Underrepresented in medicine women face low promotion rates, high risk for attrition
Key takeaways:
- No changes occurred in mean percentage of underrepresented in medicine female instructors or full professors within a decade.
- Underrepresented in medicine women had the shortest mean time to attrition.
Underrepresented in medicine female surgeons experienced a lower likelihood for promotion, and higher risk for attrition and to leave academia altogether, according to study results published in JAMA Surgery.
“Progress in increasing the number of underrepresented in medicine surgery faculty has been slow, particularly for underrepresented minorities and specifically women,” Heather Yeo, MD, MHS, MBA, MS, associate professor of surgery and population health sciences at Weill Cornell Medicine, told Healio. “We need interventions that can enable success for our strongest trainees and physicians.”
Workforce issues
Yeo and colleagues have worked to examine disparities in the surgical workforce for the past decade.
“For the current study, we wanted to see what progress has been made and understand potential ways to improve disparities,” Yeo said. “We know that diversity in providers is beneficial for patient care and outcomes, and we also know that transparency is imperative in order to make change.”
The retrospective cohort study included 31,045 academic department of surgery faculty members (73% white; 74% men) across 138 institutions with an appointment any time between 2005 and 2010.
Researchers used Kaplan-Meier and Cox time-to-event analyses to assess the intersection of race and ethnicity and sex associated with the career trajectory of academic surgeons.
Mean follow-up was 12.4 years.
Observed changes
Mean program percentage of underrepresented in medicine female faculty members increased from 2.3% to 3.3% between 2010 and 2020 compared with an increase in underrepresented in medicine male faculty from 8.4% to 8.5% (P < .001).
Results showed no change in the mean program percentage of underrepresented in medicine female instructors or full professors. However, researchers observed an increase in mean program percentage of non-underrepresented in medicine women at every rank between 2010 and 2020 in the roles of instructor (1.1 percentage points; 95% CI, 0.73-1.5), assistant professor (1.1 percentage points; 95% CI, 0.93-1.3), associate professor (0.55 percentage points; 95% CI, 0.49-0.61) and professor (0.5 percentage points; 95% CI, 0.41-0.6).
Mean percentage of underrepresented in medicine female assistant professors increased from 3% to 5%, and associate professors increased from and 1.6% to 2.2% (P = .002) between 2010 and 2020. Researchers observed no changes in mean program percentage of underrepresented in medicine male instructors, associate professors or full professors during the same time period.
Moreover, no changes were observed in the mean percentage of Black surgeons across all programs during the 10-year study period (4% vs. 4%). Whereas researchers found an increase in the mean percentage of Hispanic or Latinx surgeons from 4.9% to 6% (P < .001), and a decrease in the mean percentage of Native Hawaiian or Other Pacific Islanders (0.6% to 0.4%; P < .001) and in American Indian or Alaska Native surgeons (from 0.4% to 0.3%; P < .001).
Results further showed a 32% lower likelihood for promotion of Hispanic female surgeons within 10 years vs. white male surgeons (HR = 0.68; 95% CI, 0.54-0.86).
After 10 years, 79% of non-underrepresented in medicine men, 71% of non-underrepresented in medicine women, 68% of underrepresented in medicine men, and 63% of underrepresented in medicine women remained on faculty.
Of note, underrepresented in medicine women experienced a higher risk for attrition compared with non-underrepresented in medicine women (HR = 1.3; 95% CI, 1.1-1.5; P = .001) and non-underrepresented in medicine men (HR = 1.2; 95% CI, 1-1.4; P = .05).
Mean time to attrition was shortest for underrepresented in medicine women and longest for non-underrepresented in medicine men (8.2 years vs. 9 years; P < .001).
Essential research
Further efforts to understand these vulnerabilities are essential, researchers concluded.
“We are now looking to identify what programs are successful at retention and promotion of underrepresented in medicine physicians and understand what factors improve success,” Yeo said. “We are planning to visit institutions that have been the most successful as well as those that have struggled in order to understand what factors are most successful and impactful.”
For more information:
Heather L. Yeo, MD, MHS, MS, MBA, can be reached at hey9002@med.cornell.edu.
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