Gender and Ethnic Representation of Incoming Dermatopathology Fellows: A 10-Year Analysis.

Abstract

To the Editor: Dermatology has been one of the least diverse medical specialties.1 The US population is becoming more diverse, and it is estimated that no single ethnic group will represent the majority of the US population by 2043.2 Although there has been an increased awareness of the lack of diversity in general dermatology, there is a paucity of literature on diversity in dermatology subspecialties, including dermatopathology. Therefore, the purpose of this study was to illustrate gender and ethnic representation trends within incoming US dermatopathology fellows over a 10-year period. Data regarding the ethnic identities of graduate medical trainees matriculating into the US dermatopathology fellowship programs were extracted from the Graduate Medical Education Census published in the Journal of the American Medical Association.3 The number of individuals within each gender and ethnic group was retrospectively collected over a 10-year period (2011–2020). This information was then analyzed to highlight gender and ethnic trends over time. During the 2011–2020 academic years, our study revealed that men represented a total of 335 (48.1%) incoming fellows while women represented a total of 361 (51.9%) incoming fellows (Table 1). Ethnic representation within these years consisted of 480 (69.0%) Whites, 141 (20.3%) Asians, 36 (5.2%) Hispanics, 25 (3.6%) Blacks, 2 (0.3%) American Indian/Alaska Natives, 2 (0.3%) Native Hawaiian/Pacific Islanders, 7 (1.0%) Multiracial, and 39 (5.6%) Other/Unknown identities (Table 1). The average yearly rates of change were −0.06% for men, +0.06% for women, −1.05% for Whites, +0.02% for Asians, +0.11% for Hispanics, −0.13% for Blacks, −0.06% for American Indian/Alaska Natives, +0.05% for Native Hawaiian/Pacific Islanders, +0.65% for Multiracial groups, and +0.76% for Other/Unknown identities (Fig. 1). TABLE 1. - Number of Incoming Dermatopathology Fellows Within Different Gender and Ethnic Groups From 2011 to 2020 Academic Year Male Female Black American Indian/Alaska Native White Asian Native Hawaiian/Pacific Islander Multiracial Other/Unknown Hispanic Total Dermatopathology fellowship matriculants 2011–2020 2010–2011 39 28 2 0 50 13 0 N/A* 2 4 67 2011–2012 29 40 3 0 48 17 0 N/A* 1 1 69 2012–2013 33 49 2 1 60 16 1 N/A* 2 5 82 2013–2014 43 36 6 1 56 14 0 N/A* 2 2 79 2014–2015 33 40 3 0 51 14 0 0 5 5 73 2015–2016 37 36 2 0 46 18 0 1 6 6 73 2016–2017 32 37 0 0 50 9 0 1 9 5 69 2017–2018 27 32 5 0 37 11 0 2 4 1 59 2018–2019 31 34 0 0 45 17 0 0 3 4 65 2019–2020 31 29 2 0 37 12 1 3 5 3 60 Total 335 361 25 2 480 141 2 7 39 36 696 *Data for the multiracial group were not collected for the 2010–2014 academic years. FIGURE 1.: Gender and ethnic representation of incoming dermatopathology fellows during the 2011–2020 academic years. A, Gender trends during the 2011–2020 academic years. B, Ethnic trends during the 2011–2020 academic years.During the past decade, the proportion of incoming female dermatopathology fellows has been similar to that of the US female population, which is estimated at 50.8% per the 2020 US Census.4 Female representation displayed an overall increase in average growth per year, peaking at 59.8% in the 2012–2013 academic year. The analysis also revealed that the percentage of Blacks entering dermatopathology fellowships has slightly decreased over the past decade, reaching 0.0% in 2016–2017 and 2018–2019. By contrast, Hispanic representation has slightly increased over the past decade, peaking at 8.2% in 2015–2016. Blacks and Hispanics contribute to 13.4% and 18.5% of the US population, respectively, but this is not reflected in the population of incoming dermatopathology fellows.4 Only 2 academic years had American Indian/Alaska Native representation (2012–2013 and 2013–2014) and Native Hawaiian/Pacific Islander representation (2012–2013 and 2019–2020). Limitations of this analysis include the lack of data collected for the “Multiracial” group in the Journal of the American Medical Association Graduate Medical Education Census during the 2010–2014 academic years and a small sample size. In addition, the lack of data on the dermatopathology applicant pool precludes us from identifying whether the lack of diversity stems from the applicant pool or the applicants who matched. Despite these limitations, our study emphasizes a need to further diversify dermatopathology fellowship programs to create a workforce that can best serve the needs of the changing US population.