1 AJCP / Editorial Am J Clin Pathol 2020;XX:1-3 DOI: 10.1093/ajcp/aqaa192 © American Society for Clinical Pathology, 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Reversing Historical Trends The Crisis, the Challenge, and the Opportunity Von Samedi, MD, PhD, 1 Carla L. Ellis, MD, MS, 2 Nicole R. Jackson, MD, MPH, 3 Jordan P. Reynolds, MD, 4, and Melissa P. Upton, MD 5 From the 1 Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora; 2 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL; 3 Cook County Medical Examiner’s Offce, Chicago, IL; 4 Pathology and Laboratory Medicine Institute, The Cleveland Clinic, Cleveland, OH; and 5 Department of Pathology and Laboratory Medicine, University of Washington, Seattle. Key Words: Diversity; Inclusion; Racism; Inequities; Underrepresented minorities; Intersectionality Am J Clin Pathol 2020;XX:1–3 DOI: 10.1093/AJCP/AQAA192 The Crisis The important article “Current and Historical Trends in Diversity by Race, Ethnicity, and Sex Within the US Pathology Physician Workforce” analyzes representa- tion of women and men (self-identified), Whites, and underrepresented minorities (URMs), including Black, Hispanic/Latino, and Native American/Alaska Native/ Hawaiian Native/Pacific Islander backgrounds, in trainee and postgraduate positions in pathology, including ac- ademic and practice settings. 1 The authors used large, well-accepted databases that have captured demographic information for decades across all fields of graduate and postgraduate medicine. The timing of the article coincides with a period of extraordinary national unrest, outrage, grief, and anger related to police killings of Blacks and in the setting of an unprecedented global pandemic with disproportion- ately adverse effects on underresourced and marginal- ized populations. This context underlines the importance of addressing diversity and inclusion in the field of pa- thology and in health care generally. How diverse and inclusive is the field of pathology? The good news, per White et al, 1 is that women are now entering pathology residency and fellowship training at rates equivalent to the percentage of women in the US population. This significant and hopeful finding repre- sents a historic change. However, after training, women comprise only 38.3% of practicing pathologists and 39.6% of pathology faculty. 1 Representation in a profession is one metric, but at least as important is inclusion into positions of leadership and power. Significantly fewer women rise to leadership positions in pathology—whether chairs, division chiefs, deans, or practice chiefs—compared with men. Women held 3.7% of pathology chair positions in US medical schools in 1991 2 and still only 15.4% in 2015, when 20% to 40% of nonchair department leaders were women. 3 White et al 1 highlight three key and troubling sta- tistics regarding URMs in pathology. First, while the overall numbers and proportions in training, practice, or academia have remained low and essentially unchanged over 22 years, the underrepresentation in academic pa- thology has actually worsened since 1999. 4 Second, more URMs apply for pathology residency positions than are accepted. 1 And third, the number who reach leader- ship positions is much lower than the number of White women in these positions. Others have reported the sig- nificant underrepresentation of Black, Hispanic, and Native American men and women in academic pathology, including at assistant professor, associate professor, and chair levels. 4 Lack of representation of members of any group in- evitably leads to decreased focus on issues important to their communities, which affects the health care system as a whole. Beyond providing diagnoses, engaging in basic research, and translating new discoveries into innovative methods for testing and diagnoses, pathologists play a sig- nificant role in educating our clinical colleagues, a poten- tial key role in reducing health disparities. Recruiting and Downloaded from https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa192/5940742 by guest on 30 October 2020