Could blind hiring improve diversity in the endocrine workforce?
Blind hiring could lead to a more diverse workforce.
Despite increased attention and efforts focused on diversifying the U.S. health care workforce, little progress has been made over the past 2 decades. Blind hiring practices, successfully used in other industries, could be adapted to increase diversity in the health care workforce pipeline. Such practices would be expected to address two persistent barriers to health care workforce diversity: implicit bias and systemic bias.
Implicit bias in selection and hiring is a well-recognized problem that results in selection committees and hiring managers favoring applicants who share their own gender, race, ethnicity or other demographic group. Redacting these demographic elements from applicant files at the early screening stage increases the chance for applicants from underrepresented groups to proceed to the next step in the review process, where qualifications can be assessed in a holistic manner.
Systemic bias is not as commonly recognized and involves using selection criteria that do not directly correlate to an applicant’s ability to be successful in the position they are applying for and that are less likely to be met by applicants from underrepresented groups. Two examples of such criteria are standardized test scores and training institution. Despite substantial evidence that standardized test scores do not directly correlate with professional success or achievement, scores continue to be used to identify “strong candidates” in the health care professions. Similarly, there is no evidence demonstrating that training at any specific institution directly determines an applicant’s ability to provide excellent medical care. Use of these and similar criteria unfairly advantages individuals who have more resources, often placing individuals from underrepresented groups at a relative disadvantage. Redacting information such as test scores and educational institution names from an applicant’s file could be a way to prevent this type of bias.
A successful example of the use of blind hiring is the Henry Ford Health System, a five-hospital system in the Detroit area that blinds applicants’ demographic information at the time of initial screening by human resources recruiters. The system’s office of workforce development reviews resulting applicant pools to ensure they reflect the availability of diverse candidates for the position, and additional applicants are sought if this qualification is not met. Using this strategy, the Henry Ford Health System has earned recognition for its commitment to diversity, and it is routinely listed as one of the top performers on DiversityInc’s Top 12 Hospitals and Systems annual ranking.
To bring about significant change in the endocrine workforce, blind hiring/selection practices would need to be applied at every stage in the workforce development pipeline, starting from undergraduate and medical school training, through junior faculty and promotion to senior leadership. Additionally, blind hiring would need to be employed as one of several tools to increase diversity and should not be relied on as a sole solution. As part of an institutional effort to create a diverse and inclusive workplace, use of blind hiring practices has the potential to increase an applicant’s opportunity to be evaluated based on competencies and qualifications that add to the mission of the institution or practice. Blind hiring, used in conjunction with other efforts to expand the minority health care workforce pipeline and to build more inclusive work environments, could eventually lead to a more diverse endocrinology workforce able to effectively care for our increasingly diverse patient populations.
Rocio Pereira, MD, is chief of endocrinology at Denver Health, associate professor of medicine at the University of Colorado School of Medicine, and a former chair of the Endocrine Society Committee on Diversity and Inclusion. She is also the founder of a community-based lifestyle intervention program for Latino immigrants.
A partially blinded selection process may help, but increasing visibility may be a better tactic.
I am in support of a partially blinded selection process and/or hiring. Our endocrinology fellowship used a blinded candidate selection process this year. The four reviewers first attended training on unconscious bias, and the applications we received had candidate demographics, including gender and photos, removed. We later requested that the faculty undergo the same training on unconscious bias. Our department is very diverse, but training is still necessary.
Blinding has worked in other fields. A pioneer national directive used blinded auditions while recruiting musicians for all symphony orchestras in the United States since the 1970s. The process increased hiring of women in the five most prestigious orchestras by fivefold in 2 decades. Similarly, large corporations like Dolby and Mozilla are using blind audition companies to select candidates for positions within their companies. Acknowledging our implicit bias is important if we are to move forward with increasing diversity in medicine.
However, I also support equalization during selection process to bring more candidates from underrepresented groups to the selection process. Some research indicates that having at least two minority group members competing for an opening increases the chances of one being selected. In selection processes that have only one candidate from an underrepresented group, none has been ultimately selected for the position — none.
Race is a sensitive topic for some. It is our duty to model to our trainees development of comfort discussing sensitive topics. There are many stories of subpar care and discrimination against our Black patients, who sometimes are our own colleagues. As an example, there is a 50% increased likelihood of survival for Black babies cared for by Black physicians. We need to talk about these disparities. Change starts with us.
Lastly, it is time for our specialty to take a stand on gender categorization and increase the voice of those minority groups as well. It is disheartening that we have no data on LGBTQ, and particularly transgender, physicians who are applying for endocrinology fellowships. These physicians often feel unseen.
Karyne L. Vinales, MD, is associate program director for endocrinology fellowships and a member of the Diversity and Equality Subcommittee at the University of Arizona School of Medicine-Phoenix and chairwoman of the diversity subcommittee group of the Maricopa County Medical Society.
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