Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City.
Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora.
JAMA Netw Open. 2024 Nov 4;7(11):e2446018. doi: 10.1001/jamanetworkopen.2024.46018.
The ranks of academic physicians do not reflect the diversity of the US population. To create a diverse and effective medical workforce, it is important to know the extent to which gender, race and ethnicity, and the intersection of these factors are associated with career advancement.
To assess whether race and ethnicity and gender are associated with appointment to or promotion within academic medicine.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used Association of American Medical Colleges data on graduates of all US MD-granting medical schools from 1979 to 2019 merged with faculty appointment data since 2000. Data for this study are based on a February 19, 2021, snapshot. The analysis was performed from March 8, 2021, to May 5, 2023.
Gender and race and ethnicity among physician graduates.
The main outcome was full-time faculty appointments and promotions to the ranks of instructor, assistant professor, associate professor, full professor, and department chair. Cox proportional hazards models were used to examine the differences in likelihood of appointment and promotion for racial and ethnic minority men and women compared with White men.
The analytic sample included 673 573 graduates (mean [SD] age at graduation, 28.1 [3.2] years; 59.7% male; and 15.2% identifying as Asian, 6.1% as Black, and 69.6% as White). White men accounted for the largest subgroup of graduates (43.8%). Asian men, Asian women, Black women, and White women were more likely than White men to be appointed to entry-level positions. Among physicians graduating both before and after 2000, White men were more likely to be promoted to upper ranks compared with physicians of nearly every other combination of gender and race and ethnicity. Among physicians graduating prior to 2000, Black women were 55% less likely (HR, 0.45; 95% CI, 0.41-0.49) to be promoted to associate professor (n = 131 457) and 41% less likely (HR, 0.59; 95% CI, 0.51-0.69) to be promoted to full professor (n = 43 677) compared with White men. Conversely, Black men (HR, 1.29; 95% CI, 1.03-1.61) were more likely to be appointed as department chair (n = 140 052) than White men.
These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.
学术医师的职级并未反映美国人口的多样性。为了培养一支多元化且高效的医疗团队，了解性别、种族和族裔以及这些因素的交集与职业发展的关联程度非常重要。
评估种族、族裔和性别是否与学术医学领域的任命或晋升相关。
设计、环境和参与者：本队列研究使用美国医学协会（Association of American Medical Colleges）的数据，将 1979 年至 2019 年期间所有美国 MD 授予医学院的毕业生与 2000 年以来的教职任命数据进行了合并。本研究的数据基于 2021 年 2 月 19 日的快照。分析于 2021 年 3 月 8 日至 2023 年 5 月 5 日进行。
医生毕业生中的性别和种族、族裔。
主要结局是全职教职任命和晋升为讲师、助理教授、副教授、教授和系主任。使用 Cox 比例风险模型比较了少数族裔男性和女性与白人男性在任命和晋升方面的可能性差异。
分析样本包括 673573 名毕业生（毕业时的平均[标准差]年龄为 28.1[3.2]岁；59.7%为男性；15.2%为亚裔，6.1%为非裔，69.6%为白人）。白人男性占毕业生的最大亚组（43.8%）。亚裔男性、亚裔女性、非裔女性和白人女性比白人男性更有可能被任命为入门级职位。在 2000 年前后毕业的医生中，与几乎所有其他性别和种族、族裔组合的医生相比，白人男性更有可能晋升到更高职级。在 2000 年之前毕业的医生中，与白人男性相比，非裔女性晋升为副教授（n=131457）的可能性低 55%（HR，0.45；95%CI，0.41-0.49），晋升为教授（n=43677）的可能性低 41%（HR，0.59；95%CI，0.51-0.69）。相比之下，非裔男性（HR，1.29；95%CI，1.03-1.61）担任系主任（n=140052）的可能性高于白人男性。
这些发现表明，在新千年里，学术医学领域对白人男性的优先晋升仍在继续，而种族和族裔多样化的女性则经历了更大的晋升不足。为了实现反映美国人口多样性的劳动力，本研究表明，学术医学需要改变其教职任命和晋升方面的文化和实践。
