GENDER AND RACIAL DIVERSITY IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY TRAINEES IN THE UNITED STATES: A CROSS-SECTIONAL 3-YEAR ANALYSIS OF OB/GYN FELLOWSHIP PROGRAMS

Abstract

Diversity and equity in the physician workforce remain pivotal to providing culturally effective, optimal care. However, minority groups still remain underrepresented among medical student matriculants. In fact, in 2021, Black and Hispanic medical students comprised 7.5% and 6.5% of the entire student body, respectively while White students made up 48.5%. Data analysis of sex and racial diversity within Reproductive Endocrinology and Infertility (REI) fellowships across the U.S. is lacking. We sought to characterize demographic patterns among REI fellows who represent the emerging REI workforce, comparing these results to those of general Ob/Gyn (Gen OG) residents and other Ob/Gyn (OG) fellowships. We conducted data analysis from the U.S. Accreditation Council on Graduate Medical Education (ACGME)-approved Gen OG residency and OG fellowship training-programs (REI, MFM, Gyn-Onc and FPMRS) for the 3 years from 2017- 2020, comparing changes in self-identified gender (SIG) and racial composition over time. Chi-square analyses were used to compare annual gender trends and ethnicity make-up for the overall Gen OG. For the fellowship comparisons, contingency coefficients were used to compare annual rates of gender and ethnicity parameters among the groups. Over the study period, the number of female trainees in Gen OG programs increased (p<.002) without a change in male number (p=0.31). In post-OG fellowships, male numbers decreased within MFM and FPMRS (p<.001, respectively) while female number increased within MFM (p<.001). In REI programs, the overall number of active fellows increased 4% from 160 (2017-18) to 167 (2019-20) with the female to male ratio ranging from 3.5:1 to 4.6:1; however, a significant change in SIG-related trainee number did not occur over time. For race, Gen OG residencies demonstrated an increase over time in self-identified White (p<.001), Asian (p<.001) and Black (p=.04) trainees. This race increase did not hold for any of the post-OG fellowship programs: White (p=0.65), Hispanic (p=0.36), Asian (p=0.64), or Other (p=0.88). For Black trainees, Gyn-Onc saw a significant decrease (11.8% in 2017-18 vs. 6.2% in 2019-20; p=0.01) while REI had an absolute yet insignificant decrease (8.1% in 2017-18 to 6.5% in 2019-20; p=.08) in Black number; other fellowships showed no change. While gains have been made in racial diversity within Gen OG residency, a persistent disparity among post-Gen OG fellowship trainees exists. The demographics of REI training programs reflect both male and racial minority underrepresentation. Further research is needed to elucidate reasons underlying these disparities including efforts to increase diversity within fellowship training programs.