From the Department of Anesthesiology, Loma Linda University, Loma Linda, California.
School of Medicine, Loma Linda University, Loma Linda, California.
Anesth Analg. 2024 Nov 1;139(5):913-920. doi: 10.1213/ANE.0000000000007102. Epub 2024 Aug 19.
Patient outcomes are improved with physician-patient gender, racial, and ethnic concordance. However, female, Black, Hispanic or Latino, Native Hawaiian-Pacific Islander (NH-PI), and American Indian-Native Alaskan (AI-AN) physicians are underrepresented in anesthesiology. The American Association of Medical Colleges 2018 Diversity in Medicine Report revealed that women comprise only 35% of anesthesiologists yet nearly half of medical school graduates are women. More than 77% of anesthesiologists are White or Asian. Anesthesiology applicant and match trends may provide insights needed to address underrepresentation within anesthesiology. We hypothesized that proportionally fewer women and racially and ethnically minoritized applicants apply and match into anesthesiology.
This retrospective observational study identified 47,117 anesthesiology applicants among the 546,298 residency applicants in the Electronic Residency Application Service (ERAS) system between 2011 and 2022 and stratified applicants by self-reported gender, race, and ethnicity. The demographics of anesthesiology trainees reported in the 2014 to 2015, 2018 to 2019, and 2022 to 2023 Accreditation Counsel of Graduate Medical Education (ACGME) Data Resource Books were used as surrogates for matched applicants as demographics are not reported by the National Residency Match Program. To facilitate comparisons, ERAS applicants were grouped into 4-year epochs to align with consolidated ACGME reports corresponding to the application years. Odds ratios (OR); 95% confidence interval of applying to and matching into anesthesiology were analyzed.
Women had lower odds of applying to anesthesiology compared to men overall (OR, 0.55; 95% CI, 0.54-0.56, P < .0001) and maintained significantly lowered odds of applying within each epoch. Women had similar odds of matching into anesthesiology residency compared to men (OR, 1.10; 95% CI, 1.06-1.14, P < .0001). Black, Hispanic or Latino, Asian and NH-PI, and AI-AN applicants had similar odds to White applicants of applying to anesthesiology but odds of matching were significantly lower overall ( P < .0001) for Asian and NH-PI (OR, 0.66; 95% CI, 0.63-0.70), Black (OR, 0.49; 95% CI, 0.45-0.53), Hispanic or Latino (OR, 0.50; 95% CI, 0.46-0.54), and AI-AN (OR, 0.20; 95% CI, 0.15-0.28) applicants. The odds of matching among some minoritized applicants increased in the ACGME 2022 to 2023 report year.
From 2011 to 2022, women had lower odds of applying to anesthesiology residency than men yet had similar odds of matching. Racial and ethnic minoritized groups had significantly lower odds of matching compared to White applicants despite similar odds of applying. These findings highlight disparities in the anesthesiology match and may help identify opportunities to promote workforce diversity within the field. More detailed reporting of gender, race, and ethnicity in annual match data may better define barriers to entry and identify opportunities for improvement.
医患性别、种族和民族一致会改善患者的预后。然而，在麻醉学领域，女性、黑人、西班牙裔或拉丁裔、夏威夷原住民-太平洋岛民（NH-PI）和美洲印第安人-原住民（AI-AN）医生的人数较少。美国医学协会 2018 年的医学多样性报告显示，女性仅占麻醉师的 35%，但近一半的医学院毕业生是女性。超过 77%的麻醉师是白种人或亚洲人。麻醉学申请人和匹配趋势可能为解决麻醉学领域的代表性不足提供必要的见解。我们假设，申请和匹配进入麻醉学的女性和少数族裔申请人的比例较低。
这项回顾性观察性研究在电子住院医师申请服务（ERAS）系统中确定了 2011 年至 2022 年间 546298 名住院医师申请人中的 47117 名麻醉学申请人，并按自我报告的性别、种族和民族对申请人进行分层。2014 年至 2015 年、2018 年至 2019 年和 2022 年至 2023 年认证研究生医学教育理事会（ACGME）数据资源手册中报告的麻醉学学员的情况被用作与匹配申请人相关的替代指标，因为全国住院医师匹配计划不报告这些情况。为了便于比较，ERAS 申请人被分为 4 年组，与相应的申请年份的合并 ACGME 报告保持一致。分析了申请和匹配进入麻醉学的优势比（OR）；95%置信区间。
总体而言，与男性相比，女性申请麻醉学的几率较低（OR，0.55；95%CI，0.54-0.56，P<0.0001），并且在每个时期内申请的几率都明显较低。与男性相比，女性匹配进入麻醉学住院医师的几率相似（OR，1.10；95%CI，1.06-1.14，P<0.0001）。黑人、西班牙裔或拉丁裔、亚洲人和 NH-PI 以及 AI-AN 申请人与白人申请人申请麻醉学的几率相似，但总体而言，匹配的几率明显较低（P<0.0001），亚洲人和 NH-PI（OR，0.66；95%CI，0.63-0.70）、黑人（OR，0.49；95%CI，0.45-0.53）、西班牙裔或拉丁裔（OR，0.50；95%CI，0.46-0.54）和 AI-AN（OR，0.20；95%CI，0.15-0.28）申请人。在 2022 年至 2023 年的 ACGME 报告年度中，一些少数族裔申请人的匹配几率有所增加。
从 2011 年到 2022 年，与男性相比，女性申请麻醉学住院医师的几率较低，但匹配的几率相似。与白人申请人相比，少数族裔群体的匹配几率明显较低，尽管他们申请的几率相似。这些发现突出了麻醉学匹配中的差异，可能有助于确定在该领域促进劳动力多样性的机会。在年度匹配数据中更详细地报告性别、种族和民族可能会更好地确定进入的障碍，并确定改进的机会。
