‘Antiquated’ radiology department policies can be ‘silently discriminatory’ to certain employees

“Antiquated” radiology department policies can be “silently discriminatory” to LGBT employees, according to new research published in the Journal of the American College of Radiology [1]. 

Gen Z has the highest proportion of lesbian, gay, bisexual, trans and queer/questioning individuals compared to any other generation at 28% (vs. 16% for millennials and 7% of boomers). As this group of physicians begins enters medical training, experts believe it is essential to ensure an inclusive learning environment. 

“Discriminatory workplace policies and practices can perpetuate a culture of exclusion and can undermine efforts in promoting inclusivity,” Jordan D. Perchik, MD, with the University of Alabama at Birmingham, and co-authors wrote Aug. 28. “Radiology departments, even those that consider themselves progressive and welcoming, can have unintentional gaps in their policies and practices or may use antiquated language in group contracts and other documents that can potentially be harmful to LGBTQ+ employees.”

Perchik and colleagues utilized an audit program modeled after the Human Rights Campaign Healthcare Equality Index to assess departments’ success at inclusivity. They recruited programs via the Radiology Residency Education Research Alliance, with participating institutions performing the LGBTQ audit between late 2023 and early 2024. 

A total of nine U.S. radiology residency programs completed the audit, with scores ranging from 6 to 9 on a 10-point scale. Facilities scored highly in terms of inclusivity and institutional culture, as 8 of the 9 programs reported meeting all milestones in these two areas. The lowest scores related to departmental culture and community engagement, areas in which fewer than half of the audited programs met all milestones. Following the audit, programs reported improved self-perceived inclusivity, with post-survey scores increasing in areas related to departmental policy, inclusive facilities and LGBTQ community outreach. 

“Thankfully, there are several low investment ways to improve department culture, such as incorporating LGBTQ+ health topics into the resident education curriculum, highlighting the local LGBTQ+ community in recruitment materials, and including visible symbols of pride and advocacy in the department,” Perchik and co-authors noted. “Adding gender neutral restrooms and locker rooms can be challenging and cost prohibitive in practices with limited space. Devoting time and personnel to new community health endeavors can be burdensome to an already over-extended department. In fact, nearly all participants noted in the post-course survey that the primary barriers to enacting more inclusive LGBTQ+ policies in their institutions were related to the added cost of these new initiatives, both in financial terms and in terms of personnel, time, and added administrative responsibilities. Disproportionately, these responsibilities fall to minority members of the radiology department, which can contribute added stress and lead to burnout (a concept known as the ‘Minority Tax’).” 

DEI initiatives have become more complicated in 2024, “due to a rapidly changing legislative environment,” the authors added. Legislation curtailing these programs has muddied the role they can play in hiring practices. Gender-affirming care bans and restrictive facility use policies (“bathroom bills) may further impact recruitment and retention of diverse candidates, they contended.  

“Programs may be hesitant to pursue DEI initiatives due to the perceived financial costs, administrative responsibilities and, in some states, legal ramifications,” Perchik et al. wrote. “These limitations may have contributed to the relatively low enrollment in this audit, with only 10 programs out of over 50 electing to join the project. Still, there is reason to be optimistic. There has been a cultural shift in the field of radiology, increasingly highlighting the importance of DEI and the importance of an agile, adaptable and diverse workforce that can better serve the needs of its patients. The next generation of physicians will be the most diverse yet, and these DEI initiatives can enable radiology programs to recruit and retain top applicants to radiology. This process starts with dedicated outreach and mentorship of students from underrepresented backgrounds, developing more inclusive interview processes, intentionally reviewing department policies and practices, and ensuring that individuals have continued support throughout their careers to retain these diverse perspectives.”