Diversity Within the Most Competitive Internal Medicine Fellowships: Examining Trends from 2008 to 2018
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Department of Cardiology, University of California, San Diego, CA, USA; 2SUNY Downstate Medical Center, New York, NY, USA; 3St. George’s University, St. George’s, Grenada; 4David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
BACKGROUND: Prior studies have demonstrated the importance of diversity among physicians. Identifying trends in diversity within the most competitive internal medicine (IM) fellowships can guide focused efforts to address barriers to equal representation. OBJECTIVE: To examine the racial and gender composition of resident applicants and accepted fellows to the top five most competitive IM specialties. DESIGN: Survey data from the AAMC, JAMA, and NRMP were obtained. Fisher’s exact tests were conducted to compare differences in representation between fellows in the most competitive specialties, resident applicants into those specialties, and categorical IM residents. Linear regression was used to analyze trends within each group. PARTICIPANTS: Categorical IM residents and fellows at ACGME-accredited M.D. programs in the USA. MAIN MEASURES: Proportion of each population by gender and race/ethnicity KEY RESULTS: Women saw an increase in representation among accepted fellows to the most competitive IM fellowships from 2008 to 2013 (+ 4.4%, p < 0.011), but the trend has since plateaued at a level (34%) significantly lower than their representation among IM residents (43%, p < 0.001). Black representation among accepted fellows (4.6%) has been increasing from 2008 to 2018 (+ 1.2%, p = 0.001), but is still significantly lower than their representation among IM residents (5.6%, p < 0.001). Hispanic resident applicant and fellow representation have seen minimal change. CONCLUSION: Despite trends towards better representation among women and underrepresented minorities (URMs) among fellows in the most competitive IM specialties from 2008 to 2013, there has been a stagnation in both gender and racial diversity over the past 5 years. Further efforts must be undertaken to address barriers to entry and advocate for better representation of women and URMs in fellowship programs. KEY WORDS: diversity; medical education; fellowship; residents; medical students. J Gen Intern Med DOI: 10.1007/s11606-020-06008-5 © Society of General Internal Medicine 2020
Prior Presentation: None Received October 6, 2019 Revised March 24, 2020 Accepted June 23, 2020
BACKGROUND
In the face of an increasingly diverse population in the USA, the physician workforce has failed to adapt. While racial and gender diversity among medical school graduates has increased since 1975, this trend has plateaued from 2012 onwards with underrepresented racial minorities (URMs) representing less than one-quarter of the annual pool of graduates.1 This is further compounded by a stark decrease in the percentage of full-time faculty positions and department chairs within academic medicine held by racial and gender minorities.2 Numerous studies have demonstrated racial inequalities in health care in the USA. And while the
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