– By Matt Skoufalos –
For Verlon E. Salley, medical imaging is essentially the family business. His father was a radiologic technologist who advanced to become a nuclear medicine technologist. Growing up, Verlon would volunteer to help him in the summer in Fort Lauderdale, Florida, which means, “radiology has been on my resume since middle school,” he said. Today, Salley is the senior director of radiology at UAB Medicine in Birmingham, Alabama.
But Salley’s rise to his current position wasn’t without its challenges, and not all of them were related to his career. Growing up in Florida as a Black man, Salley said he has experienced overt racial bias, as well as “things that were more subtle.”
During his second day of a fellowship, he recalled how the hospital president stopped him from entering a meeting he was required to attend, suggesting, “Maybe you’re looking for a patient’s room? That’s on the other side of the hospital.”
“I’ve got a briefcase, I’ve got a suit and tie, and he says, ‘Oh sir, I don’t know what you’re looking for, but this is the boardroom,’ ” Salley recalled. “I point at my name badge. I said, ‘I’m the fellow. My preceptor is that guy there.’ I’m standing at the door, and he whispers something in my preceptor’s ear to allow me to come into a board meeting that I’m supposed to be at.”
“I was educated, raised, trained to expect this,” Salley said. “It doesn’t shock me, all the different things; what I’ve become is cerebral to it. I recognize that I can help by talking to the individuals in my environment.”
Sadly, experiences like those are all too common among people of color in the United States, and not just in the imaging field. Making them less common – or eliminating them altogether – means fostering opportunities to increase the diversity of today’s workforce, from rank-and-file staff to leadership roles. That can’t happen without a deep dive into human resources and demographic data at all levels of employment in the health care system, which requires buy-in from the uppermost ranks of several institutions. From senior management to front-line employees in settings from hospitals to professional organizations, Salley said he’d like to see efforts made to identify baseline diversity numbers, the better to grasp the degree of the gaps in the field.
“They more than likely have that information, but I guarantee you nobody’s ever asked,” he said. “It’s one thing to measure your organization, it’s another thing to know what the denominator is. And don’t stop just at ethnic numbers: look at gender, education; all of that matters, because once people have the opportunity to move up in management, some job descriptions require advanced degrees.”
Having the diversity mix of an organization on hand allows institutions to define and meet expectations, Salley said, which is useful when hiring managers, directors and other senior leadership. But if the imaging field is to advance beyond merely addressing a shortfall in its diversity calculus, it must do more than reinvent something like the NFL’s “Rooney Rule,” which requires teams to interview external minority and female candidates for high-ranking jobs. Such regulations can amount to little more than “checking the boxes” if organizations don’t hold themselves accountable to a higher standard, and commit to seeking qualified employees of all types, Salley said.
“Not a lot of companies look for diverse candidates,” he said, “therefore, institutions are not diverse at the higher levels because they hire from within. There’s favoritism and nepotism; individuals get hired and never leave. The organization never trains you from within.”
Salley said this kind of institutional self-examination should be accelerated by professional organizations in the imaging space, including the American College of Radiology (ACR), American Registry of Radiologic Technologists (ARRT) and the Association for Medical Imaging Management (AHRA). He’d like to see professional groups like those make themselves a part of the national conversation on the issue of diversity in the workforce.
“Even med schools where these radiologists train should consider a curriculum on health care disparities and what’s going on in the nation,” he said.
For his part, Salley is gathering data from his local chapter of the National Association of Health Service Executives (NAHSE), a non-profit association of Black health care executives on the experiences of Certified Biomedical Equipment Technicians (CBETs) who have faced discrimination in the workforce. In polling the 46 members of his local NAHSE chapter on their attitudes about discrimination in the workplace – “does it exist, have you endured it, what do you suggest” – Salley is collecting information that he believes will help him “to have a smart conversation with my upper administration.”
“I’m trying to get real data,” he said, the better to anticipate questions about the impact of his findings. Documenting instances of maltreatment is one thing, and commitments to cultivating diversity another; however, Salley said what’s even more important than either is inclusion.
“If somebody says they need to hire more people of color, and they do, and those people are not included in what happens in the organization, then all you have is diversity, and not inclusion,” he said.
“If people’s hearts are not changed, if empathy is not adopted, it won’t make a difference.”
Ernie Cerdena, president of the Medical Technology Management Institute (MTMI Global), can recall arriving in the United States from the Philippines at 23. He had a limited command of the English language, and as the newest technologist on his team, was given a lot of extra work.
“I was put on difficult shifts, the 3-to-11,” Cerdena said. “If nobody showed up for the third shift, I had to do it. I always had to double-shift. I was only making $12 an hour, and my coworkers were making more than me.”
The extra obstacles Cerdena encountered weren’t just at work, either. Newly married, when he and his wife were apartment hunting, they discovered that a landlord to whom they’d already given a security deposit mysteriously and suddenly gave the place to a different tenant. When they asked why their money had been accepted if that was the case, the rental agent was evasive, Cerdena said. It took a lot of follow-up with the city housing department to get some answers.
“For some people who’ve never experienced this, they’re never going to be able to relate to it,” Cerdena said. “It’s hard. You question your worth, your value and your role in society. Are you a burden, or are you a contributor? I work very hard to make sure that I pay my taxes; to make sure that I take care of my patients.”
Cerdena said that he’s experienced other, similar moments of prejudice throughout his career, but described himself as non-confrontational, and “tending to be silent about my own experiences.”
“So personally, I just accept it,” he said. “But at the same time, what can you do so that doesn’t happen again in the future? That’s the reality.”
Today, Cerdena is an AHRA Past President who chairs its Diversity and Inclusion Task Force. The committee aims to create awareness of diversity issues throughout the imaging field, including leadership, starting by educating AHRA members and critiquing its own processes.
“AHRA is meant to be a catalytic force in the development of imaging leadership,” Cerdena said. “Part of that know-how is to be able to recognize sensitivity to cultural diversity, ethnicity, gender, socioeconomic standards, sexual orientation, age and disability.”
Established in 2019 by current AHRA President Chris Tomlinson, the task force seeks to fulfill that mission of catalytic change by addressing the day-to-day challenges that its members face – and about which they might not speak up.
“You cannot measure the level of negative impact of that to us, because we experience it,” Cerdena said. “We were victimized by it; the ammunition to overcome those issues is education.”
When Cerdena’s committee surveyed AHRA members about their attitudes toward the concept of diversity within the organization, a vast majority said they believed that the organization cultivates a diverse membership, and that doing so is important. Similarly, respondents thought the association offers equal opportunities for all members to participate, volunteer and gain awards and recognition.
Eighty-three percent said AHRA is doing enough to address diversity and inclusion within the organization, and 78 percent said they feel comfortable voicing contrary opinions without fear of negative consequences, and can share “ideas or other aspects of their authentic self, while also feeling valued and respected by fellow members.”
Respondents also indicated, however, that they would like AHRA leadership to reflect the diversity of the organization, and that AHRA should create a scholarship program for minority demographics. The fact that 82 percent of respondents are white reflects the challenges the association has in promoting diversity internally and in the external interactions of membership.
Tomlinson, who is also the enterprise vice-president for radiology imaging, clinical lab and pathology for the emergency and hospital medicine service lines at Jefferson Health in Philadelphia, Pennsylvania, said respondents’ attitudes varied significantly by geography.
AHRA members in the northeastern United States found diversity to be “top-of-mind,” he said, while some AHRA members in the middle of the country “weren’t as sensitive to the issue, and questioned the need for the agency to focus on diversity at all.”
“They felt it was out of the scope of what a professional association should be doing,” Tomlinson said. “What the AHRA survey showed us was we really didn’t have the awareness we would have liked.”
The medical imaging industry tends to reflect its diversity most among its technical ranks, and least among those in supervisory roles. But Tomlinson noted that medical imaging leadership industry-wide is “definitely less than representative from where we feel it should be from an industry perspective.”
“We think it has to do with mentoring and unconscious bias,” he said. “If you have diversity in your community, but not in your management team, you’ve got to ask, ‘Why is that not there?’”
“Why wouldn’t the makeup of our community be the makeup of that health system across all layers, including leadership?” he asked.
Addressing gaps in mentorship and accounting for unconscious bias requires education and sustained effort, but AHRA is intended to be “the indispensible resource for imaging leaders,” and a lack of diversity among its own leadership, is “definitely a problem,” Tomlinson said.
“It’s something we need to address, and they’ve elected me president not to make them feel comfortable, but to deal with tough issues, and that’s what I’m doing,” Tomlinson said.
As a Black woman working in the medical imaging field, Chris Harris said she’s had experiences similar to those Salley and Cerdena underwent. Today, Harris is the operational manager for MRI at Children’s National Hospital in Washington, D.C., but when rising through the ranks, she didn’t have any mentors of color to guide her path.
“It’s very hard to be in a position where there’s no other people of color in leadership,” Harris said. “Working day to day, you come across situations where you need somebody to talk to. Sometimes there’s things that white people don’t understand about me and my background, and it’s hard for me to express myself to them.”
At the Children’s Hospital of Philadelphia, where Harris worked before taking the position in Washington, D.C., she said she always had to work “harder and more” than her white counterparts to be noticed, “and if you’re noticed, it still might not be enough” to advance.
“Every day, I’ve got to work 10 times as much, 10 times as hard,” Harris said. “On top of it, I’m very boisterous, and I’m looked at as aggressive. I have to sit a certain way, I have to look a certain way; I have to show a poker face. But my heart is about the patient and the process.”
Until the imaging space can work through its process and diversify its leadership more greatly and consistently, Harris thinks those in the space may have to look elsewhere for diverse mentorship, whether in educational or community institutions. As a way of setting the tone, she volunteers with high school students in blue-collar communities who may not have professional mentors in their lives.
“It’s hard because there’s not enough people of color to reach out and talk to move people of color forward,” Harris said. “I feel like the generations coming up want to support. It’s how do we get the people of color to move themselves forward?”
“We’re starting to work together as a nation,” she said. “If we keep that momentum, it can happen. If we don’t move it, it’s not going anywhere.”