelan B
      • Moros EG
      • Fahrig R
      • et al.
      Development and testing of a database of NIH research funding of AAPM members: A report from the AAPM Working Group for the Development of a Research Database (WGDRD).
      Med Phys. 2017; 44: 1590-1601
      and, relative to representation in the AAPM membership, a consistently lower proportion of women held NIH funding than did men for all years 2002 to 2019.
      • Scarpelli M
      • Whelan B
      • Farahani K.
      Domain classification and analysis of national institutes of health-funded medical physics research.
      Med Phys. 2021; 48: 605-614
      Collectively, this literature reveals that women are not only underrepresented in medical physics in general, but they are even less likely to hold roles or distinctions classically representative of PA in the field.
      Improvements in the recruitment, retention and career advancement of women and minority medical physicists would benefit the entire medical physics workforce, as a diverse and inclusive climate begets enhancements in innovation, productivity, and morale.

      Rohwerder B. Impact of diversity and inclusion within organizations. Available at: https://www.academia.edu/35132220/Impact_of_diversity_and_inclusion_within_organisations. Accessed February 10, 2022.

      ,

      Hunt V, Layton D, Prince S. Why diversity matters. Available at: https://www.mckinsey.com/∼/media/mckinsey/business%20functions/organization/our%20insights/why%20diversity%20matters/diversity%20matters.ashx. Accessed February 10, 2022.

      Furthermore, increased workforce diversity may yield improvements in both public health and individual patient experiences. As medical providers, minority physicians disproportionately care for patients of medically underserved populations, including low income, minority, and Medicaid patients.
      • Marrast LM
      • Zallman L
      • Woolhandler S
      • Bor DH
      • McCormick D.
      Minority physicians' role in the care of underserved patients: Diversifying the physician workforce may be key in addressing health disparities.
      JAMA Intern Med. 2014; 174: 289-291
      Additionally, racial concordance between patients and medical providers may be associated with increased patient satisfaction and cultural competence, longer encounters, and adherence to treatment plans.
      • Takeshita J
      • Wang S
      • Loren AW
      • et al.
      Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings.
      JAMA Netw Open. 2020; 3e2024583
      , 
      • Cooper LA
      • Roter DL
      • Johnson RL
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      • Steinwachs DM
      • Powe NR.
      Patient-centered communication, ratings of care, and concordance of patient and physician race.
      Ann Intern Med. 2003; 139: 907-915
      , 
      • Schoenthaler A
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      • Linzer M.
      Patient-physician racial/ethnic concordance and blood pressure control: The role of trust and medication adherence.
      Ethn Health. 2014; 19: 565-578
      Recent work has called attention to the particularly important role of a diverse oncology workforce in addressing racial disparities in cancer outcomes.
      • Winkfield KM
      • Flowers CR
      • Mitchell EP.
      Making the case for improving oncology workforce diversity.
      Am Soc Clin Oncol Educ Book. 2017; 37: 18-22
      Given that, in 2019, 78% of PhD, board-certified medical physicists reported their role to be “primarily clinical,”

      American Association of Physicists in Medicine. Professional survey report: Calendar year 2019. Available at: https://www.aapm.org/pubs/surveys.asp. Accessed May 2021.

      efforts to increase diversity in medical physics stand to produce meaningful improvements in patient care and outcomes.
      To our knowledge, there has not been a comprehensive, quantitative study of historical and current diversity in the medical physics workforce, leadership pools, and research activities that includes analysis of race and ethnicity in addition to gender, nor which evaluates diversity in roles associated with early career professional advancement (ECPA). In this study, we therefore seek to analyze gender, racial, and ethnic diversity within the medical physics workforce and in cohorts representative of PA in the field, including those representative of ECPA. Additionally, we use the AAPM-NIH Research Database
      • Whelan B
      • Moros EG
      • Fahrig R
      • et al.
      Development and testing of a database of NIH research funding of AAPM members: A report from the AAPM Working Group for the Development of a Research Database (WGDRD).
      Med Phys. 2017; 44: 1590-1601
      to examine trends in medical physics grant funding by principal investigator (PI) demographic characteristics. This work will provide meaningful context to support the development of actionable policy that ensures diversity and equitable opportunity for PA within medical physics.

      Methods and Materials

      The 2020 AAPM membership was queried as surrogate for the current medical physics workforce, while select subsets of the AAPM membership representing career advancement and leadership were queried as surrogates for PA and ECPA in the field. The PA cohort included CAMPEP program directors, NIH grant recipients, and AAPM committee members, committee chairs, and award recipients. The ECPA cohort was comprised of 2 subgroups, early career leadership and early career research leadership. Inclusion criteria for study analysis groups and subgroups are summarized in Table 1. Active AAPM membership in 2020 was added to the inclusion criteria for subgroups without criteria that otherwise ensured recent involvement in medical physics-related professional activities. Awards associated with the AAPM award recipients subgroup are available in Appendix E1.
      Table 1Inclusion criteria for study analysis groups and subgroups
      Study analysis groupSubgroupInclusion criteria
      2020 AAPM membership
      • Active member of AAPM in 2020
      Professional advancement cohortCAMPEP program directors
      • Director of CAMPEP-accredited medical physics residency, graduate, certificate, or professional doctorate program as of 2021
        Current or former member of AAPM
      NIH grant recipients
      • Principal investigator awarded NIH grant between 1985 and 2020
        Active member of AAPM in 2020
      AAPM award recipients
      • Ever recipient of AAPM award
        Active member of AAPM in 2020
      AAPM committee members
      • Ever AAPM committee member
        Active member of AAPM in 2020
      AAPM committee chairs
      • Ever AAPM committee chair or vice chair
        Active member of AAPM in 2020
      Early career professional advancement cohortEarly career leadership
      • Member of any professional advancement cohort subgroup
        Age <40 y as of January 1, 2020
      Early career research leadership
      • Received NIH K- or F-grant funding, an AAPM Research Seed Grant, or an AAPM early career or junior investigator award between 2016 and 2020
      Abbreviations: AAPM = American Association of Physicists in Medicine; CAMPEP = Commission on Accreditation of Medical Physics Education Programs; NIH = National Institutes of Health.
      Historical membership, committee, and awards records provided by AAPM were used to identify AAPM members, committee members and chairs, and award recipients, respectively. NIH grant recipients, CAMPEP program directors, and AAPM Research Seed Grant recipients were identified through the AAPM-NIH Research Database,
      • Whelan B
      • Moros EG
      • Fahrig R
      • et al.
      Development and testing of a database of NIH research funding of AAPM members: A report from the AAPM Working Group for the Development of a Research Database (WGDRD).
      Med Phys. 2017; 44: 1590-1601
      the CAMPEP website,

      Commission on Accreditation of Medical Physics Education Programs. Available at: https://www.campep.org/. Accessed April 10, 2021.

      and publicly available AAPM Education and Research Fund Recipients data,

      American Association of Physicists in Medicine. Grants and fellowships: AAPM education and research fund recipients. Available at: https://gaf.aapm.org/education/edfund.php. Accessed March 14, 2022.

      respectively.
      Voluntary, self-reported demographics data for current and former AAPM members were provided by AAPM. Demographics data were recoded for clarity and, for race data, consistency with United States (US) Census data.

      Jensen E, Jones N, Orozco K, et al. Measuring racial and ethnic diversity for the 2020 census. Available at: https://www.census.gov/newsroom/blogs/random-samplings/2021/08/measuring-racial-ethnic-diversity-2020-census.html. Accessed February 10, 2022.

      A detailed data recoding schema is available in Appendix E2, Figure E1. US population race and ethnicity demographics data were obtained from the 2020 US Decennial Census.

      United States Census Bureau. Decennial census. P1—Race. 2020: DEC redistricting data (PL 94-171). Available at: https://data.census.gov/cedsci/table?q=United%20States&g=0100000US&tid=DECENNIALPL2020.P1. Accessed March 14, 2022.

      ,

      United States Census Bureau. Decennial census. P2—Hispanic or Latino, and not Hispanic or Latino by race. 2020: DEC redistricting data (PL 94-171). Available at: https://data.census.gov/cedsci/table?q=United%20States&g=0100000US&tid=DECENNIALPL2020.P2. Accessed March 14, 2022.

      US population sex demographics data were obtained from the 2019 American Community Survey.

      United States Census Bureau. American community survey. DP05—ACS demographic and housing estimates. 2019: ACS 1-year estimates data profiles. Available at: https://data.census.gov/cedsci/table?tid=ACSDP1Y2019.DP05&hidePreview=true&tp=false&moe=false. Accessed March 14, 2022.

      AAPM-member demographics data representative of the 2020 AAPM membership, PA cohort, and ECPA cohort were identified through a series of data processing steps (Fig. 1). Number and percentage of members by demographic characteristic were calculated for each study analysis group. Not reported or unavailable demographics data were excluded from calculations of percentages. To evaluate historical trends in membership demographics, the process was repeated for all years of available AAPM membership data, 2002 to 2020.
      Figure 1
      Figure 1Process used to identify demographics data representative of study analysis groups. Demographics data representative of study analysis groups were identified by filtering American Association of Physicists in Medicine (AAPM)–member demographics data with lists of AAPM-member identifier numbers representative of each study analysis group. Abbreviations: CAMPEP = Commission on Accreditation of Medical Physics Education Programs; ECPA = early career professional advancement; NIH = National Institutes of Health; PA = professional advancement. *Self-reported AAPM-member demographics data was not available for all members.
      The AAPM-NIH Research Database was appended with AAPM demographics data by merging data sets on PI AAPM-member identifier number. PI race and ethnicity were identified using appended AAPM demographics data while PI gender identity was identified using a preexisting gender data field from the AAPM-NIH Research Database. Number and percentage of grants awarded by PI demographic characteristic were calculated, once across all grant activity types and once for the subset of K- and F-grants only. For both calculations, grants awarded in all years represented in the data set, 1985 to 2020, were pooled. Data were filtered to ensure that grants were counted only once regardless of years of funding. To investigate historical trends, calculations were repeated with grants stratified by first year of funding. Grants with not reported or unavailable demographics data were excluded from calculations of percentages.
      Data processing and analysis were performed using Python version 3.7.4 (Python Software Foundation, https://www.python.org/) and Microsoft Excel.

      Statistical analysis

      Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc). Demographic characteristics of the 2020 AAPM membership were compared with those of the PA cohort, ECPA cohort, and US population. The 1-sample test for proportions was used to determine whether differences in percentages of members reporting a given demographic identity were statistically significant at the P < .05 level of significance. The exact 1-sample test for proportions was used when 1-sample test assumptions were not met. Statistical analysis was not performed in cases where one or both comparison group(s) contained no members reporting a given demographic identity.

      Results

      Demographic characteristics of the 2020 AAPM membership, PA cohort, ECPA cohort, and US population are summarized in Table 2. Granular demographic characteristics of PA and ECPA cohort subgroups are available in Appendix E3, Tables E1 and E2, respectively. Notably, AAPM-member demographics data was limited, with gender identity, race, and ethnicity reported by 90.2%, 38.6%, and 28.2%, respectively, of members represented in the data set overall.
      Table 2Demographic characteristics of the US population, 2020 American Association of Physicists in Medicine membership, and medical physics professional advancement and early career professional advancement cohorts
      CharacteristicUS population
      US population data by race and ethnicity obtained from the 2020 US Decennial Census.2829 US population data by sex obtained from the 2019 American Community Survey.30
      		2020 AAPM membership (N = 9450)Professional advancement cohort (n = 2894)Early career professional advancement cohort (n = 703)
      Gender identity, n (%
      Counts for 'Not reported or unavailable' groups were excluded from calculation of percentages.
      )
       Man161,588,973 (49.2)6844 (76.1)2189 (76.4)430 (61.7)
       Woman166,650,550 (50.8)2149 (23.9)674 (23.5)266 (38.2)
       Gender identity minority3 (<0.1)1 (<0.1)1 (0.1)
       Not reported or unavailable454306
      Race, n (%
      Counts for 'Not reported or unavailable' groups were excluded from calculation of percentages.
      )
       White alone204,277,273 (61.6)2611 (64.6)935 (69.3)268 (68.5)
       Asian alone19,886,049 (6.0)1112 (27.5)321 (23.8)99 (25.3)
       Black or African American alone41,104,200 (12.4)107 (2.6)29 (2.1)7 (1.8)
       Native Hawaiian or Pacific Islander alone689,966 (0.2)6 (0.1)3 (0.2)0 (0.0)
       American Indian or Alaska Native alone3,727,135 (1.1)7 (0.2)2 (0.1)2 (0.5)
       Some other race alone27,915,715 (8.4)89 (2.2)26 (1.9)5 (1.3)
       2 or more races33,848,943 (10.2)110 (2.7)34 (2.5)10 (2.6)
       Not reported or unavailable54081544312
      Ethnicity, n (%
      Counts for 'Not reported or unavailable' groups were excluded from calculation of percentages.
      )
       Hispanic, Latinx, or Spanish62,080,044 (18.7)289 (9.1)90 (8.7)41 (12.2)
       Not Hispanic, Latinx, or Spanish269,369,237 (81.3)2875 (90.9)944 (91.3)294 (87.8)
       Not reported or unavailable62861860368
      Abbreviations: AAPM = American Association of Physicists in Medicine; US = United States.
      low asterisk US population data by race and ethnicity obtained from the 2020 US Decennial Census.

      Jensen E, Jones N, Orozco K, et al. Measuring racial and ethnic diversity for the 2020 census. Available at: https://www.census.gov/newsroom/blogs/random-samplings/2021/08/measuring-racial-ethnic-diversity-2020-census.html. Accessed February 10, 2022.

      United States Census Bureau. Decennial census. P1—Race. 2020: DEC redistricting data (PL 94-171). Available at: https://data.census.gov/cedsci/table?q=United%20States&g=0100000US&tid=DECENNIALPL2020.P1. Accessed March 14, 2022.

      US population data by sex obtained from the 2019 American Community Survey.

      United States Census Bureau. Decennial census. P2—Hispanic or Latino, and not Hispanic or Latino by race. 2020: DEC redistricting data (PL 94-171). Available at: https://data.census.gov/cedsci/table?q=United%20States&g=0100000US&tid=DECENNIALPL2020.P2. Accessed March 14, 2022.

      † Counts for 'Not reported or unavailable' groups were excluded from calculation of percentages.
      In general, diversity within medical physics study analysis groups was limited (Fig. 2A), and women and minority groups were frequently underrepresented. Women were significantly underrepresented in the 2020 AAPM membership relative to the US population (P < .001) and comprised a minority (23.5%) of PA cohort members. Similarly, Hispanic/Latinx/Spanish members were underrepresented in the 2020 AAPM membership relative to the US population (P < .001) and comprised only 8.7% of PA cohort members. Interestingly, the ECPA cohort was more diverse by gender and ethnicity, comprised of significantly higher percentages of women (P < .001) and Hispanic/Latinx/Spanish members (P < .05) relative to the 2020 AAPM membership.
      Figure 2
      Figure 2Diversity in the current and historical medical physics workforce. A, Representation of various demographic groups in the 2020 American Association of Physicists in Medicine (AAPM) membership were calculated and compared with those in the US population, professional advancement cohort, and early-career professional advancement cohort. Stars denote a statistically significant difference between the percentage of the 2020 AAPM membership reporting a given demographic characteristic and the percentage of individuals in the respective comparison group reporting the same characteristic. *P < .05. **P < .01. ***P < .001. B, Historical trends in AAPM membership demographics. Percentages of members reporting various demographic characteristics were calculated for each year in available membership records 2002 to 2020. Abbreviations: AI/AN = American Indian or Alaska Native; NH/PI = Native Hawaiian or Pacific Islander.
      Racial diversity within all medical physics groups was highly limited. Despite comprising 32.4% of the US population, racial groups other than White or Asian alone collectively comprised only 7.9%, 7.0%, and 6.1% of the 2020 AAPM membership, PA cohort, and ECPA cohort, respectively. Black/African American members were significantly underrepresented in the 2020 AAPM membership relative to the US population, as were American Indian/Alaska Native members and members reporting some other race or 2 or more races. While Asian members were overrepresented in the 2020 AAPM membership relative to the US population (P < .001), they were underrepresented in the PA cohort relative to the 2020 AAPM membership (P < .01); however, there was no significant difference between the proportion of Asian members in the ECPA cohort and the 2020 AAPM membership. Two-sided P values for all statistical tests are available in Appendix E3, Table E3.
      The proportions of women, Hispanic/Latinx/Spanish, and Asian members in the AAPM membership generally increased between 2002 and 2020 while proportions of men, non-Hispanic/Latinx/Spanish, and White members decreased accordingly (Fig. 2B). Individually, racial groups other than White or Asian have consistently comprised very low (<3%) percentages of the AAPM membership.
      Of NIH grants listed in the AAPM-NIH Research Database, 97.9%, 27.8%, and 22.7% were matched to PI gender identity, race, and ethnicity, respectively (Table 3). By percentage of grants, funding has primarily been awarded to men (90.6%), White and Asian PIs (98.3%), and non-Hispanic/Latinx/Spanish PIs (94.7%). Notably, no grants have been awarded to American Indian/Alaska Native PIs. By gender, the distribution of K- and F-grants appears more equitable than the distribution of grants overall (28.6% vs 9.4% of grants awarded to women, respectively); however, interpretation is limited by low sample size.
      Table 3National Institutes of Health grants awarded to American Association of Physicists in Medicine members by grant activity type and principal investigator demographic characteristics, 1985-2020 pooled
      CharacteristicTotal grants: Any activity typeTotal grants: K- and F-grants only
      Gender identity, n (%
      Counts for not reported or unavailable groups were excluded from calculation of percentages.
      )
       Man1537 (90.6)35 (71.4)
       Woman159 (9.4)14 (28.6)
       Gender identity minority0 (0.0)0 (0.0)
       Not reported or unavailable361
      Race, n (%
      Counts for not reported or unavailable groups were excluded from calculation of percentages.
      )
       White alone300 (62.2)13 (76.5)
       Asian alone174 (36.1)3 (17.6)
       Black or African American alone1 (0.2)0 (0.0)
       Native Hawaiian or Pacific Islander alone1 (0.2)0 (0.0)
       American Indian or Alaska Native alone0 (0.0)0 (0.0)
       Some other race alone2 (0.4)1 (5.9)
       2 or more races4 (0.8)0 (0.0)
       Not reported or unavailable125033
      Ethnicity, n (%
      Counts for not reported or unavailable groups were excluded from calculation of percentages.
      )
       Hispanic, Latinx, or Spanish21 (5.3)6 (37.5)
       Not Hispanic, Latinx, or Spanish373 (94.7)10 (62.5)
       Not reported or unavailable133834
      low asterisk Counts for not reported or unavailable groups were excluded from calculation of percentages.
      The percentage of NIH grants awarded to women generally increased between 1985 and 2020 but, as of 2020, remained disproportionately low relative to the proportion of women within AAPM (Fig. 3). By race, notable trends in the allocation of funding included an increase in the percentage of grants awarded to Asian PIs mirrored by a decrease in the percentage awarded to White PIs. Percentages of grants awarded to PIs identifying as Black/African American, Native Hawaiian/Pacific Islander, some other race, 2 or more races, or Hispanic/Latinx/Spanish have generally remained low (<10%) and disproportionate relative to representation within the AAPM membership.
      Figure 3
      Figure 3Trends in the allocation of National Institutes of Health grants to American Association of Physicists in Medicine (AAPM) members by principal investigator demographic characteristics. Grants listed in the AAPM–National Institutes of Health Research Database were stratified by first year of funding. Percentages of grants awarded by principal investigator demographic characteristic were calculated for each period (blue bars). Percentages of the 2020 AAPM membership by demographic group are provided for context (striped orange bars).

      Discussion

      This study revealed important insights regarding diversity and equity in medical physics. Limited diversity in the 2020 AAPM membership relative to the US population suggests a costly disproportionality in recruitment of individuals to the profession. Additionally, limited diversity in the PA cohort and within grant-funded research activities may be indicative of bias, discrimination and/or exclusion in the advancement to leadership positions. Notably, underrepresentation of Asian members in the PA cohort relative to AAPM demonstrates, in the case where sufficient data exists, that barriers to PA may exist even for minority groups with relatively high representation in the workforce. In comparisons to related fields, representation of women and minorities
      Including individuals reporting race as Asian, Black or African American, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, ‘Some other race’, or two or more races, or reporting a Hispanic, Latinx, or Spanish ethnicity.
      in AAPM was similar to that observed in physical science fields and science and engineering fields overall,

      National Science Board Science & Engineering Indicators 2018. Chapter 3: Science and engineering labor force: Women and minorities in the S&E workforce. Available at: https://www.nsf.gov/statistics/2018/nsb20181/report/sections/science-and-engineering-labor-force/women-and-minorities-in-the-s-e-workforce. Accessed February 16, 2022.

      was generally in line with physician workforce demographics,

      Association of American Medical Colleges. Diversity in medicine: Facts and figures 2019. Available at: https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Accessed February 8, 2022.

      and was very similar to radiation oncology workforce demographics.
      • Fung CY
      • Chen E
      • Vapiwala N
      • et al.
      The American Society for Radiation Oncology 2017 radiation oncologist workforce study.
      Int J Radiat Oncol. 2019; 103: 547-556
      Prior work has linked a number of factors to the exclusion of women and minorities from leadership roles and participation in research activities in STEMM.
      • Rissler LJ
      • Hale KL
      • Joffe NR
      • Caruso NM.
      Gender differences in grant submissions across science and engineering fields at the NSF.
      Bioscience. 2020; 70: 814-820
      , 
      • Pell AN.
      Fixing the leaky pipeline: Women scientists in academia.
      J Anim Sci. 1996; 74: 2843-2848
      , 
      • Buckles K.
      Fixing the leaky pipeline: Strategies for making economics work for women at every stage.
      J Econ Perspect. 2019; 33: 43-60
      , 
      • Liu SC
      • Brown SEV
      • Sabat IE.
      Patching the “leaky pipeline”: Interventions for women of color faculty in STEM academia.
      Arch Sci Psychol. 2019; 7: 32-39
      , 
      • Beeler WH
      • Griffith KA
      • Jones RD
      • et al.
      Gender, professional experiences, and personal characteristics of academic radiation oncology chairs: Data to inform the pipeline for the 21st century.
      Int J Radiat Oncol. 2019; 104: 979-986
      ,
      • Shavers VL
      • Fagan P
      • Lawrence D
      • et al.
      Barriers to racial/ethnic minority application and competition for NIH research funding.
      J Natl Med Assoc. 2005; 97: 1063-1077
      ,
      • O'Connell C
      • McKinnon M.
      Perceptions of barriers to career progression for academic women in STEM.
      Societies. 2021; 11: 27
      While work specific to medical physics has been limited, existing literature, focused primarily on gender, offers important insight. A study of work-life integration among medical physicists revealed that, more so than men, women report that their academic productivity and ability to “keep up” in their career advancement are limited by childcare needs and other domestic responsibilities.
      • Paradis KC
      • Ryan KA
      • Schmid S
      • et al.
      Gender differences in work-life integration among medical physicists.
      Adv Radiat Oncol. 2021; 6100724
      Indeed, recent analysis of research productivity among radiation therapy physicists revealed gendered differences in h-index, number of publications and representation as senior faculty.
      • Meeks SL
      • Shang MH
      • Willoughby TR
      • Kelly P
      • Shah AP.
      Research productivity of radiation therapy physics faculty in the United States.
      J Appl Clin Med Phys. 2021; 22: 185-195
      Such reports may also explain the existence of large, persistent disparities in NIH grant funding by gender despite similar award success rates among men and women.
      • Chaudhary AMD
      • Naveed S
      • Safdar B
      • et al.
      Gender differences in research project grants and R01 grants at the National Institutes of Health.
      Cureus. 2021; 13: e14930
      ,
      • Whelan B
      • Moros EG
      • Fahrig R
      • et al.
      Development and testing of a database of NIH research funding of AAPM members: A report from the AAPM Working Group for the Development of a Research Database (WGDRD).
      Med Phys. 2017; 44: 1590-1601
      ,
      • Scarpelli M
      • Whelan B
      • Farahani K.
      Domain classification and analysis of national institutes of health-funded medical physics research.
      Med Phys. 2021; 48: 605-614
      Beyond research, inequitable leadership promotion practices, including selection processes reliant on networking with male colleagues and a lack of transparency regarding opportunity for promotion, may also contribute to limited representation of women within leadership roles.
      • Covington EL
      • Moran JM
      • Paradis KC.
      The state of gender diversity in medical physics.
      Med Phys. 2020; 47: 2038-2043
      ,
      • Knoll MA
      • Glucksman E
      • Tarbell N
      • Jagsi R.
      Putting women on the escalator: How to address the ongoing leadership disparity in radiation oncology.
      Int J Radiat Oncol. 2019; 103: 5-7
      Further study of these issues is needed, especially in the context of other excluded groups in addition to gender (eg, racial/ethnic minoritized populations, sexual and gender minorities, disabled populations, and others), which have been investigated to a lesser extent in existing literature. Additionally, future analysis of PA subgroup demographics may reveal potential areas for targeted intervention, as limited diversity within certain leadership cohorts may be indicative of unique barriers to PA.
      It is unclear whether increased diversity in the ECPA cohort and K- and F-grant funding pools
      Although data for T-grant subaward recipients would similarly inform this area of analysis, information pertaining to T-grant institutional subawards was not available.
      represents a broader trend toward improved workforce diversity or early, yet-unaffected stages of a leaky pipeline. In the context of prior work implicating the early career and postdoctoral stages as particularly critical breakpoints for career attrition and trajectory,
      • Pell AN.
      Fixing the leaky pipeline: Women scientists in academia.
      J Anim Sci. 1996; 74: 2843-2848
      ,
      • Martinez ED
      • Botos J
      • Dohoney KM
      • et al.
      Falling off the academic bandwagon. Women are more likely to quit at the postdoc to principal investigator transition.
      EMBO Rep. 2007; 8: 977-981
      ,
      • Gibbs Jr, KD
      • McGready J
      • Griffin K.
      Career development among American biomedical postdocs.
      CBE Life Sci Educ. 2015; 14: ar44
      our findings may be suggestive of critical losses in medical physics workforce diversity at graduate-to-early-career and/or early-to-mid-career transitions. Additional work is required to further evaluate demographic trends in the medical physics pipeline and assess the extent to which such trends explain disparities in leadership and research representation. In any case, given an increasingly diverse pool of STEMM bachelor's degree holders,

      National Science Foundation, National Center for Science and Engineering Statistics. Women, minorities, and persons with disabilities in science and engineering. Available at: https://ncses.nsf.gov/pubs/nsf21321/. Accessed February 8, 2022.

      efforts to recruit and support a diverse body of early career medical physicists will be paramount in ensuring future improvements in diversity. Interventions may include improvement of mentorship and networking opportunities; fostering a sense of belonging and identity; provision of social, financial, faculty, departmental and institutional support; bias training; and the development of interinstitutional relationships between primarily majority- and minority-serving institutions.
      • Buckles K.
      Fixing the leaky pipeline: Strategies for making economics work for women at every stage.
      J Econ Perspect. 2019; 33: 43-60
      , 
      • Liu SC
      • Brown SEV
      • Sabat IE.
      Patching the “leaky pipeline”: Interventions for women of color faculty in STEM academia.
      Arch Sci Psychol. 2019; 7: 32-39
      , 
      • Beeler WH
      • Griffith KA
      • Jones RD
      • et al.
      Gender, professional experiences, and personal characteristics of academic radiation oncology chairs: Data to inform the pipeline for the 21st century.
      Int J Radiat Oncol. 2019; 104: 979-986
      , 
      • Allen-Ramdial SA
      • Campbell AG.
      Reimagining the pipeline: Advancing STEM diversity, persistence, and success.
      Bioscience. 2014; 64: 612-618
      ,

      The AIP National Task Force to Elevate African American Representation in Undergraduate Physics & Astronomy. The time is now: Systemic changes to increase African Americans with bachelor's degrees in physics and astronomy. Available at: https://www.aip.org/sites/default/files/aipcorp/files/teamup-full-report.pdf. Accessed February 16, 2022.

      , 
      • Holliday EB
      • Jagsi R
      • Thomas Jr, CR
      • Wilson LD
      • Fuller CD.
      Standing on the shoulders of giants: Results from the Radiation Oncology Academic Development and Mentorship Assessment Project (ROADMAP).
      Int J Radiat Oncol. 2014; 88: 18-24
      , 
      • Farkas AH
      • Bonifacino E
      • Turner R
      • Tilstra SA
      • Corbelli JA.
      Mentorship of women in academic medicine: A systematic review.
      J Gen Intern Med. 2019; 34: 1322-1329
      , 
      • Daley S
      • Wingard DL
      • Reznik V.
      Improving the retention of underrepresented minority faculty in academic medicine.
      J Natl Med Assoc. 2006; 98: 1435-1440
      The role of current leadership in achieving these ends cannot be overstated. While a lack of representation in leadership reinforces experiences of marginalization and devaluation that contribute to career attrition, the converse improves access to key resources for overcoming barriers to PA.
      • Pololi L
      • Cooper LA
      • Carr P
      Race, disadvantage and faculty experiences in academic medicine.
      J Gen Intern Med. 2010; 25: 1363-1369
      , 
      • Yedidia MJ
      • Bickel J.
      Why aren't there more women leaders in academic medicine? The views of clinical department chairs.
      Acad Med. 2001; 76: 453-465
      , 

      Cech EA, Waidzunas T. STEM inclusion study organization report: American Physical Society (APS). Available at: https://www.aps.org/publications/apsnews/201806/upload/STEM-Inclusion-Study-Climate-Report.pdf. Accessed February 16, 2022.

      However, given limited diversity in existing medical physics leadership roles, women and minority medical physicists may not have access to leaders and/or mentors with similar backgrounds and experiences. Despite this limitation, underrepresented medical physicists may benefit from support systems including individuals not exclusively from their own demographic group.
      • Jackson VA
      • Palepu A
      • Szalacha L
      • Caswell C
      • Carr PL
      • Inui T.
      Having the right chemistry”: A qualitative study of mentoring in academic medicine.
      Acad Med. 2003; 78: 328-334
      Although non-White, non-Asian racial groups individually comprise low percentages of the AAPM membership, they collectively comprise nearly the same share as do Hispanic/Latinx/Spanish members (Fig. 2B). Given that improvements in inclusion and leadership promotion may be fueled by the development of a “critical mass” of nonmajority group members,
      • Morahan PS
      • Rosen SE
      • Richman RC
      • Gleason KA.
      The leadership continuum: A framework for organizational and individual assessment relative to the advancement of women physicians and scientists.
      J Womens Health. 2011; 20: 387-396
      as may be the case for women and Hispanic/Latinx/Spanish medical physicists, support networks promoting connections across demographic lines may be beneficial for members of other underrepresented groups. In the context of research, funded women and Asian investigators may be a source of support as they are similarly nonmajority but have received funding to a relatively broad extent. In any case, allocation of resources to the development of avenues of support will be critical in improving the retention and advancement of talented minority medical physicists, in turn driving improvements in workforce and leadership diversity.

      Limitations and future directions

      There are several limitations of this study. Low reporting rates of AAPM-member demographic characteristics, especially race and ethnicity, preclude a complete understanding of workforce diversity, limit evaluation of associations between demographic factors and PA, and restrict statistical analysis. While improved demographics data are critical to our understanding and may improve data interpretation, there are well-established concerns with self-reporting of such metrics by underrepresented and often vulnerable individuals.
      • Burnett NP
      • Hernandez AM
      • King EE
      • Tanner RL
      • Wilsterman K.
      A push for inclusive data collection in STEM organizations.
      Science. 2022; 376: 37-39
      ,

      Kader F, Doan LN, Lee M, Chin MK, Kwon SC, Yi SS. Disaggregating race/ethnicity data categories: Criticisms, dangers, and opposing viewpoints. Available at: https://www.healthaffairs.org/do/10.1377/forefront.20220323.555023. Accessed June 17, 2022.

      Efforts to increase diversity within AAPM will help yield more meaningful results.
      AAPM is not necessarily representative of the entire medical physics workforce, as there are many specialty fields that are not prominently represented in the activities of the AAPM membership but which can be considered subfields of medical physics.
      • Scarpelli M
      • Whelan B
      • Farahani K.
      Domain classification and analysis of national institutes of health-funded medical physics research.
      Med Phys. 2021; 48: 605-614
      The generalizability of this work is dependent on whether or how the demographic characteristics of these fields differ from those that are more predominant in AAPM. Future work may pursue a broader definition of the medical physics workforce by including investigation of non-AAPM medical physicists, although limited availability of quality demographics data may hinder this approach.
      The data presented in this report does not speak to the unique experiences of the individuals it represents, nor does it directly address climate. In 2021, AAPM conducted its first climate survey of its membership, focused on equity, diversity, and inclusion within medical physics.

      Hendrickson KRG, Avery SM, Castillo R, et al. AAPM equity, diversity, and inclusion climate survey executive summary [e-pub ahead of print]. Int J Radiat Oncol. 2021. https://doi.org/10.1016/j.ijrobp.2022.02.030. In press.

      The findings of this survey provide important insight into personal experiences of individuals and groups within the specialty.

      Conclusion

      Women and most racial and ethnic minority groups are underrepresented in the medical physics workforce and in roles and activities classically representative of PA in the field. Given an increasingly diverse pool of STEMM graduates, actionable policy and targeted efforts at recruitment and retention should be developed and implemented to ensure future improvements in workforce diversity and inclusivity, as well as equitable opportunity for PA and leadership promotion. Given limited coverage in the existing literature, future work should pursue understanding of the unique experiences of minority medical physicists.

      Acknowledgments

      We acknowledge Dimitri Zaras for guidance regarding statistical methods, Julius Dollison for guidance regarding American Association of Physicists in Medicine Professional Survey data, and the gracious support of the Winship Cancer Institute.

      Appendix. Supplementary materials

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      Article info

      Publication history

      Published online: August 28, 2022
      Accepted: August 10, 2022
      Received: March 29, 2022

      Footnotes

      Sources of support: This work had no specific funding.

      Disclosures: Dr Whelan has received a grant from the Australian National Health and Medical Research Council, is a shareholder of 4D Medical, was granted patent #US11105874B2 issued to Siemens Healthcare GmbH, and is an American Association of Physicists in Medicine committee member. Dr Pollard-Larkin is a board member of the American Association of Physicists in Medicine. Dr Scarpelli is an employee of Purdue University and is supported by therapeutic agents for research study from Imagion Biosystems. Dr Paradis has received grants from Michigan Medicine and the University of Michigan, related to the current work. No other disclosures were reported.

      Data sharing statement: Data underlying this study include American Association of Physicists in Medicine (AAPM) membership records, AAPM committee rosters, AAPM awards rosters, AAPM member demographics data, AAPM Education and Research Fund Recipient records, the AAPM–National Institutes of Health Research Database, and United States population demographics data. AAPM membership records, AAPM committee rosters, AAPM awards rosters, and AAPM member demographics data were provided to the authors by AAPM; however, the authors do not own these data and are therefore unable to share them. AAPM Education and Research Fund Recipient records were made publicly available by AAPM and are available at https://gaf.aapm.org/education/edfund.php. The AAPM–National Institutes of Health Research Database is available to AAPM members upon request. United States population demographics data are publicly available at https://data.census.gov/cedsci/.

      Identification

      DOI: https://doi.org/10.1016/j.adro.2022.101057

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