Understanding Diversity: An ASTCT-NMDP ACCESS Initiative Survey of the Hematopoietic Cell Transplant and Cellular Therapy Workforce in the United States

The American Society for Transplantation and Cellular Therapy (ASTCT) and NMDP established the ACCESS Initiative to address barriers to hematopoietic cell transplantation (HCT) and cellular therapy (CT), with the Junior Faculty and Trainee Immersion Program (JFIP) supporting workforce development. To assess diversity within the US HCT/CT workforce, an electronic survey was disseminated to ASTCT members. Of 437 total respondents, 408 met the inclusion criteria. The respondents were predominantly female (72.1%) and 53.4% were between 36 and 55 years of age. Racial and ethnic composition was skewed compared with the US population, with 64.5% identifying as White or European, 18.6% as Asian or Asian American, 4.7% as Hispanic or Latino, and 4.2% as Black or African American. Geographical disparities were notable, particularly in the Southwest and Midwest, where minorities were disproportionately underreported compared with US Census-recorded regional representation. Forty-six percent of survey respondents were physicians with 35% identifying as international medical graduates (IMGs). Among IMGs, 44.6% were Asian or Asian American, 11% Hispanic or Latino, and 6.2% Black or African American. Notably, 54.3% of physicians were multilingual, although 37.3% felt their language skills were underutilized. Most responding physician HCT/CT directors were female (55%) and White (50.5%), with limited representation of Black (5.6%) and Hispanic (13.9%) individuals. Nonphysician respondents (53.9%) were primarily nurses (28.6%), administrators (13.6%), and data managers (16.8%). LGBTQ+ (4.2%) disabled (2.9%), and military veteran (2.5%) representation was limited among all survey respondents. Despite these self-reported disparities, 72% (range 59% to 85%) of respondents perceived their transplant center's workforce diversity as "adequate" or even "exemplary." Within the limitations of survey data, these findings highlight persistent workforce disparities, as well as a discrepancy between the perception and reality of workforce diversity, suggesting the need for targeted initiatives to enhance representation, mentorship, and workforce equity. Awareness of these gaps is critical to fostering culturally competent care and potentially improving patient outcomes in HCT/CT.