Abstract
Diversity of healthcare providers increases patient engagement, satisfaction, and health outcomes, highlighting the importance of representation and culturally humble care.1 Obstetrics and Gynecology is one of the most racially and ethnically diverse medical specialties with a higher proportion of Black and Hispanic physicians, who are more likely to practice in areas of higher poverty, than other specialties.2,3 However, the need for increased diversity amongst obstetrics and gynecology trainees persists, and recruitment by resource-rich hospitals continues to be a barrier to increasing practice in more resource-scarce settings.4 We aimed to identify student sociodemographic characteristics and experiences associated with intention to pursue obstetrics and gynecology and practice in underserved areas. The Association of American Medical Colleges provided de-identified, self-reported data from its annual Student Record System and Graduation Questionnaire for respondents who matriculated at U.S. MD-conferring medical schools in academic years 2007-2012 (Supplemental Figure 1), as previously described.5 Descriptive statistics are reported as frequencies with percentages. We used multivariable log-binomial regression to estimate crude and adjusted risk ratios (RR and aRR, respectively) and 95% confidence intervals for intention to enter obstetrics and gynecology and to practice in underserved areas. All models were adjusted for sex, race/ethnicity, first-generation status, and age. The Albany Medical College Institutional Review Board approved the study (Supplemental Materials and Methods). A total of 57,307 (65.1%) medical graduates completed the questionnaire (Supplemental Figure 1) and specified a specialty; 3,649 (6.4%) reported intention to pursue obstetrics and gynecology, of which 1,361 (37.3%) intended to practice in an underserved area. Male respondents were significantly less likely than females to report intention to pursue obstetrics and gynecology (aRR: 0.15 [0.14-0.17]) and practice in an underserved area (aRR: 0.82 (0.71-0.96], Table 1). Race and ethnicity were significantly associated with intention to practice in underserved areas among respondents choosing obstetrics and gynecology. Compared with non-Hispanic white respondents, non-Hispanic Black/African American (aRR: 2.14 [1.92-2.39]), Hispanic (aRR: 1.38 [1.19-1.59]), and non-Hispanic Asian (aRR: 1.18 [1.01-1.38]) respondents were more likely to report intention to practice in underserved areas. Additionally, intention to practice in underserved areas was associated with higher levels of debt, older age at matriculation, degree programs and receipt of scholarship. With the exception of working on a thesis project, working on research, and having authorship on an oral or poster presentation, all medical school experiences on the questionnaire were significantly associated with intention to practice in underserved areas. For example, respondents with health disparities (aRR: 1.76 [1.54-2.02] and global health experiences (aRR: 2.07 [1.77-2.41] more often reported intention to practice in underserved areas than respondents without those experiences (Table 1). We believe this is the first comparative study conducted among US medical school graduates to explore the association of sociodemographic factors and medical school experiences with intent to practice in underserved areas within obstetrics and gynecology. We found that race/ethnicity, sex, debt, and medical school experiences were associated with intention to both practice in obstetrics and gynecology and underserved areas. Specifically, respondents who identified as non-Hispanic Black/African American and Hispanic were significantly more likely to state intention to pursue obstetrics and gynecology and practice in underserved areas. Given the association with higher levels of debt, targeted financial education could maximize student utilization of financial incentive programs and assist in navigating the financial feasibility of career options. This, in turn, may increase the number of students planning to practice in underserved communities.
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