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Surgical time out: Our counts are still short on racial diversity in academic surgery

      Abstract

      Background

      This study provides an updated description of diversity along the academic surgical pipeline to determine what progress has been made.

      Methods

      Data was extracted from a variety of publically available data sources to determine proportions of minorities in medical school, general surgery training, and academic surgery leadership.

      Results

      In 2014–2015, Blacks represented 12.4% of the U.S. population, but only 5.7% graduating medical students, 6.2% general surgery trainees, 3.8% assistant professors, 2.5% associate professors and 2.0% full professors. From 2005-2015, representation among Black associate professors has gotten worse (−0.07%/year, p < 0.01). Similarly, in 2014–2015, Hispanics represented 17.4% of the U.S. population but only 4.5% graduating medical students, 8.5% general surgery trainees, 5.0% assistant professors, 5.0% associate professors and 4.0% full professors. There has been modest improvement in Hispanic representation among general surgery trainees (0.2%/year, p < 0.01), associate (0.12%/year, p < 0.01) and full professors (0.13%/year, p < 0.01).

      Conclusion

      Despite efforts to promote diversity in surgery, Blacks and Hispanics remain underrepresented. A multi-level national focus is imperative to elucidate effective mechanisms to make academic surgery more reflective of the US population.

      Keywords

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      References

        • Bach P.B.
        • Cramer L.D.
        • Warren J.L.
        • et al.
        Racial differences in the treatment of early-stage lung cancer.
        N Engl J Med. 1999; 341: 1198-1205
        • Silber J.H.
        • Rosenbaum P.R.
        • Ross R.N.
        • et al.
        Racial disparities in colon cancer survival: a matched cohort study.
        Ann Intern Med. 2014; 161: 845-854
        • Ravi P.
        • Sood A.
        • Schmid M.
        • et al.
        Racial/ethnic disparities in perioperative outcomes of major procedures: results from the national surgical quality improvement program.
        Ann Surg. 2015; 262: 955-964
        • Cooper-Patrick L.
        • Gallo J.J.
        • Gonzales J.J.
        • et al.
        Race, gender, and partnership in the patient-physician relationship.
        JAMA. 1999; 282: 583-589
        • Laveist T.A.
        • Nuru-Jeter A.
        Is doctor-patient race concordance associated with greater satisfaction with care?.
        J Health Soc Behav. 2002; 43: 296-306
        • Thornton R.L.
        • Powe N.R.
        • Roter D.
        • et al.
        Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality.
        Patient Educ Couns. 2011; 85: e201-e208
        • Branson R.D.
        • Davis K.
        • Butler K.L.
        African Americans' participation in clinical research: importance, barriers, and solutions.
        Am J Surg. 2007; 193 (discussion 40): 32-39
        • Hughes T.B.
        • Varma V.R.
        • Pettigrew C.
        • et al.
        African Americans and clinical research: evidence concerning barriers and facilitators to participation and recruitment recommendations.
        Gerontologist. 2015; https://doi.org/10.1093/geront/gnv118
        • Marrast L.M.
        • Zallman L.
        • Woolhandler S.
        • et al.
        Minority physicians' role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities.
        JAMA Intern Med. 2014; 174: 289-291
        • Moy E.
        • Bartman B.A.
        Physician race and care of minority and medically indigent patients.
        JAMA. 1995; 273: 1515-1520
        • Xu G.
        • Fields S.K.
        • Laine C.
        • et al.
        The relationship between the race/ethnicity of generalist physicians and their care for underserved populations.
        Am J Public Health. 1997; 87: 817-822
        • Komaromy M.
        • Grumbach K.
        • Drake M.
        • et al.
        The role of black and Hispanic physicians in providing health care for underserved populations.
        N Engl J Med. 1996; 334: 1305-1310
        • Rabinowitz H.K.
        • Diamond J.J.
        • Veloski J.J.
        • et al.
        The impact of multiple predictors on generalist physicians' care of underserved populations.
        Am J Public Health. 2000; 90: 1225-1228
        • Cantor J.C.
        • Miles E.L.
        • Baker L.C.
        • et al.
        Physician service to the underserved: implications for affirmative action in medical education.
        Inquiry. 1996; 33: 167-180
        • Lightfoote J.B.
        • Fielding J.R.
        • Deville C.
        • et al.
        Improving diversity, inclusion, and representation in radiology and radiation oncology part 1: why these matter.
        J Am Coll Radiol. 2014; 11: 673-680
      1. The Sullivan Commission on Diversity in the Healthcare Workforce Missing Persons: Minorities in the Health Professions 2004. Available at: http://www.aacn.nche.edu/media-relations/SullivanReport.pdf. Accessed October 18, 2016.

        • Butler P.D.
        • Longaker M.T.
        • Britt L.D.
        Major deficit in the number of underrepresented minority academic surgeons persists.
        Ann Surg. 2008; 248: 704-711
        • Landry A.M.
        • Stevens J.
        • Kelly S.P.
        • et al.
        Under-represented minorities in emergency medicine.
        J Emerg Med. 2013; 45: 100-104
        • Julien J.S.
        • Lang R.
        • Brown T.N.
        • et al.
        Minority underrepresentation in academia: factors impacting careers of surgery residents.
        J Racial Ethn Health Disparities. 2014; 1: 238-246
        • Yu P.T.
        • Parsa P.V.
        • Hassanein O.
        • et al.
        Minorities struggle to advance in academic medicine: a 12-y review of diversity at the highest levels of America's teaching institutions.
        J Surg Res. 2013; 182: 212-218
        • Daniels E.W.
        • French K.
        • Murphy L.A.
        • et al.
        Has diversity increased in orthopaedic residency programs since 1995?.
        Clin Orthop Relat Res. 2012; 470: 2319-2324
        • Butler P.D.
        • Britt L.D.
        • Longaker M.T.
        Ethnic diversity remains scarce in academic plastic and reconstructive surgery.
        Plast Reconstr Surg. 2009; 123: 1618-1627
        • Butler P.D.
        • Britt L.D.
        • Green Jr., M.L.
        • et al.
        The diverse surgeons initiative: an effective method for increasing the number of under-represented minorities in academic surgery.
        J Am Coll Surg. 2010; 211: 561-566
        • Butler P.D.
        • Britt L.D.
        • Richard C.E.
        • et al.
        The diverse surgeons' initiative: longitudinal assessment of a successful national program.
        J Am Coll Surg. 2015; 220: 362-369
      2. Society of Black Academic Surgeons. http://www.sbas.net/. Accessed October 18, 2016.

      3. Association of American Medical Colleges FACTS: Applicants, Matriculants, Enrollment, Graduates, M.D.-Ph.D., and Residency Applicants Data. Available at: https://www.aamc.org/data/facts/. Accessed January 2016.

      4. Association of American Medical Colleges FAMOUS (Faculty Administrative Management Online User System). https://www.aamc.org/data/facultyroster/. Accessed January 2016.

        • Brotherton S.E.
        • Etzel S.I.
        Graduate medical education, 2015-2016.
        JAMA. 2016; 316: 2291-2310
      5. Accreditation Council of Graduate Medical Education. ACGME Data Resource Book Academic Year 2015-2016. http://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book. Accessed October 18, 2016.

      6. U.S. Census Bureau American Community Survey. https://www.census.gov/programs-surveys/acs/. Accessed October 18, 2016.

      7. American College of Surgeons Committee on Diversity Issues. https://www.facs.org/about-acs/governance/acs-committees/committee-on-diversity-issues. Accessed October 18, 2016.

      8. American College of Surgeons Committee on Health Care Disparities. https://www.facs.org/health-care-disparities. Accessed October 18, 2016.

      9. The Society of Surgery of the Alimentary Tract. http://ssat.com/about/committees.cgi?s=1&cc=DTF. Accessed May 17, 2017.

      10. Otolaryngology Diversity Committee. http://www.suo-aado.org/Diversity-Committee. Accessed January 16, 2017.

        • Saha S.
        • Guiton G.
        • Wimmers P.F.
        • et al.
        Student body racial and ethnic composition and diversity-related outcomes in US medical schools.
        JAMA. 2008; 300: 1135-1145
        • Wong R.L.
        • Sullivan M.C.
        • Yeo H.L.
        • et al.
        Race and surgical residency: results from a national survey of 4339 US general surgery residents.
        Ann Surg. 2013; 257: 782-787
        • Cropsey K.L.
        • Masho S.W.
        • Shiang R.
        • et al.
        Why do faculty leave? Reasons for attrition of women and minority faculty from a medical school: four-year results.
        J Womens Health (Larchmt). 2008; 17: 1111-1118
        • Dimou F.M.
        • Eckelbarger D.
        • Riall T.S.
        Surgeon burnout: a systematic review.
        J Am Coll Surg. 2016; 222: 1230-1239
        • Elmore L.C.
        • Jeffe D.B.
        • Jin L.
        • et al.
        National survey of burnout among US general surgery residents.
        J Am Coll Surg. 2016; 223: 440-451
        • Nickens H.W.
        • Ready T.P.
        • Petersdorf R.G.
        Project 3000 by 2000. Racial and ethnic diversity in U.S. medical schools.
        N Engl J Med. 1994; 331: 472-476
        • Garces L.M.
        • Mickey-Pabello D.
        Racial diversity in the medical profession: the impact of affirmative action bans on underrepresented student of color matriculation in medical schools.
        J High Educ. 2015; 86: 264-294
        • Terrell C.
        • Beaudreau J.
        3000 by 2000 and beyond: next steps for promoting diversity in the health professions.
        J Dent Educ. 2003; 67: 1048-1052
      11. Barbarin, O. Ready or not! African American males in kindergarten. In B. Bowman (Ed.). Love to Read: Preparing African American Children for Reading Success. (pp.1-15) Washington D.C.: National Black Child Development Institute.

      12. Barbarin, O. Emotional and social development of African American children. Journal of Black Psychology, 19:381-390.

        • Association of American Medical Colleges
        Altering the Course: Black Males in Medicine.
        2015 (Accessed May 17, 2017)
        • Incorvaia A.N.
        • Ringley C.D.
        • Boysen D.A.
        Factors influencing surgical career decisions.
        Curr Surg. 2005; 62: 429-435
        • Gabram S.G.
        • Allen L.W.
        • Deckers P.J.
        Surgical residents in the 1990s. Issues and concerns for men and women.
        Arch Surg. 1995; 130: 24-28
        • Butler P.D.
        • Longaker M.T.
        • Britt L.D.
        Addressing the paucity of underrepresented minorities in academic surgery: can the “Rooney Rule” be applied to academic surgery?.
        Am J Surg. 2010; 199: 255-262