Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce An Official American Thoracic Society Workshop Report

Workforce diversity is crucial for innovation and excellence in medicine, leading to improved patient outcomes and satisfaction. Racial and ethnic concordance between physician and patient improves trust, preventative care use, adherence, and overall health outcomes. The pediatric population is increasingly diverse, yet the pediatric pulmonology workforce significantly underrepresents URiM groups (Black, Hispanic/Latino, Indigenous people). A 2014 survey revealed limited representation of URiM among board-certified pediatric pulmonologists, a trend that persisted over nearly 20 years. Similarly, in 2019, URiM representation among pediatric pulmonology trainees fell far short of US population demographics. This report details the efforts of the American Thoracic Society (ATS) Pediatrics Assembly's Diversity, Equity, and Inclusion Advisory Group (DEI-AG) to address these disparities.

The introduction cites several studies highlighting the positive impact of physician-patient racial and ethnic concordance on patient outcomes and satisfaction. It also points to the existing literature on the underrepresentation of URiM in the medical profession, particularly within pediatrics and pediatric pulmonology. The report references data from surveys showing the persistent lack of diversity within the field and the projected shortage of pediatric pulmonologists.

The DEI-AG, composed of trainees and senior faculty (70% from URiM groups), was formed in 2020. Three subcommittees focused on pathways into pediatric pulmonology, fellowship training, and faculty development/retention. A DEI Needs Assessment Survey was distributed in the US and Canada to 317 individuals (72 trainees and 245 pediatric pulmonologists). Descriptive analyses were performed on quantitative data, while qualitative data underwent thematic analysis using Braun and Clarke's approach. A two-day ATS-sponsored workshop was held to review survey findings, share best practices, and develop implementation strategies. The final report was prepared through a collaborative process involving all co-chairs and workshop members.

The survey revealed that while many institutions had DEI programs, fewer than half were aware of specific DEI hiring policies for pediatric pulmonology divisions. A concerning number of respondents were unaware of formal reporting systems for DEI concerns. Pediatric pulmonology trainees reported high frequencies of experiencing (65%) and witnessing (84%) racism, discrimination, microaggressions, or gaslighting. Faculty also reported high rates of these experiences (63% experienced, 78% witnessed). Free-text responses revealed themes of poor institutional support, low URiM recruitment/retention, and the "minority tax" (additional unpaid work for DEI efforts). Key challenges and recommendations for action were identified for each stage of the pipeline (secondary/high school, undergraduate education, medical education, residency training, and faculty development and retention).

The findings highlight the significant disparity between the racial and ethnic demographics of the pediatric population and the pediatric pulmonology workforce. The high rates of reported discrimination experienced by trainees and faculty emphasize the urgent need for systemic change within the field. The "minority tax" highlights the disproportionate burden placed on URiM faculty for DEI initiatives. The recommendations offered in the report provide practical steps for addressing these issues at each stage of professional development, from early recruitment to faculty retention. The success of these recommendations hinges upon genuine institutional commitment and resource allocation for DEI initiatives.

This report provides a comprehensive assessment of DEI issues in pediatric pulmonology. The findings underscore the need for multifaceted interventions targeting recruitment, training, and retention of URiM individuals. Future research should focus on evaluating the effectiveness of implemented strategies and adapting them to address the unique challenges faced by various URiM groups and other underrepresented communities within the field. Collaboration among professional organizations, institutions, and individual practitioners is vital for achieving sustainable change.

The survey's voluntary nature means the results may not fully represent the entire pediatric pulmonology community. The focus on racial and ethnic URiM groups excludes other underrepresented communities (LGBTQIA+, international medical graduates). Demographic data is based on self-identification and may not capture the full complexity of individual experiences. The lack of institutional-level data limits the ability to draw definitive conclusions about specific organizational policies and their impact.