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

Abstract

PURPOSE: Across all specialties we see a leaky pipeline for diversity, from applying to residency to matriculating to residency and ascending in the ladder of academia [1]. These disparities in representation often disproportionately affect surgical specialties, for which long training programs, socioeconomic stressors, and cultural influences may dissuade qualified but underrepresented students from pursuing a surgical career. This study examines how demographic and socioeconomic variables affect the choice of specialty. METHOD: A qualtrics survey was disseminated via email to a listserv of all residents at a single institution between September 2021 and February 2022. The survey queried (1) demographic information, (2) childhood socioeconomic information, (3) residency socioeconomic information, and (3) reasons for specialty choice. Data analysis was performed using SPSS and included chi squared analysis, Fisher’s exact test, and multiple logistic regression with subgroup analysis comparing medical and surgical specialties, and the Top 10 earning specialties (of which 7 are surgical). RESULTS: A total of 294 responses (86 in surgical fields, 204 in medical fields) were collected, with a response rate of 46%. Seventy-six individuals (25.9%) identified as belonging to a disadvantaged group. The average amount of student debt was $183,000. Residents pursuing a Top 10 earning residency were more likely to cite loan repayment (45%, 23%, p<0.001) and potential salary after residency (72%, 55%, p=0.013) as concerns factoring into their specialty decision. Medical residents were significantly more likely to cite concern with length of training as a deciding factor in choosing a specialty than surgical residents were (S:35%, M:59%, p<0.001). Surgical residents were significantly more likely to be pursuing a fellowship than medical residents (S:69%, M:49%, p=0.013). In a multiple logistic regression, race (p=0.041), ethnicity (p=0.046), and being part of a disadvantaged group (p = 0.072) were seen to be the most significant unique predictors of choosing a medical residency over a surgical residency. Specifically, 17% of medical residents were Black, Native Hawaiian, or Mixed Race as compared to 10% of surgical residents. Female gender (46% v 61%), 0.014) and being the sole source of income (17% v 26%, p=0.018) were predictive of not pursuing a top 10 earning specialty. On the other hand, higher parent/guardian level of education was predictive of choosing a top 10 paying residency (p=0.05). CONCLUSION: Understanding the socioeconomic influences on specialty choice provides insight into how we can work to alleviate barriers that dissuade qualified and diverse applicants from pursuing surgical careers. Loan repayment concerns, the length of training, and the need to support one’s family financially are all reasons that dissuade students from pursuing surgery, alongside persistent gender and racial barriers. It is imperative that we actively help alleviate these financial burdens and create a culture supportive of diversity in order to attract the most diverse and highly qualified candidates. REFERENCES: 1. Nieblas-Bedolla E, Williams JR, Christophers B, Kweon CY, Williams EJ, Jimenez N. Trends in Race/Ethnicity Among Applicants and Matriculants to US Surgical Specialties, 2010-2018. JAMA Netw Open. 2020;3(11):e2023509. doi:10.1001/jamanetworkopen.2020.23509