Lack of diverse backgrounds greater among dermatology students

Students pursuing dermatology compared with other specialties were less likely to come from diverse backgrounds or pursue careers in underserved care and public health, according to a cross-sectional study.

“Several calls to action have been proposed to address the lack of diversity in dermatology and its detrimental consequences,” Yi Gao, MD, a board-certified dermatologist in Minneapolis, and colleagues wrote. “However, few comprehensive data exist on the diversity within the dermatology workforce training pipeline and the association of diverse identities with the intended career goals of trainees.”

This study examined diversity factors, including racial and ethnic groups that are underrepresented in medicine (URM) and sexual “minority” (SM) groups among the dermatology workforce pipelines. Researchers also evaluated the association between these diversity factors and the intended career goals of dermatology students compared with students in other specialties.

The researchers conducted a secondary analysis of a repeated cross-sectional study using data from the 2016 to 2019 AAMC Graduation Questionnaires. Among 58,077 participants, 49% were women, 14.5% were URM and 6.3% were SM. Also, 1,361 students were pursuing dermatology, whereas 56,716 were pursuing other specialties.

A greater proportion of students pursuing dermatology vs. other specialties were younger, women and in an MD combined degree program, although a smaller proportion were URM (11.2% vs. 15.2%; P < .001).

Although more women pursued dermatology, a smaller proportion of these women identified as URM (11.6% vs. 17.2%; P < .001) or SM (1.9% vs. 5.7%; P < .001) compared with women in other specialties. However, a greater proportion of men who pursued dermatology vs. other specialties identified as SM (12% vs. 6.9%; P < .001), but did not differ greatly when considering URM.

Furthermore, dermatology students vs. those in other specialties had decreased odds of pursuing careers that cared for underserved populations (18.3% vs. 34%; adjusted OR = 0.4; 95% CI, 0.35-0.47). More specifically, compared with other specialties, dermatology students were less likely to practice in underserved areas (12.7% vs. 25.9%; aOR = 0.4; 95% CI, 0.34-0.47) or practice public health (17% vs. 30.2%; aOR = 0.44; 95% CI, 0.38-0.51), but they were more likely to pursue careers in research (64.7% vs 51.7%; aOR = 1.76; 95% CI, 1.57-1.97).

However, of the dermatology students that expressed an interest in underserved care, women were more likely than men to help underserved populations (20.1% vs. 15.4%; aOR = 1.49; 95% CI, 1.09-2.05) and pursue public health (18.1% vs. 15.4%; aOR = 1.4; 95% CI, 1.02-1.92).

URM vs. non-URM dermatology students also reported a higher likelihood of caring for underserved populations (42.3% vs. 15.2%; aOR = 4.05; 95% CI, 2.83-5.8), practicing in underserved areas (31.4% vs. 10.3%; aOR = 3.93; 95% CI, 2.66-5.8) and pursuing public health (25.6% vs. 15.9%; aOR = 1.7; 95% CI, 1.14-2.53).

Dermatology students who identified as SM vs. heterosexual were also more likely to plan to care for underserved populations (28.8% vs. 17.6%; aOR = 2.02; 95% CI, 1.16-3.49) and pursue public health (31.3% vs. 16.1%; aOR = 2.55; 95% CI, 1.51-4.31), in addition to being more likely in intent to become medical faculty (56.3% vs. 46.1%; aOR = 1.6; 95% CI, 1.01-2.57), pursue administrative roles (38.9% vs. 26.9%; aOR = 1.6; 95% CI, 1.01-2.59) and conduct research (76.3% vs. 64%; aOR = 1.73; 95% CI, 1.01-2.98). These two groups did not, however, differ in intent to practice in underserved areas.

“Addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline,” Gao and colleagues wrote. “These efforts may help reduce health disparities faced by underserved populations by increasing the collective engagement of all dermatologists in underserved care and by enriching training and practice environments.”