Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Computational Biology & Bioinformatics, University of Kerala, Thiruvananthapuram, India.
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100178. doi: 10.1016/j.ajogmf.2020.100178. Epub 2020 Jul 9.
Diversity among healthcare teams enhances team function and improves the quality of patient care and outcomes. Women and racial minorities are historically underrepresented in medicine. However, the representation of gender and racial or ethnic groups in academic obstetrics and gynecology in the United States has not been described in recent years.
This study aimed to describe the recent state and trends in gender and racial or ethnic disparities in academic obstetrics and gynecology.
Data from the Association of American Medical Colleges between 2007 and 2018 were analyzed to describe the trends in the representation of women and racial (white, Asian, black) or ethnic (Hispanic) groups. The 12-year trends in representation by academic ranks (all academic physicians, full professor, associate professor, instructor), leadership positions (chairperson), and tenure (not on track for tenure, on track for tenure, or tenured) were depicted. The 12-year trends were assessed using linear regression to determine whether the slope depicting the change in representation of each group from 2007 to 2018 was significantly nonzero. In addition, average representation of each group across the 12-year period was compared using a Student t test (for gender) or analysis of variance (for race and ethnicity).
In 2018, there were 152 institutions and 6302 academic physicians included in the data set. On average across the 12-year period, academic physicians in obstetrics and gynecology were 43% male, 57% female, 68% white, 12% Asian, 8% black, and 5% Hispanic. Across the 12-year period, there was an increase in the total number of physicians from 4755 to 6302 (+166 per year; 95% confidence interval, 146-186; P<.0001), a 15% increase in the proportion of women (+1.38% per year; 95% confidence interval, 1.08%-1.68%; P<.0001), and an increase in the proportion of physicians from racial minorities (Asian, +0.11% per year; 95% confidence interval, 0.08-0.15; P<.0001; black, +0.07% per year; 95% confidence interval, 0.04-0.09; P=.0002; Hispanic, +0.06% per year; 95% confidence interval, 0.02-0.1; P=.0039). There was a greater proportion of white physicians in higher academic ranks (eg, full professor), leadership positions (eg, chairperson), and tenure than the proportion of white physicians overall, whereas the opposite was true for black and Hispanic physicians. Although women now make up 64% of all academic physicians in obstetrics and gynecology, there remains a far higher proportion of males in leadership positions (chairperson) and higher academic ranks (full professor). Similarly, a greater proportion of males were tenured than females.
Across the 12-year period, the representation of women and racial minorities has increased in academic obstetrics and gynecology in the United States. There is now a predominance of women, but there remains a trend for a predominance of white and male physicians in higher academic ranks, leadership positions, and tenure. It will be important to assess how these groups are represented in the coming years as the changing demographics of incoming cohorts progress through their careers to more senior positions. Promoting diversity in medical schools, leadership positions, and higher academic ranks may be an important area of focus.
医疗团队的多样性可以增强团队功能，并提高患者护理和治疗效果的质量。在医学领域，女性和少数族裔历来代表性不足。然而，近年来，美国妇产科领域的性别和种族或族裔群体的代表性尚未得到描述。
本研究旨在描述近年来美国妇产科领域学术职位中性别和种族或族裔差异的现状和趋势。
对美国医学协会（American Medical Colleges）在 2007 年至 2018 年期间的数据进行了分析，以描述女性和种族（白种人、亚洲人、黑种人）或族裔（西班牙裔）群体代表性的趋势。描述了学术职称（所有学术医生、正教授、副教授、讲师）、领导职位（主席）和任期（无终身教职、有终身教职、终身教职）的 12 年趋势。使用线性回归评估 12 年趋势，以确定从 2007 年到 2018 年每个群体的代表性变化斜率是否显著为零。此外，使用学生 t 检验（用于性别）或方差分析（用于种族和族裔）比较每个群体在 12 年期间的平均代表性。
在 2018 年，共有 152 个机构和 6302 名学术医生纳入了数据集。在整个 12 年期间，妇产科的学术医生平均 43%为男性，57%为女性，68%为白种人，12%为亚洲人，8%为黑种人，5%为西班牙裔人。在 12 年期间，医生总数从 4755 人增加到 6302 人（每年增加 166 人；95%置信区间，146-186；P<.0001），女性比例增加了 15%（每年增加 1.38%；95%置信区间，1.08%-1.68%；P<.0001），来自少数族裔的医生比例增加（亚洲人，每年增加 0.11%；95%置信区间，0.08-0.15；P<.0001；黑人，每年增加 0.07%；95%置信区间，0.04-0.09；P=.0002；西班牙裔人，每年增加 0.06%；95%置信区间，0.02-0.1；P=.0039）。在更高的学术职称（如正教授）、领导职位（如主席）和终身教职中，白种医生的比例高于整体白种医生的比例，而黑人和西班牙裔医生的比例则相反。尽管女性现在占妇产科所有学术医生的 64%，但在领导职位（主席）和更高的学术职称（正教授）中，男性的比例仍然更高。同样，男性获得终身教职的比例高于女性。
在过去的 12 年中，美国妇产科领域的女性和少数族裔代表人数有所增加。虽然现在女性占主导地位，但在更高的学术职称、领导职位和终身教职中，仍存在以白人和男性医生为主的趋势。随着未来几年新入学医生群体的人口统计学变化进入职业生涯并担任更高级别的职位，评估这些群体的代表性将非常重要。在医学院、领导职位和更高的学术职称中促进多样性可能是一个重要的关注领域。
