Creating a diverse workforce is paramount to the success of the surgical field. A diverse workforce allows us to meet the health needs of an increasingly diverse population and to bring new ideas to spur technical innovation. The purpose of this study was to assess trends in workforce diversity within vascular surgery (VS) and general surgery (GS) compared with orthopedic surgery (OS), a specialty that instituted a formal diversity initiative more than a decade ago. Data on the trainee pool for VS (fellowships and integrated residencies), GS, and OS were obtained from the U.S. graduate medical education reports for 1999 through 2017. Medical student demographic data were obtained from the Association of American Medical Colleges U.S. medical school enrollment reports. The proportion of each group (female, Hispanic, and black) in medical school was compared with their proportion of the surgical trainee populations. The proportion of female trainees increased significantly between the two time periods for the three surgical disciplines examined (P < .001), although the increase was less robust in OS. Hispanic trainees also represented an increasing proportion of all three disciplines (P < .001). The proportion of black trainees did not significantly change in any discipline between the two periods (Table). Relative to their proportion in medical school, Hispanics were well represented as surgical trainees in all surgical specialties studied (relative ratio [RR], 0.95-1.52; 0.95 OS, 1.00 GS, 1.52 VS fellowship, and 1.23 VS residency). Compared with their representation in medical school, women were under-represented as surgical trainees (RR: 0.32 OS, 0.82 GS, 0.56 VS fellowship, and 0.78 VS residency) as were blacks (RR: 0.63 OS, 0.90 GS, 0.99 VS fellowship, and 0.81 VS residency). The lack of increase in black trainees across all specialties was particularly discouraging. Whereas there were significant increases in the number of women and Hispanic trainees in these three surgical disciplines during the study period, only Hispanics enter the surgical field at a rate similar to their proportion of medical students. Women and black trainees were under-represented in all specialties compared with their representation in medical school. The data presented suggest potential problems with recruitment at multiple levels of the pipeline. Particular attention should be paid to increasing the pool of qualified undergraduate students who are under-represented in medicine.TableProportion of women, black, and hispanic trainees in each surgical discipline between the two time periods1999-20052013-2017P valueWomen Vascular residencyN/A36.7%– Vascular fellowship13.8%27%<.001 General surgery24.7%38.5%<.001 Orthopedic surgery10.1%14.6%<.001Blacks Vascular residencyN/A5.1%– Vascular fellowship4.3%5.4%NS General surgery5.9%5.7%NS Orthopedic surgery4%4%NSHispanics Vascular residencyN/A7.3%– Vascular fellowship5.2%8.7%<.001 General surgery6.1%8.4%<.001 Orthopedic surgery3.3%5.3%<.001 Open table in a new tab
Read full abstract