The call to action to increase racial and ethnic diversity in dermatology: A retrospective, cross-sectional study to monitor progress

Abstract

To the Editor: Racial and ethnic diversity in medicine contributes to improved access to care and quality of care for underserved populations and, ultimately, improved public health. In the United States, the population of African Americans, Hispanics, and American Indian or Alaskan Natives continues to grow and is now at 31.9%.1United States Census Bureau. Quick facts.https://www.census.gov/quickfacts/fact/table/US/POP010220Date accessed: October 5, 2021Google Scholar Although awareness of the lack of diversity in the dermatology workforce has been increasing, dermatology ranked second to last in diversity compared to other specialties in a study published in 2016.2Pandya A.G. Alexis A.F. Berger T.G. Wintroub B.U. Increasing racial and ethnic diversity in dermatology: a call to action.J Am Acad Dermatol. 2016; 74: 584-587Google Scholar We conducted a retrospective, cross-sectional study of data from 2012 to 2019 to determine whether there has been an increase in the percentage of US dermatology applicants, residents, and dermatologists in the workforce who self-identify as underrepresented in medicine (UIM). Self-reported race and ethnicity data were obtained from the Association of American Medical Colleges and the Journal of the American Medical Association National Graduate Medical Education Census.3Table C-5: Residency Applicants from U.S. MD-Granting Medical Schools to ACGME-Accredited Programs by Specialty and Race/Ethnicity, 2012-2013, 2014-2015, 2015-2016, 2016-2017, 2017-2018, 2018-2019, 2019-2020. Association of American Medical Colleges.https://www.aamc.org/data-reports/students-residents/interactive-data/2020-facts-electronic-residency-application-service-eras-dataDate accessed: January 16, 2020Google Scholar, 4Brotherton S.E. Etzel S.I. Graduate medical education, 2019-2020, 2018-2019, 2017-2018, 2016-2017, 2015-2016, 2014-2015, 2013-2014.JAMA. 2020; 324: 1230-1250Google Scholar, 5Diversity in Medicine: Facts and Figures 2019. Table 12. Practice Specialty, Females by Race/Ethnicity, 2018. Association of American Medical Colleges.https://www.aamc.org/data-reports/workforce/data/table-12-practice-specialty-females-race/ethnicity-2018Date accessed: November 24, 2020Google Scholar We expanded the number of specialties included in the physician workforce analysis compared with the 2016 study. UIM was defined as racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population—specifically, African Americans, Hispanics, and American Indian or Alaskan Natives. From 2012 to 2019, total applicants to dermatology residency programs increased by 29.5%. The percentage of these applicants who were UIM decreased from 16.4% in 2012 to 9.9% in 2016; however, this figure rose to 13% in 2019 (Fig 1, A). The downward trend of UIM dermatology residents prior to 2016 has reversed in recent years (Fig 1, A). Fig 2, A and B, shows that the UIM workforce in dermatology continues to be low compared to the general population but has increased slightly, from 7.1% in 2013 to 8.1% in 2018. Dermatology also continues to have a significantly lower UIM workforce than other fields, especially primary care specialties. The small but notable increase in the UIM workforce in dermatology and other medical specialties suggests that the broad focus on diversity, equity, and inclusion in medicine, including dermatology, in recent years is producing the intended results. The percentage of UIM individuals in medical school has also gradually increased (from 12.6% in 2016 to 14.1% in 2019) but is still far lower than that in the general population. This difference is thought to represent the long-term effects of structural racism in the United States, which has created inequities in education, income, housing, and neighborhoods that disproportionally affect UIM medical school candidates and, thus, residency applicants. Current initiatives, including the American Academy of Dermatology President's Diversity Conference (2017), Diversity Champion Workshop, mentorship programs sponsored by numerous dermatologic societies, consideration of conscious and unconscious bias in residency selection committees, and exploration of holistic measures in review of residency applicants, could improve UIM representation in our specialty. Future research on the impact of these programs and workforce trends in dermatology should be performed. The call to action to increase racial and ethnic diversity in dermatology continues. None disclosed.