NEW YORK (Reuters Health)—Continued efforts are needed to increase the number of women and minorities in graduate medical education (GME) to ensure a diverse U.S. physician workforce, say the authors of a research letter published today.
“Diversifying the physician workforce has been discussed as requisite to addressing health disparities and inequities. Minority physicians continue to provide the majority of care for underserved and non-English speaking populations,” first author Dr. Curtiland Deville of Johns Hopkins University, Baltimore, Md., told Reuters Health by email.
Using publicly reported data, the researchers determined that in 2012, there were 16,835 medical school graduates, of which 48.3% were women and 15.3% were minority groups (including 7.4% Hispanic and 6.8% black).
There were 115,111 trainees in GME in 2012, of which 46.1% were women and 13.8% were minority groups (7.5% Hispanic and 5.8% black).
Of the 688,468 practicing physicians in 2012, 30.1% were women and 9.2% were members of underrepresented minorities, including 5.2% who were Hispanic and 3.8% who were black.
In 2012, women accounted for 82.4% of trainees in obstetrics and gynecology and for 74.5% of pediatrics trainees, but only 13.8% of trainees in orthopedics. Women also accounted for more than 50% of GME trainees in dermatology (64.4%), family medicine (55.2%), pathology (54.6%) and psychiatry (54.5%).
Among black trainees, family medicine (7.5%) and obstetrics and gynecology (10.3%) were top picks, while otolaryngology (2.2%) was least favorite. Among Hispanic trainees, top picks were psychiatry (9.3%), family medicine (9%), obstetrics and gynecology and pediatrics (each 8.7%) while ophthalmology (3.6%) was least favorite.
“Our study shows that while representation is increased in certain specialties for females, Blacks, and Hispanics, it remains largely unchanged in others,” Dr. Deville told Reuters Health.
“Efforts have been made to increase the available pipeline of diverse medical school graduates with perhaps the assumption that this increased diversity will translate downstream to all specialties. Our study shows that this is not the case. There remain some specialties such as radiology, orthopedics, and otolaryngology, with disproportionate underrepresentation of women and minorities,” he noted.
What’s needed to increase diversity in GME?
“First is the need to increase the available pipeline of diverse medical students,” Dr. Deville said. “This is especially the case for Blacks, Hispanics, and other underrepresented groups. In parallel, is the need to ensure that female, black, and Hispanic medical students are exposed, prepared, and engaged to join all medical specialties. As the country becomes increasingly diverse, the physician workforce should mirror that diversity in all fields to ensure improve health equity and reduce health disparities,” he said.
The study was published online Aug. 24 in JAMA Internal Medicine.
In a commentary published with the paper, Dr. Laura E. Riley of Massachusetts General Hospital in Boston says this study calls attention “yet again to the continued underrepresentation of women and minority groups in medicine.”
“Ensuring a diverse physician workforce will require the continuing attention of medical school leadership and health care systems, and interventions to provide opportunities for diverse physicians to join the leadership ranks. Increasing physician diversity is yet another opportunity to improve the quality of care for all of our patients, particularly the most disadvantaged and those with a disproportionate burden of disease,” Dr. Riley writes.
In an interview with Reuters Health, Marc Nivet, chief diversity officer at the Association of American Medical Colleges (AAMC), said this is “an important paper primarily because, in my mind, it calls to question if we need to be doing more research to figure out why women remain predominantly in three specialties, family medicine, pediatrics and OBGYN. Is that based on choice or are they in some way being relegated to those particular fields, or not being given advice to go into orthopedics or surgery specialties. Is there gender bias at play?”
Nivet said the study also confirms that minorities are more likely to go into primary care. “We’ve had this rationale of wanting minorities to go into primary care and go and serve the underserved. But I think we need to appreciate the fact that we also need more minority surgeons and more minority psychiatrists and dermatologists, etc. Again, is there steering going on or is it choice?”
“We need to be sure that all students that have the talent, capacity and desire to go into medicine have the opportunity to do so because we need them for sure,” Nivet said.
He added, “I do think there is a role for hospitals and medical schools to make sure that their environments are as inclusive as possible. A minority or a woman shouldn’t look at a particular field like orthopedics and say, ‘Well, that’s not for me.’ There should be training that’s happening for the graduate medical education leaders (and) for the faculty members of institutions to make sure that they are exposing all students to different opportunities so they can make the right choice for themselves.”