Gender, Racial, and Socioeconomic Determinants of Choosing a Surgical Career

Abstract

• Surgical specialties continue to struggle with achieving proportionate representation of minorities. • Those from racial/ethnic minorities and lower socioeconomic status backgrounds are more likely to choose non-surgical careers. • Multiple potential solutions exist, including more loan relief programs for surgical specialties, increasing exposure in pre-clinical education, funded research programs, and improving accessibility to mentorship. Surgical specialties continues to struggle with achieving proportionate representation of women, racial and ethnic minorities, and LGBTQ individuals at all levels of training and academic positions. This study aimed to analyze how socioeconomic determinants and demographic variables including gender and race/ethnicity affect choice of specialty. A 25-question survey was distributed via Qualtrics to residents at a single institution between September 2021 and February 2022. This study was performed at a single-institution, at an academic university center. All resident physicians at the institution, ranging from post-graduate year 1 to post-graduate year 9, were invited to participate in the survey. All specialties were invited to participate. A total of 294 responses (86 in surgical fields, 204 in medical fields) were collected, with an overall response rate of 47%. The average amount of reported student debt was USD 183,000. Underrepresented in medicine (UIM) students chose significantly shorter residencies (p=0.046), had significantly lower average household incomes and grew up in poorer communities (p<0.001), were more likely to have an urban upbringing (p<0.001), and were more likely to have parents without graduate education (p=0.016). Average household income growing up was higher for those from surgical specialties than those from medical specialties (USD 167,000, 144,000, p=0.051). In a multiple logistic regression , race (p=0.041) and ethnicity (p=0.046) were the most significant unique predictors of choosing a medical residency over a surgical residency. Female gender (p=0.014), being the sole source of income (p=0.018), and lower parent/guardian educational status were factors predictive of not pursuing a top 10 paying residency. Understanding the socioeconomic influences in specialty choice provides important insight to guide future programs and policies focused on alleviating barriers that dissuade qualified and diverse applicants from pursuing surgical careers.