Perception and Reality of Racial and Ethnic Workforce Diversity in the U.S HCT/CT Workforce: Results from the ASTCT-NMDP Access Initiative Survey

The American Society of Transplantation and Cellular Therapy (ASTCT)-NMDP ACCESS Initiative aims to expand access to hematopoietic cell transplant and cellular therapy (HCT/CT) for patients in need. One way to achieve this goal is to improve HCT/CT workforce diversity to facilitate culturally competent care. While it is known that racial and ethnic minorities are underrepresented in medicine, the HCT/CT workforce in the U.S. has yet to evaluate its current diversity and to interrogate the accuracy of its perceived diversity. To assess self-identified racial and ethnic workforce diversity, thereby establishing a benchmark metric to monitor changes in HCT/CT workforce diversity over time. The ASTCT-NMDP ACCESS Initiative circulated an anonymous 18-question electronic survey to members of ASTCT and the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC). Of 437 total responders, 408 were included in the analyses given data exclusion for missing geographical region (n=3), academic position (n=1), or respondent location outside of the U.S. (n=25). Responses were analyzed overall and by U.S. geographic region. Profiles of the 408 respondents are depicted in Figure 1 . Most respondents self-identified as White or European (range 54-72%) in all U.S. geographic regions with Black or African American (BAA) (4.2%) and Hispanic or Latino (HIS) (4.7%) persons making up an exceedingly small proportion of the HCT/CT workforce (despite these minority groups encompassing 18.7% and 12.1% of the total U.S. population, respectively, per the 2020 U.S. Census) ( Figure 2 ). Discrepancies were most notable in regions expected to have a higher number of underrepresented minority (URM) persons, such as the Southwest (3.4% HIS in the workforce versus 19.8% of the population) and Midwest (no BAA respondents versus 12.3% of the Midwest population). Interestingly, 72% of all respondents (range 59-85% by geographic region) perceived that their transplant center's workforce diversity was ‘adequate’ or ‘exemplary’ ( Figure 3 ). In summary, two significant survey findings were noted: (1) lack of racial and ethnic diversity in the U.S. HCT/CT workforce in geographical areas anticipated to have a higher number of URM persons and (2) discordant perception by a large majority of respondents that workforce diversity at their center was ‘adequate’ or ‘exemplary’ despite lack of racial and ethnic diversity captured by the survey. Racial and ethnic diversity in the U.S. HCT/CT workforce is highly discrepant with overall and geographical prevalence of URM groups across the nation. Notwithstanding restrictions inherent to survey data, these results provide an understanding of the current HCT/CT workforce as an important first step towards improving racial and ethnic representation within the HCT/CT community and promoting culture-based patient care.