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Figure.  Representation Ratio and Percentage of Women and Underrepresented Groups in Medicine Faculty in US Medical Schools by Academic Department
Representation Ratio and Percentage of Women and Underrepresented Groups in Medicine Faculty in US Medical Schools by Academic Department

Data are from the Association of American Medical Colleges Faculty Roster as of December 31, 2019, and Accreditation Council of Graduate Medical Education for 2012 to 2013. Representation ratio is the proportion of women or underrepresented group in medicine for faculty in 2019 divided by that for residents 6 years prior, in the 2012 to 2013 academic year. Academic medical departments are displayed by magnitude of representation ratio. Underrepresented groups depicted include Black, Hispanic, and American Indian or Alaska Native individuals. Individuals identified as multiple race, Native Hawaiian, or Other Pacific Islander were not included owing to the inability to distinguish these subcategories within resident data.

Table.  Women and Underrepresented Groups in US Academic Medical School Faculty, 1990-2019a
Women and Underrepresented Groups in US Academic Medical School Faculty, 1990-2019a
1.
Yehia  BR, Cronholm  PF, Wilson  N,  et al.  Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds.   BMC Med Educ. 2014;14:26. doi:10.1186/1472-6920-14-26PubMedGoogle ScholarCrossref
2.
Ogunwole  SM, Dill  M, Jones  K, Golden  SH.  Trends in internal medicine faculty by sex and race/ethnicity, 1980-2018.   JAMA Netw Open. 2020;3(9):e2015205. doi:10.1001/jamanetworkopen.2020.15205PubMedGoogle Scholar
3.
Hofler  LG, Hacker  MR, Dodge  LE, Schutzberg  R, Ricciotti  HA.  Comparison of women in department leadership in obstetrics and gynecology with those in other specialties.   Obstet Gynecol. 2016;127(3):442-447. doi:10.1097/AOG.0000000000001290PubMedGoogle ScholarCrossref
4.
Lett  LA, Murdock  HM, Orji  WU, Aysola  J, Sebro  R.  Trends in racial/ethnic representation among US medical students.   JAMA Netw Open. 2019;2(9):e1910490. doi:10.1001/jamanetworkopen.2019.10490PubMedGoogle Scholar
5.
Peek  ME, Kim  KE, Johnson  JK, Vela  MB.  “URM candidates are encouraged to apply”: a national study to identify effective strategies to enhance racial and ethnic faculty diversity in academic departments of medicine.   Acad Med. 2013;88(3):405-412. doi:10.1097/ACM.0b013e318280d9f9PubMedGoogle ScholarCrossref
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    1 Comment for this article
    Asian Americans
    Heidi Koenig, MD | University of Louisville
    I find the data presented interesting and am encouraged that we are making progress with representation of minorities identified among physicians. I am dismayed that Indian Americans, a small portion of our population and close to 25% of physicians practicing in the US. cannot be identified. Also, Asian Americans who represent ~7% of the population also cannot be identified. My sense is there is much more work to be done. I would be eager to see a more thorough analysis of the physician workforce.
    CONFLICT OF INTEREST: None Reported
    Research Letter
    Health Policy
    August 30, 2021

    Representation of Women and Underrepresented Groups in US Academic Medicine by Specialty

    Author Affiliations
    • 1Department of Neurology, University of Rochester Medical Center, Rochester, New York
    • 2Department of Brain and Cognitive Sciences, University of Rochester, Rochester, New York
    • 3Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
    JAMA Netw Open. 2021;4(8):e2123512. doi:10.1001/jamanetworkopen.2021.23512
    Introduction

    Diversity in the physician workforce has always been and remains a critical issue. Prior studies demonstrate the number of women and members of underrepresented groups in medicine (URM), such as American Indian or Alaskan Native, Black, Latino or Hispanic, and Native Hawaiian or other Pacific Islander individuals, are increasing throughout academic medicine.1,2 However, little is known in the current literature regarding variation and trends in demographics of academic faculty across medical specialties or the retention of residents identifying as women or URM as academic faculty. This study adds to the literature by examining 30-year demographic trends across academic medicine departments and providing novel comparisons of the proportion of individuals identifying as women or URM between academic faculty and specialty-matched residents.

    Methods

    This cross-sectional study was deemed exempt from review and informed consent by the University of Rochester institutional review board because it was deemed non–human participant research. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    We evaluated the distribution of women and URM among US medical school faculty for 16 clinical academic medicine departments using the Association of American Medical Colleges Faculty Roster from 1990 through 2019. Race/ethnicity of faculty was self-identified. Linear mixed-effects models were used to estimate the mean change per year (ie, linear slope) in percentages of women and percentages of URM, which included department, time, and a department-by-time interaction term with an autoregressive correlation structure for repeated measures (eAppendix in the Supplement). Bonferroni correction for multiple comparisons was used; statistical significance defined as 2-sided P < .003.

    Demographics, including race and ethnicity, of US resident physicians from 2012 to 2013 were obtained from the Accreditation Council of Graduate Medical Education. Representation ratios3 were calculated by dividing the proportion of women or URM faculty in 2019 by the proportion of women or URM residents in the 2012 to 2013 academic year (allowing for a 6-year time lag). This metric denotes the representativeness of women or URM faculty compared to the corresponding trainee pipeline (eAppendix in the Supplement).

    Analyses were performed using SAS version 94 (SAS Institute), and representation ratios were calculated using R version 4.04 (R Project for Statistical Computing). Data were analyzed in December 2019.

    Results

    From 1990 to 2019, there were a total of 3 146 342 faculty entries, including 1 089 892 women (34.6%) and 2 252 134 faculty entries for White physicians (71.9%). Proportions of women faculty increased, with women comprising more than 50% of faculty members in 5 of 16 clinical academic departments by 2019 (Table). Proportions of URM faculty also increased for 8 of 16 specialties (Table).

    In 2019, specialties with high proportions of women faculty did not necessarily have high representativeness compared with residents. Obstetrics and gynecology, which has the highest proportion of women faculty, demonstrated the third lowest representation ratio (0.81). In contrast, despite having the lowest overall proportion of women faculty, orthopedic surgery had the highest representation ratio (1.48) (Figure, A). In respect to URM, most specialties had representation ratios less than 1.0 (overall representation ratio, 0.76) (Figure, B-D).

    Discussion

    This cross-sectional study found increases in the proportions of women faculty across clinical academic departments over the past 3 decades. Racial and ethnic diversity among faculty also increased, although at a lower rate. Increasing faculty diversity can be partially attributed to comparably modest improvements in diversity among medical students and residents.4 However, URM faculty are underrepresented compared with the resident pipelines for most specialties. Nearly all departments captured only a fraction of the available URM resident pipeline, and there were differences in representation ratios across departments for women. Further investigation is needed to understand factors that may dissuade or obstruct women and URM trainees from pursuing academic careers. Previous studies, such as a 2013 study by Peek et al,5 have found that medical schools with URM role models and available, experienced mentors (URM and non-URM) were more likely to have high proportions of URM students. Studies are needed to determine modifiable differences and how to implement change to optimize faculty demographics.

    This study has some limitations. The interpretation of the representation ratio in this study is limited by the inability to control for trainee preferences for academics and does not account for personal and structural factors that may influence career choice. Other limitations include the use of nationally aggregated deidentified data, which prohibits control of confounding factors, including regional demographics and status of Historically Black Colleges and Universities. Further study of individualized faculty and institutional-level data are needed.

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    Article Information

    Accepted for Publication: June 28, 2021.

    Published: August 30, 2021. doi:10.1001/jamanetworkopen.2021.23512

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Yoo A et al. JAMA Network Open.

    Corresponding Author: Alexander Yoo, MD, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY 14642 (alexander_yoo@urmc.rochester.edu).

    Author Contributions: Dr Yoo had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Yoo, George, Paul.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Yoo, George.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Auinger, Paul.

    Administrative, technical, or material support: Yoo, George.

    Supervision: George.

    Conflict of Interest Disclosures: None reported.

    References
    1.
    Yehia  BR, Cronholm  PF, Wilson  N,  et al.  Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds.   BMC Med Educ. 2014;14:26. doi:10.1186/1472-6920-14-26PubMedGoogle ScholarCrossref
    2.
    Ogunwole  SM, Dill  M, Jones  K, Golden  SH.  Trends in internal medicine faculty by sex and race/ethnicity, 1980-2018.   JAMA Netw Open. 2020;3(9):e2015205. doi:10.1001/jamanetworkopen.2020.15205PubMedGoogle Scholar
    3.
    Hofler  LG, Hacker  MR, Dodge  LE, Schutzberg  R, Ricciotti  HA.  Comparison of women in department leadership in obstetrics and gynecology with those in other specialties.   Obstet Gynecol. 2016;127(3):442-447. doi:10.1097/AOG.0000000000001290PubMedGoogle ScholarCrossref
    4.
    Lett  LA, Murdock  HM, Orji  WU, Aysola  J, Sebro  R.  Trends in racial/ethnic representation among US medical students.   JAMA Netw Open. 2019;2(9):e1910490. doi:10.1001/jamanetworkopen.2019.10490PubMedGoogle Scholar
    5.
    Peek  ME, Kim  KE, Johnson  JK, Vela  MB.  “URM candidates are encouraged to apply”: a national study to identify effective strategies to enhance racial and ethnic faculty diversity in academic departments of medicine.   Acad Med. 2013;88(3):405-412. doi:10.1097/ACM.0b013e318280d9f9PubMedGoogle ScholarCrossref
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