Henry Ford Health, Detroit, Michigan.
Wayne State University School of Medicine, Detroit, Michigan.
JAMA Netw Open. 2023 Sep 5;6(9):e2335529. doi: 10.1001/jamanetworkopen.2023.35529.
For the past 50 years, significant gaps have existed in gender and racial diversity across various medical specialties, despite the many benefits of a diverse physician workforce. One proposed approach to increasing diversity is top-down diversification, in which diverse leadership results in increased minority and female workforce representation.
To investigate the changes in academic medical leadership diversity from 2007 to 2019 and to assess the recent leadership diversity of various specialties compared with the averages across all specialties.
DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional analysis of physicians in varying academic roles in 2007, 2019, and 2020. Demographic data were collected via specialized reports from the Association of American Medical Colleges. Included were 4 primary care specialties (internal medicine, family medicine, pediatrics, obstetrics/gynecology [OB/GYN] and 4 surgical specialties (orthopedic surgery, neurologic surgery, otolaryngology [ENT], general surgery). Study participants were faculty, program directors, and chairpersons. Data were analyzed for the years 2007, 2019, and 2020.
Self-reporting of demographic information to residency programs collected via the Graduate Medical Education Track Survey.
Proportions of each race/ethnicity and sex among cohorts of participants and comparisons between them.
The total number of individuals investigated included 186 210 faculty from 2019 (79 441 female [42.7%]), 6417 program directors from 2020 (2392 female [37.3%]), 1016 chairpersons from 2007 (89 female [8.8%]), and 2424 chairpersons from 2019 (435 female [17.9%]). When comparing chairperson diversity from 2007 to 2019, only internal medicine and general surgery experienced significant increases in minority (aggregate category used throughout the investigation to refer to anyone who self-identified as anything other than non-Hispanic White) representation (90% increase [11.7 percentage points, from 13.0% in 2007 to 24.7% in 2019]; P = .01 and 96% increase [13.0 percentage points, from 13.5% in 2007 to 26.5% in 2019]; P < .001), respectively; meanwhile, several specialties saw significant increases in female representation during this period (family medicine by 107.4%, P =.002; pediatrics by 83.1%, P =.006; OB/GYN by 53.2%, P =.045; orthopedic surgery by +4.1 percentage points, P =.04; general surgery by 226.9%, P =.005). In general, surgical specialties had lower leadership diversity than the average diversity of all residency programs, whereas primary care specialties had similar or increased diversity.
Study results suggest that some specialties have made significant contributions toward bridging diversity gaps whereas others continue to lag behind. Our recommendations to improve academic medical leadership diversity include programs and institutions (1) publishing efforts and outcomes of diversity representation, (2) incorporating a representative demographic for leadership selection committees, and (3) actively promoting the importance of diversity throughout the selection process.
重要性：在过去的 50 年中，尽管多元化的医生队伍有许多好处，但在各个医学专业中，性别和种族多样性方面仍然存在着显著的差距。增加多样性的一种方法是自上而下的多样化，即多元化的领导层会增加少数民族和女性劳动力的代表性。
目的：调查从 2007 年到 2019 年学术医学领导多样性的变化，并评估与所有专业的平均水平相比，各专业最近的领导多样性。
设计、设置和参与者：这是一项对 2007 年、2019 年和 2020 年不同学术角色的医生进行的横断面分析。人口统计数据是通过美国医学协会的专门报告收集的。包括 4 个初级保健专业（内科、家庭医学、儿科、妇产科/妇科）和 4 个外科专业（骨科、神经外科、耳鼻喉科、普通外科）。研究参与者为教师、项目主任和主席。对 2007 年、2019 年和 2020 年的数据进行了分析。
干预措施：通过住院医师培训项目跟踪调查，自行报告人口统计信息。
主要结果和措施：各队列参与者的各种族/族裔和性别的比例以及它们之间的比较。
结果：共调查了 2019 年的 186210 名教师（79441 名女性[42.7%]）、2020 年的 6417 名项目主任（2392 名女性[37.3%]）、2007 年的 1016 名主席（89 名女性[8.8%]）和 2019 年的 2424 名主席（435 名女性[17.9%]）。比较 2007 年和 2019 年主席的多样性时，只有内科和普通外科的少数民族（在整个调查中使用的一个综合类别，指的是任何自我认同为非西班牙裔白人以外的人）代表人数有显著增加（90%的增长[11.7 个百分点，从 2007 年的 13.0%上升到 2019 年的 24.7%]；P =.01 和 96%的增长[13.0 个百分点，从 2007 年的 13.5%上升到 2019 年的 26.5%]；P<.001）；与此同时，在此期间，一些专业的女性代表人数也显著增加（家庭医学增加了 107.4%，P =.002；儿科增加了 83.1%，P =.006；妇产科增加了 53.2%，P =.045；骨科增加了+4.1 个百分点，P =.04；普通外科增加了 226.9%，P =.005）。一般来说，外科专业的领导多样性低于所有住院医师培训项目的平均多样性，而初级保健专业的领导多样性相似或有所增加。
结论和相关性：研究结果表明，一些专业在弥合多样性差距方面做出了重大贡献，而其他专业则继续落后。我们改善学术医学领导多样性的建议包括：（1）公布多样性代表性的努力和成果；（2）将具有代表性的人口统计数据纳入领导层选拔委员会；（3）在整个选拔过程中积极宣传多样性的重要性。
