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Original Investigation
May 5, 2021

Diversification of Academic Surgery, Its Leadership, and the Importance of Intersectionality

Author Affiliations
  • 1Department of Surgery, University of Florida College of Medicine, Gainesville
  • 2Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University, Richmond
JAMA Surg. Published online May 5, 2021. doi:10.1001/jamasurg.2021.1546
Key Points

Question  What is the importance of gender and racial/ethnic intersectionality along the surgical pipeline?

Findings  In this cross-sectional study of US surgical faculty, female faculty who identify as members of a racial/ethnic minority group experienced an increase in representation at nearly all junior and midcareer faculty positions, with a more favorable trajectory than their male colleagues. However, representation of racial/ethnic minority groups among female full professors decreased, whereas representation increased marginally among their male colleagues.

Meaning  Intersectionality of gender and race/ethnicity may leave female surgeons in minority groups more disadvantaged than their male colleagues in achieving leadership positions, despite superior trends in representation at junior and midcareer faculty positions.

Abstract

Importance  Diversity in academic surgery is lacking, particularly among positions of leadership.

Objective  To evaluate trends among racial/ethnical minority groups stratified by gender along the surgical pipeline, as well as in surgical leadership.

Design, Setting, and Participants  This cross-sectional and longitudinal analysis assessed US surgical faculty census data obtained from the Association of American Medical Colleges faculty roster in the Faculty Administrative Management Online User System database. Surgical faculty members captured in census data from December 31, 2013, to December 31, 2019, were included in the analysis. Faculty were identified from the surgery category of the faculty roster, which includes general surgeons and subspecialists, neurosurgeons, and urologists.

Main Outcomes and Measures  Gender and race/ethnicity were obtained for surgical faculty stratified by rank. Descriptive statistics with annual percentage of change in representation are reported based on faculty rank.

Results  A total of 15 653 US surgical faculty, including 3876 women (24.8%), were included in the data set for 2019. Female faculty from racial/ethnic minority groups experienced an increase in representation at instructor and assistant and associate professorship appointments, with a more favorable trajectory than male faculty from racial/ethnic minority groups across nearly all ranks. White faculty maintain most leadership positions as full professors (3105 of 3997 [77.7%]) and chairs (294 of 380 [77.4%]). The greatest magnitude of underrepresentation along the surgical pipeline has been among Black (106 of 3997 [2.7%]) and Hispanic/Latinx (176 of 3997 [4.4%]) full professors. Among full professors, although Black and Hispanic/Latinx male representation increased modestly (annual change, 0.07% and 0.10%, respectively), Black female representation remained constant (annual change, 0.00004%) and Hispanic/Latinx female representation decreased (annual change, −0.16%). Overall Hispanic/Latinx (20 of 380 [5.3%]) and Black (13 of 380 [3.4%]) representation as chairs has not changed, with only 1 Black and 1 Hispanic/Latinx woman ascending to chair from 2013 to 2019.

Conclusions and Relevance  A disproportionately small number of faculty from minority groups obtain leadership positions in academic surgery. Intersectionality may leave female members of racial/ethnic minority groups more disadvantaged than their male colleagues in achieving leadership positions. These findings highlight the urgency to diversify surgical leadership.

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