Gender and Racial Disparity among Addiction Psychiatry Fellows in the United States

Implementing a Holistic Review Process for Psychiatry Residency Screening and Interviewing

Within psychiatry, the proportions of individuals underrepresented in medicine (URM) are lower than are the proportions among the general U.S. population. Holistic review of residency applications may alleviate deficiencies in representation and disparities in care.  A holistic review process was implemented (2021-2022) in the University of California, San Diego, psychiatry residency program. The data (2016-2022) were extracted from the Electronic Residency Application Service to compare differences in the applicant pool before and after implementation of the holistic review.  A total of 6,602 individuals applied to the program between 2016 and 2022, increasing from 762 in 2016 to 1,148 in 2021. The proportion of women applying significantly increased (χ2=12.6, p<0.002), from 42.3% in 2016 to 50.6% in 2022. Across all years, a significantly greater proportion (χ2=22.0, p<0.001) of those selected to interview were women (55.1%), with the greatest proportion in 2022 (64.5%), after implementation of the holistic review. The proportion of applicants from URM groups significantly increased (χ2=28.0, p<0.001), from 13.4% in 2016 to 21.3% in 2022. There were no significant differences in the proportion of these applicants selected to interview across all years and no increase following the holistic review.  The proportion of women interviewed was greater than the proportion of women who applied, particularly after implementing the holistic review. The proportion of applicants from URM groups increased over time and, although the proportion interviewed remained greater than the number applying, that number did not change across the years studied.

Evaluating ACGME-accredited addiction psychiatry fellowship online content: A critical analysis of addiction psychiatry fellowship program websites in the US

Introduction: There is an extreme shortage of addiction psychiatrists and a lack of representation of addiction psychiatry (ADP) fellows from racial/ethnic minoritized backgrounds. ADP fellowship websites are integral in engaging potential applicants. It is therefore critical to understand the quality of engagement that trainees are having with ADP fellowship websites. The aim of this study was to investigate the accessibility and content of ADP fellowship program websites in the U.S. Methods: A list of ADP Fellowship programs was obtained from the Accreditation Council for Graduate Medical Education. A critical textual analysis of 42 unique factors within four categories (accessibility, recruitment, education, and health equity) was performed for each ADP fellowship website. Results: Of 51 ADP fellowships, 47 (92.2%) had websites. Information about social media accounts was largely missing from ADP fellowship websites. For recruitment, program description (95.7%) and program director name (76.6%) were most readily available, while interview day (0.00%) and vacation details (10.6%) were least available. For education, a list of rotations (55.3%) and didactics/lectures (40.4%) were most readily available, while post fellowship placement (6.4%), call schedule (4.3%), and responsibility progression (2.1%) were least available. The most prevalent health equity factors were gender-inclusive language (100%) and an absence of stigmatizing addiction language (100%). The least listed were statements of commitment to health equity (0.0%), antiracism training (2.1%), and harm-reduction strategies (4.3%). Conclusions: There are considerable gaps in the amount and types of information provided by ADP fellowship websites. Many existing websites are poorly interfacing with potential leaders in the field. The development of ADP fellowship websites could serve as a low-cost recruitment tool to engage potential addiction specialists. Our findings underscore the need for ADP fellowships to optimize their websites to engage bourgeoning leaders in addiction and optimize access to more comprehensive information.