Radiologists worry that anti-DEI legislative efforts could exacerbate staffing shortages

Radiologists are expressing concern that legislative efforts to curb diversity, equity and inclusion initiatives could exacerbate staffing shortages in the specialty.

Between late 2022 and April of this year, lawmakers have introduced 85 anti-DEI bills. This included a “notable peak” in the year leading up to January 2024, mirroring the beginning of legislative sessions, researchers detailed Monday in the Journal of the American College of Radiology [1].

At the time of the study, state legislatures had passed about 16% (or 14) of these bills, with 26% still in the introductory phase. Lead author Florence X. Doo, MD, and colleagues believe this anti-DEI push could derail strides the specialty has made to improve diversity in recent years.

“While anti-DEI legislation will affect radiology practices of all types, academic radiology programs are particularly vulnerable, as university-associated practice members may be considered employees of the bills targeting institutions of higher education,” Doo, with the Department of Diagnostic Radiology and Nuclear Medicine at the University of Maryland, and co-authors wrote Aug. 26. “Additionally, anti-DEI efforts negatively impact all radiology practices by shrinking the workforce pool of candidates at all levels, exacerbating the current shortage of radiologists and other healthcare workers. This reduced talent pool, coupled with increasing demands in radiology, will negatively affect the quality and access to care for patients.”

For the study, Doo et al. examined the introduction and outcome of all DEI bills introduced in the U.S. between December 2022 and May of this year. They tracked the legislative progress of each bill over time, also mapping the geographical distribution in relation to radiology practices. Introduced bills most frequently targeted “diversity statements” (42/85, 49%), “mandatory DEI training” (37/85, 44%), “identity-based preferences (30/85, 35%) and “DEI offices” (29/85, 34%).

Lawmakers in Missouri introduced the highest number of anti-DEI bills with 13 (or 15% of the total) during the study period. Texas was the next with seven (or 8%) followed by Arizona’s five (6%). Texas led the way with two passed bills, tied with Florida. Ten other states had signed at least one bill into law, including Alabama, Idaho, Indiana, Iowa, Kansas, North Carolina, North Dakota, Tennessee, Utah and Wyoming. Analyzing data by state showed that about 15 radiology practices in teaching settings would be impacted in Texas, for example, along with another 231 outside of academia.

Doo and co-authors also tracked demographic trends of full-time academic radiology faculty during the pre-anti-DEI legislative period spanning 2012 to 2021. They highlighted 16% growth in head count, rising from 9,081 faculty members to 10,510 by the end of the study period. Most of the radiology faculty workforce was categorized as being within the highest medical school funding quartile, the authors found. There has been a “persistent” gender disparity in the specialty, at about 71% male and 62% white (or 4,502 faculty members total).

To enforce compliance, anti-DEI laws have threatened revoking state funding eligibility. Alabama and Texas also have allowed for the firing of employees of academic institutions that violate their regulations.

“Threats of termination, lack of institutional support from a defined DEI office, and withheld state funding for DEI activities could disproportionately drive radiologists from underrepresented backgrounds away from states that enact anti-DEI legislation,” the authors charged. “This study is the first to highlight this legislative activity over time with geographic mapping to associated academic radiology practices and can potentially inform future DEI advocacy initiatives.”

Doo and co-authors believe academic radiology faces an “important opportunity to proactively address these challenges.” Possible strategies to mitigate the impact of anti-DEI legislation could include adapting policies to adhere to the new legal boundaries, reframing roles/offices, or engaging in policy advocacy. Radiology leaders also could develop initiatives with outside entities “to strategically align institutions of higher education with broader community DEI goals.” The authors cautioned they are not policy experts and could not guarantee these strategies would pass legal muster.

“Future studies could also evaluate more qualitative aspects such as individual experiences and institutional responses, which could provide more nuanced insight into the effects of anti-DEI legislation on the radiologist workforce,” the authors concluded. “This study emphasizes the need for continued advocacy and strategic planning to uphold DEI efforts in academic radiology while the legislative landscape evolves. Understanding the impact of anti-DEI legislation is essential in order to support diverse and inclusive environments and to promote a resilient culture of belonging, purpose and well-being for the pipeline of future doctors and the patients they serve.”