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“As soon as I realized we had so few Black residents, I began to ask around to find out if there were reasons why. One person brought up the fact that we happen to be the smaller institution between 3 other larger universities within an hour away and even bigger world-class institutions just 6 hours away. So, there is always a chance that Black residents may be choosing to go to more urban and populous cities for more job opportunities and networking. Another attending explained that the county we are in is in the top ten most populous counties in all of the United States, but Black or African Americans make up only 1.7% of the demographics. There are some odds that black applicants may not have family close enough for support and choose to go elsewhere. But despite these potential reasons, even though our county’s demographic makeup is admittedly small, it’s still better than our institution’s hiring rate.”
Karen Tran-Harding is a radiologist who blogs at How the Other Side Thinks.
She shares her story and discusses her KevinMD article, “When your institution has a less than 1% hiring rate for Black residents.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Karen Tran-Harding. She is a radiologist, and she wrote the KevinMD article “When your institution has a less than 1 percent hiring rate for Black residents.” Karen, welcome to the show.
Karen Tran-Harding: Thank you so much for having me. When I just got the invite to do the podcast, I was just really excited just to meet you, so this is so exciting. This is great.
Kevin Pho: Well, thanks for being on the show, and thanks for your contributions on KevinMD. So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?
Karen Tran-Harding: Sure. So I am actually a radiologist. I’m an attending radiologist, and I practice in Southern California. I’m from Southern California, but I actually did most of my medical training, or all of it actually, one and a half residencies and my medical school training, in Kentucky. So I actually just got back home not too long ago. I just did a fellowship last year in abdominal imaging and then luckily got hired on at the same institution, so it’s nice to be back home.
Kevin Pho: So we’re talking in the middle of December, and of course the whole country is in the midst of the latest wave of COVID-19. What are some typical findings that you find on X-rays that you could teach some of us in primary care?
Karen Tran-Harding: So honestly, it’s been kind of sad, because we’ve been reading a lot of chest CTs and chest X-rays recently, and almost all of them have what we call an atypical pneumonia. The main finding, and sometimes it can be kind of nonspecific too, is some ground-glass opacities. As an abdominal radiologist, sometimes I see the lung bases a little bit more, but mainly it’s those kind of ground-glass opacities at the lung bases, and they can be on the periphery too. And then sometimes there are some areas of airspace sparing as well. So those are kind of the main things. And sometimes you just see really bad consolidation at the lung bases too. So those are the things that I’ve been seeing most recently.
Kevin Pho: All right, so let’s transition into your KevinMD article, “When your institution has a less than 1 percent hiring rate for Black residents.” Now, for those who haven’t read your article, can you just walk my audience through it and share the story of why you decided to write it?
Karen Tran-Harding: Yeah, sure. So, like I was saying, I did a lot of my training in Kentucky and then finally came back home to this new institution not too long ago. One of the things I noticed was that we have this kind of hall of fame of all of the residents that have graduated from our diagnostic radiology program. We usually have about six residents a year. I was just kind of walking down the hall, and in that specific hallway it goes back to the 1980s, and I was actually going down there just looking at all their smiling faces, wondering where they are now, things that you think about when residents graduate. And then it just kind of dawned on me, based on pictures alone, right, because I don’t know if anyone is of mixed ethnicity or race or anything like that, but based on what I could see, there just weren’t a lot of Black residents. Over the past 30 years, I only actually saw definitively, based on pictures alone, one. So that only made it a less than 1 percent hiring rate for residents in our program, specifically for Black residents.
And my husband is actually an internal medicine physician at the same facility, and it was funny, because he actually noticed the exact same thing, that we just have such a low hiring rate. So of course we wondered why, and of course what we can do about it, because it’s very, very important to hire Black and African American physicians at your institution. Statistically, they aren’t going to make up a ton, just statistically, but it should be better than 1 percent, right?
So after we realized that, we explored reasons why that could be at our institution, and we came up with a couple of reasons. The demographics of our specific county don’t really have a high population of the Black community, but it’s still better than our institution’s hiring rate. So my husband and I are now on the committees to interview residents and fellows, so we definitely do want to do more of an outreach to hire, of course, a lot more residents. And also our institution actually recently started a Black Thriving Initiative, which is really nice and something I’m really proud of too, because the institution has long recognized that the hiring and encouraging of Black students and faculty and other workers to come to our facility has not been great for a while. So they already started this initiative, where all of us can take a pledge and really help create a good, safe working environment for the Black community.
Kevin Pho: And from being involved in this committee and from your research, what are some of the obstacles that Black applicants face when it comes to applying to radiology residencies?
Karen Tran-Harding: I think some of the obstacles, and I know this is specific to our institution, where I am, are that, like I said, we don’t have a large Black demographic where we are. I think that’s one of the challenges, because even me, when I trained in Kentucky, when I was applying for med schools, I did look to see how much diversity a certain program has, and I did want to go to one where there was a little bit more diversity, right? Just because I think we’re all more comfortable when we go somewhere and we have people there that we can relate to and who could be good role models and have some real-life experiences.
So I think that’s one of the challenges where we are specifically. If a Black applicant were to apply, the unfortunate thing is we don’t have a lot of even Black attendings where we are, probably for similar reasons. So they don’t necessarily have someone that they can 100 percent relate to, a role model and things like that. So that’s one of the challenges. If you go somewhere and you don’t see a lot of people that are similar to you, I think that’s a challenge. It’s not that you would hesitate to apply, but you just kind of want to see people that you can relate to.
Kevin Pho: And nationwide, do you know demographically what the minority breakdown is when it comes to radiology?
Karen Tran-Harding: For radiology itself, I’m not 100 percent sure what it is as far as the demographic. I know the demographic where I trained is 8 percent, and then where I am in California, it’s actually 6 percent for the whole state, and my actual county is actually only 1.7 percent of all physicians. But again, that’s still better than our hiring rate. And yes, I actually don’t know what the specific demographic in radiology is, but I do know that where I trained, we had more Black radiologists who were actually even in leadership positions. So I think that was a really stark contrast for me, to just not see that many here.
Kevin Pho: Now let’s talk about some of the solutions that institutions can do to address this issue. You mentioned you’re part of some committees that can come up with some of these solutions. So what are some specific things that they can do?
Karen Tran-Harding: I think specific things that people can do are, of course, you want to start at the medical student level, right, and kind of outreach to them. So actually, one of the things that we did do, and I think a lot of institutions have actually done recently, is kind of meet-and-greets through Zoom, where you invite all the medical students who are interested in your program, across the entire nation or anywhere in the world, to do this meet-and-greet. We had a lot of attendings, which I was involved in as well, just speak to the medical students, and we actually did talk about how much we want to increase our diversity and how much we want to make it a good environment for different races and ethnicities, and we just answered all their questions and any concerns that they may have had, and things like that. So I think outreaching ahead of time to the medical students is really, really helpful too.
And again, with hiring of attendings too, because I’m actually the fellowship director where I am now for abdominal imaging, I think even outreaching to residents and maybe even fellows to kind of promote the hiring of attendings as well would be really, really helpful.
Kevin Pho: How did you bring this issue up to your institution, and if you did, what was their response?
Karen Tran-Harding: I did ask around leadership in our department, the residency program director and everything like that. And what was really nice was that everyone knows that it has been an issue, and so that made me happy, that everyone has already noticed that and has been working on that. And especially the residency program director, I know he personally is very, very committed to increasing the diversity in our program. He has long recognized it. The thing is, we do have a diverse makeup, but just not all that I’d like to see in our program. But he has even addressed the fact that he wants to get on more female radiologists and, of course, more Black residents and things like that. So the response to my question about why we don’t have a lot has been positive, and everyone wants to see this change as well.
Kevin Pho: We’re talking to Karen Tran-Harding. She’s a radiologist, and she wrote the KevinMD article “When your institution has a less than 1 percent hiring rate for Black residents.” Karen, if you were to give residency directors across the country some advice, what would your number one tip be in terms of addressing the diversity in your programs?
Karen Tran-Harding: I think a tip is, if you do recognize that this is an issue, to just kind of be upfront about it and just be really honest about it to your applicants, about why you think that maybe the diversity isn’t as high as you’d like it to be. So I think being very, very honest, being very open, and answering any questions that any medical student or resident or physician has is a really good first step.
Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?
Karen Tran-Harding: With just the way things have been going in medicine, with the coronavirus global pandemic, election politics, things like that, we’re noticing things that maybe we haven’t noticed before, and maybe we’re having a lot more disagreements than we’ve had before. And I just think that, again, with just my article, everyone should talk to as many people as possible, even people who maybe don’t have the same opinions as you, just to open up that conversation. I think it’s especially important with people that you may not always speak to or who have different viewpoints than you, because I think the first step whenever there’s a problem is to first notice that there’s a problem and talk to as many people as you can to see as many different viewpoints. And then that’s kind of the first step to maybe coming up with a solution.
Kevin Pho: Karen, thank you so much for sharing your time and insight, and thanks again for being on the show.
Karen Tran-Harding: Yeah, thank you so much, Dr. Pho. Again, it was just a pleasure meeting you. Thanks for having me.
Kevin Pho: All right, thank you.
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