National trends in gender and ethnicity in dermatology training: 2006 to 2018

Abstract

To the Editor: Sex and race concordance between physicians and patients is associated with improved perceptions of clinical care.1Street R.L. O'Malley K.J. Cooper L.A. Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity.Ann Fam Med. 2008; 6: 198-205Crossref PubMed Scopus (341) Google Scholar In 2017, 48.9% and 64.5% of dermatology attendings and residents, respectively, were female.2Bae G. Qiu M. Reese E. Nambudiri V. Huang S. Changes in sex and ethnic diversity in dermatology residents over multiple decades.JAMA Dermatol. 2016; 152: 92-94Crossref PubMed Scopus (41) Google Scholar Academic dermatology leadership positions are underrepresented in sex and ethnic diversity.3Jayakumar K.L. Lipoff J.B. Trends in the dermatology residency match from 2007 to 2018: implications for the dermatology workforce.J Am Acad Dermatol. 2019; 80: 788-790Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,4McDonald T.C. Drake L.C. Replogle W.H. Graves M.L. Brooks J.T. Barriers to increasing diversity in orthopaedics: the residency program perspective.JB JS Open Access. 2020; 5: e0007PubMed Google Scholar We examined sex and ethnicity trends of dermatology residents and fellows compared to other medical and surgical trainees. Demographics of dermatology residents and fellows and other of medical/surgical trainees were obtained from the Accreditation Council for Graduate Medical Education annual census, 2006 to 2018. Underrepresented minority (URM) was defined as Black/African American, Hispanic, or Native American. A 2-sample z-test was used to compare sex and ethnicity proportions in 2006 and 2018 (α level, <.05). Female representation in dermatology residency was stable at approximately 60% (Supplemental Table I; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1), and the overall residency census national average increased from 44% to 46% (P < .01) during the study period. Proportions of women in procedural dermatology and dermatopathology increased from 27% to 44% and from 46% to 54%, respectively (P > .05) (Fig 1). Female representation increased in all fellowship comparator groups; however, proportions of female fellows were consistently less than those of corresponding residencies in internal medicine, plastic surgery, and general surgery (Supplemental Table II; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1). All fields trended toward a narrowing of residency-fellowship gender gaps. Average URM representation in the overall residency national census increased from 12.5% in 2006 to 13.6% in 2018 (P < .05) (Supplemental Table I). URM representation in dermatology residency and fellowship increased from 8.2% to 9.3% and decreased from 9.5% to 3.1% (P > .05), respectively. URM representation in dermatology residency was consistently below the national average (Fig 2). URM residency-fellowship disparities persist in other fields (Supplemental Table II); however, only dermatology experienced a downward trend of URM fellowship representation over time. This study is limited by use of self-reported data and unknown rates of fellowship application by candidates of differing gender/ethnicity. We did not have access to pediatric dermatology fellowship data or total number of dermatology residency/fellowship positions. Our study showed significant narrowing of female residency-fellowship gaps and persistent URM dermatology residency underrepresentation and residency-fellowship gaps compared to the national average. Physician diversity is essential in addressing health care disparities.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Lack of URMs in leadership positions, mentorship, racism, and implicit bias have been cited as barriers for URMs pursuing subspecialties. Female and URM residents should be encouraged to seek mentorship from leaders of concordant and discordant gender and ethnicity. Mentorship programs, through the American Academy of Dermatology and Women's Dermatologic Society, which support URM medical students interested in pursuing dermatology and female resident dermatologists pursuing subspecialties, likely contributed to some of the upward trends observed. The Perry and student to resident institutional vehicle for excellence initiatives, Nth Dimension programs, and near-peer mentors have been successful in encouraging URMs to apply for competitive fields, subspecialties, and academic faculty positions. Similar initiatives should be adopted for dermatology. Early exposure of URMs to dermatology, updated curricula including skin of color topics, and rethinking residency selection criteria are also essential.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Our study highlights positive trends for women in dermatology residency/fellowships and significant deficiencies in URM representation in dermatology residency/fellowships. Increased efforts are needed to understand barriers to pursuing subspecialties and initiatives taken to promote mentorship and guidance to underrepresented groups. None disclosed.