Still not seen: Representation in Canadian dermatology leadership lags behind
Survey of leaders reveals racial, ethnic minorities underrepresented at all levels of leadership (Issue #245, 1,300 words, 7 minutes)
Findings from a new study published in BMJ Leader (April 21, 2025: leader-2024-00113) suggest a potential underrepresentation of racial and ethnic minorities among Canadian dermatologists in leadership positions.
The study was conducted by a team of Canadian physicians, including dermatologists Dr. Reetesh Bose (Ottawa), Dr. Monica Li (Vancouver), Dr. Mohannad Abu-Hilal (Hamilton, Ont.), and Canadian Medical Association President-Elect Designate Dr. Boluwaji Ogunyemi (St John’s), along with McMaster University medical students Grace Xiong and Ted Zhou.
This team conducted a cross-sectional study to assess the self-reported racial and ethnic backgrounds and Fitzpatrick skin types of Canadian dermatology leaders. Investigators identified individuals who held one or more leadership positions in the past 10 years and sent them an anonymous online survey. The authors analyzed respondents' demographic information and perspectives on diversity in dermatology with proportions and thematic analysis, respectively.
Half of the contacted leaders completed the survey (55/110). Of those, 65.5% (36/55) identified as White/Caucasian. More respondents identified as having Fitzpatrick skin types I or II (65.5%) than Fitzpatrick skin types III to VI (34.5%). More respondents (68.9%) holding leadership positions in national, provincial or regional societies identified as White/Caucasian than leaders in academic or research roles (56.5%). Most respondents believed that Black, Indigenous, and people of colour are not sufficiently represented in Canadian dermatology leadership and that skin of colour is not adequately represented in dermatology educational curricula.
“Our study suggests a potential underrepresentation of racial and ethnic minorities in Canadian dermatologists in national, provincial and regional society leadership positions,” the authors conclude. “Most Canadian dermatologists previously or currently holding leadership roles believe that further efforts are necessary to improve equity, diversity and inclusion in the field.”
Bottom line: There is an underrepresentation of racial and ethnic minorities among Canadian dermatology leadership at all levels. Most survey respondents say that the current levels of representation in leadership and dermatology educational materials are inadequate.
From the literature on dermatology in skin of colour
Program director perspectives on DEI initiatives in the dermatology residency selection process
The authors of this paper note that the American Academy of Dermatology has maintained a commitment to diversity, equity, and inclusion (DEI) initiatives; however, a recent setback of affirmative action by the U.S. Supreme Court has called similar efforts into question. This court action prompted researchers to investigate dermatology program directors’ (PDS) perceptions of DEI programming and its integration into resident selection.
For the investigation, the authors conducted a cross-sectional survey of PDs at U.S. dermatology residency programs from April 2024 to July 2024 (n=30). A total of 29 surveys were completed.
When asked about their satisfaction level with the current amount of DEI efforts within the AAD, 17% (5/29) of respondents said they were very satisfied, 59% (17/29) said they were satisfied, 17% (5/29) said they were neutral, and 7% (2/29) said they were dissatisfied.
Twenty respondents answered when prompted to classify their level of satisfaction further: 70% (14/20) said there should be more DEI efforts through the AAD providing financial support, and 50% (10/20) wanted more nonfinancial support.
The authors conclude their results suggest strong support among PDs for advancing DEI in dermatology, although challenges such as legal restrictions and knowledge gaps persist. These findings underscore the importance of sustained efforts to foster a more diverse and inclusive dermatology workforce in alignment with the nation's demographics.
Digital photography guide for dermatologists with special considerations for diverse populations
This paper was inspired by a perceived need to evaluate the best practices for capturing clinically accurate digital images in dermatology. It particularly emphasizes techniques to improve photography portraying individuals of colour, dermatologic conditions in skin of colour, and pigmentary disorders.
Among the observations and recommendations, the paper authors note that royal blue backgrounds are often preferred when photographing darker skin, as this background colour offers increased contrast without creating aberrant hues.
Soft diffuse lighting, such as that emitted from an attachable ring light, should be used when possible.
Furthermore, other aspects of photography in the clinical setting should be standardized, including a fixed distance from the patient and a dedicated space for photography.
Specific lighting techniques, such as cross-polarization, may be used inaccurately to capture erythema, inflammation, and pigmentary alterations in colour skin.
The authors also discuss humanistic aspects that should be considered when photographing a patient's dermatologic condition.
Association of socioeconomic factors with teledermatology usage
Researchers conducted a repeated cross-sectional analysis of the 2020 to 2022 U.S. Medical Expenditure Panel Survey, including individuals with at least one dermatology visit.
They used multivariate logistic regression to assess associations between sociodemographic factors and teledermatology use, with two-part models examining spending.
Among 5,280 respondents, representing 68,315,000 patients, visits in 2021 (adjusted odds ratio [aOR]=2.725, p=0.003) had higher odds of teledermatology use, as did Black (aOR=6.467, p<0.001), Hispanic (aOR=5.520, p=0.012), and non-Black, non-White, non-Hispanic race patients (aOR=3.416, p=0.002). Patients with a bachelor's degree (aOR=5.470, p=0.019) also had increased odds. Medicaid was associated with lower out-of-pocket costs.
The authors conclude that teledermatology use grew during the study period, benefiting racial minorities, but educational barriers persist. They suggest targeted interventions are needed to enhance access.
VIDEO: Skin of Colour Savvy: Diversity in Dermatology Within the Modern Landscape
In this video from the Skin of Color Society, Crystal Aguh, MD, associate professor of dermatology and Director of the Ethnic Skin Program at the Johns Hopkins School of Medicine, and John Harris, MD, the founding Director of the Vitiligo Clinic and Research Center, founding director of the Autoimmune Therapeutics Institute and professor and chair of the Department of Dermatology at UMass Chan Medical School in Worcester, explore the importance of mentorship, visibility, and leadership among dermatologists and dermatology trainees of different backgrounds.
At the intersection of skin and society
In the recent federal election, Canadians elected the largest number of Indigenous candidates, reports ICT News.
Of the Members of Parliament chosen by voters in the April 28 election, 12 were Indigenous — the most ever to sit in Parliament. The largest number of Indigenous MPs elected to the House of Commons previously had been 11. It was initially thought that a dozen Indigenous candidates had been elected in 2021, but Liberal Randy Boissonault later admitted he was not Indigenous and resigned from the cabinet.
Assembly of First Nations National Chief Cindy Woodhouse Nepinak praised the Indigenous candidates and the Indigenous voters who helped put a record number into office.
“We recognize all First Nation candidates that ran in this election,” Woodhouse Nepinak said in a statement. “We are proud and inspired by your courage to step forward. Importantly, we lift up First Nations citizens across the country who took the time to vote, including those casting a ballot for the first time.”
She continued, “Thanks to you, First Nation voices mattered in this campaign. I am very proud of our people.”
This week
May 11 to 17 is Food Allergy Awareness Week
May 12 to 18 is Sun Awareness Week in the U.K.
May 16 is Malcolm X Day in the U.S.
Something to think about in the week ahead . . .
—David Seabury (1885-1960), U.S. psychologist
Next week
In a presentation at the first annual Indigenous Skin Spectrum Global Summit, Dr. Rachel Asiniwasis identified the top North American priorities for improving Indigenous skin health.
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