Gender Diversity in General Surgery Residency Leadership

Exploring the gender gap: A nationwide comparative analysis of general surgery residency program leadership

Background

The gender disparity in surgery leadership roles is well-reported. However, the effect of program type and region on mean number of men or women occupying a particular leadership role has yet to be explored. This study aims to investigate the gender disparity of leadership positions in different types of General Surgery Residency Programs (GSRPs).

Methods

Leadership roles of the general surgery departments were collected from the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) database. Each GSRP was categorized by region and program type using FRIEDA. Analysis of the mean number of men and women holding various leadership positions by program type and region was conducted using one-way ANOVA with post-hoc tests.

Results

A total of 345 GSRPs were analyzed. The mean number of women occupying various leadership roles was significantly higher at university-based programs when compared to community-based programs. No significant difference in mean number of women leaders was observed by region.

Conclusions

Women consistently occupy a lower number of GSRP leadership positions when compared to men, regardless of program type or region. University-based GSRP leadership positions have significantly greater gender inclusion compared to community-based GSRPs.

Key messages

University-based general surgery residency programs had a higher mean number of women in all leadership roles compared to other program types. In comparison, region did not appear to be a significant factor impacting the leadership gender disparity. Improvement is needed in community-based general surgery residency programs to bridge the gender gap in leadership roles.

Dissecting Diversity: A Comprehensive Look at the Present Landscape and Future Challenges in Surgical Specialties

BACKGROUND

As the US demographic evolves, surgical fields must adapt to ensure equitable healthcare. Healthcare disparities notably affect minority populations, with communities of color often facing physician shortages and higher rates of diseases such as coronary disease, stroke, and cancer. Research shows that minority physicians significantly improve patient satisfaction and outcomes in underserved communities, highlighting the need for increased physician diversity to enhance cultural competency and patient centered care. Data from the Association of American Medical Colleges (AAMC) reveals minimal increases in underrepresented minorities (URM) in surgical residency and academic careers over the past thirty-six years, with little change URM applicants and matriculants in the nine surgical specialties recognized by the American College of Surgeons from 2010 to 2018.

OBJECTIVE

This review aims to critically evaluate the current landscape of racial and gender diversity in six out of the nine defined surgical specialties (general surgery, plastic surgery, neurosurgery, orthopedic surgery, cardiothoracic surgery, and vascular surgery) in the US.

DESIGN

We conducted a comprehensive literature review to assess of the state of diversity within surgical specialties in the United States. By analyzing the benefits of diversity in surgical fields, evaluating the effectiveness of various diversity programs and initiatives, examining the comparative diversity between surgical subspecialties, and assessing the impact of diversity on patient outcomes, our aim is to highlight the critical importance of enhancing diversity in surgical fields.

RESULTS

While nuances in representation and diversity vary across surgical specialties, all fields persistently exhibit underrepresentation of certain racial/ethnic groups and persistent gender disparities. These disparities manifest throughout various phases, including in residency, and in the recruitment and retention of URM individuals in surgery and surgical subspecialties. While interventions over the past decade have contributed to improving diversity in surgical fields, significant disparities persist. Limitations include the time required for recent interventions to show significant impacts and the inability of established interventions to eliminate disparities.

CONCLUSIONS

Despite the clear benefits, diversity within surgical specialties remains an uphill battle. Addressing the diversity gap in surgical fields is crucial for improving patient outcomes, healthcare access, and workplace environments, requiring strategies such as targeted recruitment, mentorship programs, and addressing systemic biases. This review highlights the undeniable imperative for change and serve a call to action.

Gender Disparity in Academic Trauma Surgery: The Current State of Affairs

INTRODUCTION

Despite the increasing number of female surgeons in general surgery programs, women are still inadequately represented in leadership positions. This study aims to investigate the magnitude of gender bias in university-based trauma surgery fellowship programs and leadership positions in the United States of America.

MATERIAL AND METHODS

FRIEDA was used to identify trauma surgery programs. A thorough website review of each program obtained further information on faculty members, including their name, age, gender, and faculty rank. Trauma surgeons with an MD or DO qualification and a faculty rank of Professor, Associate Professor, or Assistant Professor were selected for inclusion in this study. SCOPUS was used to assess the H-index and the number of publications and citations of surgeons.

RESULTS

The total number of programs included was 136, consisting of 715 faculty members. Less than a quarter (n = 166; 23.2%) comprised females and less than one-fifth (n = 30; 19%) of female surgeons were Professors. The difference in the research productivity of male and female trauma surgeons was statistically significant (P < .05), with the average H-index being 10 vs 7.5, respectively, amongst the top 50 surgeons of both genders. Based on a multiple regression analysis, academic rank was significantly associated (P < .05), and gender was not significantly associated (P > .05) with H-index.

CONCLUSION

Gender disparity exists in the field of trauma surgery, as noted in senior faculty ranks and leadership positions. Female-inclusive state policies, appropriate mentorship, and supportive institutions can help to bridge this gap.

Diversity in Hand Surgery Leadership: The Impact of Mentorship and Bias

BACKGROUND

Diversity in leadership drives innovation. However, underrepresented minorities may face barriers. The aim of this study is to understand the impact of gender and race on the experience of leaders in hand surgery.

METHODS

An anonymous survey was sent to leaders in hand surgery who attained the position of national society president, head of a division/department, or hand fellowship director. The survey assessed demographic information, grit, mentorship, and bias.

RESULTS

One hundred twenty-one leaders responded for a response rate of 60.5%. Men represented 81.0% and women 19.0%. Most respondents were white (87.6%) with 7% Asian and 6% any other race. Ninety-one percent of female respondents lived in a dual career household, compared with 53.7% of male respondents (odds ratio [OR] 0.15, P = .017). Female respondents had significantly higher grit compared with male respondents (4.3 vs 4.0, P = .050). Male respondents were more likely to have a male mentor/sponsor than women (95% vs 76%, respectively, P = .001). White respondents were more likely to have a white mentor/sponsor than nonwhite respondents (91% vs 61%, respectively, P = .009). Ninety-five percent of women reported experiencing bias compared with 27% of men (P < .001). Specifically, women reported bias in salary, promotion, nomination, sponsorship, networking, and clinical resources. Nonwhite respondents were significantly more likely to experience bias in promotion (P = .006).

CONCLUSIONS

Women and racial minorities face bias and barriers to leadership within hand surgery.

You Want to be a Surgical Leader? Consider Training Elsewhere - An Observation of How Training Background May Impact Leadership Selection

OBJECTIVE

The significance of thought differences has always held importance in medicine, but it could be considered as increasingly acknowledged and valued to a greater extent in recent times as more emphasis is placed on diversity, equity, and inclusion. These unique perspectives have been examined according to race, gender, and ethnicity, but there is limited published data examining the prevalence of leadership roles within surgical departments in terms of training background. Our main objective is to identify trends in surgical leaders' education, and emphasize training diversity in surgical leadership.

DESIGN

A descriptive study of the training background of all surgical academic leaders.

SETTING

This internet search was performed at a tertiary care, academic medical center.

PARTICIPANTS

Academic chairpersons, division directors, and program directors.

RESULTS

124 programs had pertinent information available. There was a mean of 7.6 leaders per institute examined: total 939 positions (119 chairs, 704 division directors, 116 program directors). 90/119 (76%) of the Chairs led at institutions outside of the places they completed their training. 4/119 (3%) did all their training at the same institution they chaired. 25/119 (21%) completed at least some but not all their training there, and later rose to the role of Chair. Among division directors, 217/704 (31%) did some training at that institution, and program directors were significantly more likely to have completed some training at their current institute (53/116, 46%; p = 0.001). There were no statistically significant differences when examined geographically. Women made up 18% of the leaders and were significantly more likely to lead as program director rather than a chair or division director (p < 0.001).

CONCLUSION

A majority of surgery chairs hold positions at institutions where they did not complete their medical training. This suggests that outside perspective could be a contributing factor when searching for this position.

Race and sex diversity in Canadian academic surgical societies

BACKGROUND

It is vital for national professional surgical societies to embrace diversity, inclusion, and equity. This study examines race and sex diversity in two Canadian surgical societies.

METHODS

Websites of the Canadian Society of Cardiac Surgeons (CSCS) and the Canadian Association of General Surgeons (CAGS) and previous programs of their annual meetings were reviewed. Leadership positions, conference speakers, and award winners were categorized by race and sex.

RESULTS

White males made up the largest category of Cardiac Surgery meeting speakers (73/142 [51%]), CAGS committee members (89/198 [45%]), CAGS past presidents (38/43 [88%]), and General Surgery meeting speakers (841/1472 [57%]). Of the 17 members that made up the CSCS board of directors and officers, 8 were White males (47%), 5 were BIPOC males (29%), 3 were White females (18%), and 1 was a BIPOC female (6%). Of the 42 members of the CAGS board of directors and advisory committee, 16 were White males (38%), 5 were BIPOC males (12%), 17 were White females (40%), and 4 were BIPOC females (10%).

CONCLUSIONS

BIPOC individuals and females are underrepresented in both societies compared to White males. However, in CAGS, improvements in representation can be seen in recent years. It is important that both of these organizations continue to embrace diversity.

Scholarly Activity and Gender of an Applicant for a General Surgery Residency

INTRODUCTION

Applying to general surgery residency is undoubtedly a competitive process. Participation in scholarly activity (SCA) has been cited as a criterion when selecting applicants for interview and in the ranking process. This study aims to evaluate the association between gender of applicants to surgery residency and SCA and to characterize trends in SCAs over time.

METHODS

We analyzed the SCA of applicants interviewed at a general surgery residency program over 6-interview cycles (2016-2021). Eight SCA categories were included: (1) Poster Presentation, (2) Oral Presentation, (3) Peer-Reviewed (PR) Journal Articles/Abstracts, (4) PR Journal Articles/Abstracts (Other than Published), (5) PR Online Publication, (6) PR Book Chapter, (7) Nonpeer reviewed Online Publication, and (8) Other Articles/Scientific Monograph.

RESULTS

Of a total of 335 interviewed applicants, 288 (86%) had at least one count of SCA. Overall, no difference between male and female applicants was noticed (n = 178, 84.8% versus n = 110, 88%, P = 0.409) and no change in percentage of SCA over the six cycles (P = 0.239). The most reported SCAs were poster presentations (n = 242, 72.2%), oral presentations (n = 159, 47.5%), PR journal articles/abstracts (n = 159, 47.5%). Female applicants have marginally higher median (interquartile range) for SCAs compared to male applicants (5 [3, 8] versus 4 [3, 8], P value 0.272).

CONCLUSIONS

No association between gender and SCA among applicants for general surgery residency positions was observed. While more than three-fourths of applicants have at least one SCA, only a small fraction of applicants were published. Students should be made aware of the importance of SCA early in graduate medical education.

A census of general surgery consultants in England and Wales: implications for the current and future surgical workforce

INTRODUCTION

This study aimed to describe the composition of the current general surgical consultant body in England and Wales and quantify levels of inequality within it as well as describe future workforce challenges.

METHODS

This is an observational study of all general surgical departments in England and Wales. Consultant general surgeons were identified and data regarding their gender, country of undergraduate medical education, subspecialty and private practice were recorded.

RESULTS

Of the 2,682 consultant general surgeons in England and Wales identified for this study, just 17% are women, with gender inequality most marked in university teaching hospitals and among certain subspecialties. Almost 40% of consultants did not obtain their primary undergraduate degree in the United Kingdom and there are considerably fewer surgeons who studied abroad in university teaching hospitals. Over 40% of current general surgical consultants have been qualified for more than three decades and there is no equivalent sized group of younger consultants.

CONCLUSIONS

There remains considerable gender and racial inequality in the consultant general surgical workforce, with pockets of a lack of diversity within university or teaching hospital surgical departments and some subspecialties. The proportion of surgeons in their fourth decade of clinical practice represents the largest group of current practising consultants, which points towards an impending workforce crisis should senior clinicians seek to reduce activity or consider taking early retirement.

Trends in Mohs surgery fellowship directors

The purpose of this study is to illustrate demographic trends among Mohs Micrographic Surgery (MMS) Fellowship Directors. Our search was constructed from the 2022 to 2023 Mohs Micrographic Surgery Fellowship Directory on the Accreditation Council for Graduate Medical Education (ACGME) website. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. We identified 77 FDs, of which all 77 were included in this study. The mean age was 55.5 years; 55 (71.4%) were men and 20 (26.0%) were women. Most of the FDs who completed the survey did not self-report ethnicity or race, so these measures were not included. The top residency institutions that produced the most FDs were Cleveland Clinic (n = 4), Mayo Clinic (n = 4), New York University Medical Center (NYU, n = 4), and University of California-Los Angeles (UCLA, n = 4); the top fellowship institutions were NYU (n = 7), UCLA (n = 5), Cleveland Clinic (n = 4), and Geisinger Medical Center (n = 4). The mean H-index was 15.9, the mean number of peer-reviewed publications was 71, and the mean time from training completion until FD appointment was 10 years. Our results indicate that a majority of FDs are men (71.4%) and that FDs are more likely to have graduated from certain residency and fellowship programs.

Language Differences by Race on Letters of Recommendation for the Pediatric Surgery Match

OBJECTIVE

This study aims to evaluate if there is any significant linguistic difference in LoR based on applicant's race/ethnicity.

DESIGN

Retrospective review of applications to pediatric surgery fellowship at a single institution (2016-2020). Race was self-reported by applicants. LoR were analyzed via the Linguistic Inquiry and Word Count (LIWC) software program.

SETTING

Johns Hopkins All Children's Hospital, St. Petersburg, Florida USA. A free-standing tertiary pediatric hospital.

PARTICIPANTS

Pediatric surgery fellowship applicants from 2016 to 2020.

RESULTS

A total of 1086 LoR from 280 applicants (52% female) were analyzed. Racial distribution was Caucasians 62.1%, Asian 12.1%, Hispanics 7.1%, multiracial 6.4% African Americans 5%, and other/unknown 7.1%. Letter writers were largely male (84%), pediatric surgeons (63%) and professors (57%). There was no difference in LoR word count across races. LoR for female multiracial candidates contained higher use of affiliation and negative emotion terms compared to Hispanic females (p = 0.002 and 0.048, respectively), and past focus terms when compared to Caucasian and Asian female applicants (p < 0.001 and p = 0.003, respectively). Religion terms were more common in LoR for Asian females when compared to Caucasian females (p < 0.001).

CONCLUSION

This study demonstrates linguistic differences in LoR for pediatric surgery training programs based on applicant race/ethnicity. While differences are present, these do not suggest overt bias based on applicants race or ethnicity.

Ethnic and Racial Diversity Among Surgeon and Non-Surgeon Deans of Allopathic Medical Schools

INTRODUCTION

Previous publications have assessed the diversity among medical students, residents, faculty, and department leaders in surgery and medicine overall. We aim to evaluate the diversity among medical school deans in the United States. We quantify and compare the representation of women and underrepresented minority surgeon and non-surgeons.

METHODS

151 allopathic medical schools were included. Data regarding demographics, education, training, and previous leadership position were collected from institutional websites, online resources, and July 2021 Association of American Medical Colleges Council of Deans. Demographics for surgeon and non-surgeon were compared using chi square and logistic regression with 5% significance interval.

RESULTS

21.9% (n = 33) of all medical school deans were surgeons. 21.2% (n = 7) were women, which was not significantly different from non-surgeons (22%, P = .92). All the women surgeons were non-Hispanic white, similar to all deans (P = .83). 78.8% (n = 26) of all surgeon deans were non-Hispanic White compared to 84.7% (n = 100) overall (P = .28). There were 13 Black deans, four of whom were surgeons, and only one Hispanic dean, who was not a surgeon. Surgeons were more likely to be fellows of their professional society (P = .012).

CONCLUSION

The demographic diversity of surgeon and non-surgeon US medical school deans is not significantly different. The deficiencies in leadership diversity in medicine persists among medical school deans. There remains substantial room to improve the representation of women and underrepresented minorities as deans.

Beyond Parity: Gender Diversity of National and International Pediatric Surgery Societal Leadership

PURPOSE

Despite trends toward equal gender representation among medical school graduates, surgical trainees and fellows, diversity in higher levels of pediatric surgery is largely unstudied. This study aims to quantify gender diversity among leadership of pediatric surgical associations and societies across the globe.

METHODS

National and international pediatric surgical organizations were identified from the websites of the American Pediatric Surgical Association (APSA) and World Federation of Associations of Pediatric Surgery (WOFAPS). Compositional gender data of current and past organizational leadership was collected by examining publicly available archives of executive membership rosters. If roster pictures were not available, member names were input into social media sites and other search engines to ensure accurate gender denotation. Univariate analyses of organizational metrics and aggregate data of 5-year time intervals were performed via Fischer's Exact Test with significance of p < 0.05.

RESULTS

Nineteen pediatric surgical organizations were included for study analysis. Of 189 current organizational leaders, 50 (26.4%) are women. Eight organizations (42.1%) have less than 20% of leadership positions filled by women members, while two executive boards have no women members. Four organizations (22.2%) have a current woman seated as president/chairperson. Historical gender distribution stratified by organization demonstrates a range of 0-7.8% (p = 0.99), with one organization having yet to elect a woman president/chairperson. Longitudinally, women presidential representation remained consistently low (5-11%) across all time intervals from 1993 to 2022 (p = 0.35).

CONCLUSIONS

Despite advances in diversity in medical school graduates, surgical training, and workforce recruitment, there are still significant disparities in gender representation within pediatric surgery societal leadership.

LEVEL OF EVIDENCE

IV.

How Did We Get Here and Where Are We Going? Career Trajectories of United States General Surgery Residency Program Directors

OBJECTIVE

To develop the future of United States (US) surgical education leadership, surgical trainees and early career faculty who aspire to become program directors (PDs) must understand the potential career pathways and requisite skills and experience to become a general surgery residency PD. The objective of this study was to understand the demographics, career experiences, and professional satisfaction of US PDs in general surgery.

DESIGN

An anonymous, cross-sectional survey utilizing a novel instrument.

SETTING

An electronic survey distributed to US general surgery PDs between June and November 2022 PARTICIPANTS: PDs of US general surgery residency programs. A list of the Accrediting Council for Graduate Medical Education (ACGME)-accredited general surgery PDs was created from the ACGME list from the 2022 to 23 academic year.

RESULTS

The survey achieved a response rate of 46.2% (159/344). Only 32.1% of PDs identified as female and 67.3% identified as male with 1 respondent preferring not to identify their gender. PDs were White or Caucasian (68.6%), Asian (13.8%), and Black (3.7%); 4.4% were Hispanic or Latino. Only 83.7% of PDs completed fellowship training. PDs have been in the role for an average of 5.5 ± 4.9 years. The PDs were compensated for an average of 54.7% (±14.9% SD, 0%-100% range) of their time towards clinical duties. They were compensated on average for 35.7% (±12.6%, 0%-100%) of effort for residency-related administrative duties. Only 5% of PDs had obtained or were enrolled in an education-related degree. Only 55.4% of PDs had received formal surgical education training in teaching and assessment. 54.1% of PDs were interested in obtaining a more senior leadership position in the future. Most PDs (38.4%) expect to serve as PD for 5 to 8 years in total. Overall, the majority of PDs were very satisfied (29.6%) or satisfied (51.6%) professionally; similarly 28.9% were very satisfied and 48.4% satisfied personally.

CONCLUSIONS

This study represents the most up-to-date characterization of the personal, academic, and career-related features of current surgical residency PDs across the US. PDs enjoy a high degree of professional and personal satisfaction and most aspire to increasing leadership within their organizations. Compared to prior data, PDs have become more diverse in terms of both gender and race over time. Opportunities exist for increased mentorship of aspiring and current PDs as well as increased training in teaching and assessment.

Gender Diversity in Hand Surgery Leadership

BACKGROUND

Diversity in leadership drives innovation; however, women are underrepresented in leadership positions across academic medicine. The aim of this study was to assess the current gender representation in hand surgery leadership positions.

METHODS

This was a cross-sectional analysis of leaders in hand surgery. Leaders were defined as President, Board and Committee members of the American Society for Surgery of the Hand and the American Association for Hand Surgery, as well as hand surgery fellowship program directors and physician lead editors of peer-reviewed hand journals. The representation of women in leadership was compared to the percentage of female hand fellows over the same period. Years in practice, academic rank, additional degrees, h-index, m-index, National Institutes of Health (NIH) funding, publications, and citations were compared between male and female leaders.

RESULTS

Twenty-nine of 213 leadership positions (13.6%) are held by women which is fewer than would be expected based on hand surgery fellowship composition. Female leaders were earlier in practice than their male counterparts (13.5 ± 5.7 versus 20.8 ± 11.1 years, P < .01). Women were more likely to hold position of assistant professor and less likely to be full professors (P < .05). There was no gender difference in NIH funding, h-index, m-index, publications, or citations. The greatest gender disparity was at the level of National Society President, which is a title held by only 2 women and 119 men.

CONCLUSIONS

Gender disparities in hand surgery exist and are accentuated at the leadership level. Further work is needed to decrease leadership promotion disparities between men and women.

Gender Disparity in Earliest Phase of Academic Surgical Training: An Area for Intervention

BACKGROUND

To overcome persistent gender disparities in academic surgery, it is critical to examine the earliest phase of surgical training. This national study sought to assess whether gender disparities also existed among surgical interns, as a proxy for medical school research experience in both quantity and quality.

STUDY DESIGN

Using the 2021 to 2022 public information of 1,493 US-graduated categorical general surgery interns, a bibliometric evaluation was conducted to assess medical school research experience. Multivariable linear regressions with response log-transformed were performed to evaluate the impact of intern gender on (1) total number of peer-reviewed publications, (2) total impact factor (TIF), and (3) adjusted TIF based on authorship placement (aTIF). Back-transformed estimates were presented.

RESULTS

Of these interns, 52.3% were female. Significant differences were observed in TIF (male 6.4 vs female 5.3, p = 0.029), aTIF (male 10.8 vs female 8.7, p = 0.035), gender concordance with senior authors (male 79.9% vs female 34.1%, p < 0.001), Hirsch index (male 21.0 vs female 18.0, p = 0.026), and the geographic region of their medical schools (p = 0.036). Multivariable linear regressions revealed that female interns were associated with lower TIF (0.858, p = 0.033) and aTIF (0.851, p = 0.044). Due to a significant gender-by-region interaction, adjusted pairwise comparisons showed that male interns in the Northeast had approximately 70% higher TIF (1.708, p = 0.003) and aTIF (1.697, p = 0.013) than female interns in the South.

CONCLUSIONS

Gender disparities existed in the quality of research experience in the earliest phase of surgical training. These timely results call for additional interventions by the stakeholders of graduate medical education.

Satisfaction and attrition in Canadian surgical training program leadership: a survey of program directors

BACKGROUND

Surgical program directors (PDs) play an integral role in the well-being and success of postgraduate trainees. Although studies about medical specialties have documented factors contributing to PD burnout, early attrition rates and contributory factors among surgical PDs have not yet been described. We aimed to evaluate Canadian surgical PD satisfaction, stressors in the role and areas institutions could target to improve PD support.

METHODS

We administered a cross-sectional survey of postgraduate Canadian surgical PDs from all Royal College of Physicians and Surgeons of Canada accredited surgical specialties. Domains we assessed included PD demographics and compensation, availability of administrative support, satisfaction with the PD role and factors contributing to PD challenges and burnout.

RESULTS

Sixty percent of eligible surgical PDs (81 out of 134) from all 12 surgical specialties responded to the survey. We found significant heterogeneity in PD tenure, compensation models and available administrative support. All respondents reported exceeding their weekly protected time for the PD position, and 66% received less than 0.8 full-time equivalent of administrative support. One-third of respondents were satisfied with overall compensation, whereas 43% were unhappy with compensatory models. Most respondents (70%) enjoyed many aspects of the PD role, including relationships with trainees and shaping the education of future surgeons. Significant stressors included insufficient administrative support, complexities in resident remediation and inadequate compensation, which contributed to 37% of PDs having considered leaving the post prematurely.

INTERPRETATION

Most surgical PDs enjoyed the role. However, intersecting factors such as disproportionate time demands, lack of administrative support and inadequate compensation for the role contributed to significant stress and risk of early attrition.

Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome

(1) Background: Patient sex is associated with differential outcome of many procedures although the exact mechanisms remain unknown. Especially in transplant surgery, surgeon-patient sex-concordance is rarely present for female patients and outcome may be negatively affected. (2) Methods: In this single-center retrospective cohort study, recipient, donor, and surgeon sex were evaluated and short- and long-term outcome was analyzed with regards to sex and sex-concordance of patients, donors, and surgeons. (3) Results: We included 425 recipients in our study; 50.1% of organ donors, 32.7% of recipients, and 13.9% of surgeons were female. Recipient-donor sex concordance was present in 82.7% of female recipients and in 65.7% of male recipients (p = 0.0002). Recipient-surgeon sex concordance was present in 11.5% of female recipients and in 85.0% of male recipients (p < 0.0001). Five-year patient survival was comparable between female and male recipients (70.0% vs. 73.3%, p = 0.3978). Five-year patient survival of female recipients treated by female surgeons was improved without reaching significance (81.3% vs. 68.4%, p = 0.3621). (4) Conclusions: Female recipients and female surgeons are underrepresented in liver transplant surgery. Societal factors influencing outcome of female patients suffering from end-stage organ failure need to be further examined and acted upon to possibly improve the outcome of female liver transplant recipients.

The Experiences of Motherhood in Female Surgeons: A Scoping Review

OBJECTIVE

The objective of this study is to systematically synthesize the existing literature on the experiences of motherhood in female surgeons both during surgical training and as staff physicians, to identify knowledge gaps, and to provide recommendations for institutional changes to better support pregnant female surgeons.

BACKGROUND

There are disproportionately fewer medical students pursuing surgical specialties, as surgery is often seen as incompatible with childbearing and pregnancy. However, no review has summarized the published literature on the collective experiences of female surgeons in navigating motherhood.

METHODS

Four databases were searched and 1106 abstracts were identified. Forty-two studies were included and a thematic analysis was performed.

RESULTS

Four themes were identified: path toward motherhood (n=18), realities of motherhood (n=25), medical culture and its impact on career and family life (n=24), and institutional reproductive wellness policies (n=21). Female surgeons are more likely to delay motherhood until after training and have high rates of assisted reproductive technology use. Pregnancy during surgical training is associated with negative perception from peers, pregnancy complications, and scheduling challenges. Maternity leave policies and breastfeeding and childcare facilities are variable and often inadequate. Many female surgeons would agree that greater institutional support would help support women in both their roles as mothers and as surgeons.

CONCLUSIONS

Both female residents and staff surgeons experience significant and unique barriers before, during, and after motherhood that impact their personal and professional lives. Understanding the unique challenges that mothers face when pursuing surgical specialties is critical to achieving gender equity.

Correlations Between Department and Training Program Online Presence and Women in Orthopedic Surgery Training

Background

Orthopedic residency programs increasingly use websites and social media to reach students. This accelerated during the COVID-19 pandemic, especially as away rotations became limited. Women remain a minority of orthopedic residents, and there are no data that indicate the correlation between department/program website content or social media presence on the gender diversity of residency classes.

Methods

Orthopedic department websites were assessed between June 2021 and January 2022 to identify program director's gender, as well as the gender composition of the faculty and residents. Instagram presence for the department and/or program was also identified.

Results

There was no correlation found between the residency program director's gender and the gender diversity of residents in a given program. The percentage of women faculty identified on a department website was significantly correlated with the percentage of women residents in the program, regardless of the program director's gender. While there was an increase in the percentage of women residents among programs with Instagram accounts for the class that started in 2021, this was negated when the percentage of women faculty was taken into account.

Conclusion

Efforts on multiple fronts will be needed to increase the number and percentage of women applying for and training in orthopedic surgery. Given the increasing use of digital media, we need a better understanding of what information, including faculty gender diversity, can be conveyed through this format that is useful for women medical students interested in orthopedic surgery to address their concerns about the field.

Gender differences in academic productivity, educational positions, and leadership appointments of physicians in the U.S

BACKGROUND

Promotions in academic medicine are frequently based on number of publications and leadership positions held. While prior study has established women publish less than men, many evaluations are limited to individual specialties and do not evaluate involvement with educational activities.

OBJECTIVE

To compare gender differences in academic output, intramural leadership positions, and educational leadership positions of academic physicians.

METHODS

The curriculum vitae and de-identified demographic data of all permanent physicians employed at a multi-site academic medical center were reviewed from April to May 2020. Multivariable logistic and Poisson regressions evaluated leadership positions and number of publications.

RESULTS

Of 3,359 physicians in the demographic database, 32.3% (n = 1,087) were women and 72.5% were white (n = 2,510). Of the 3,015 physicians in the curriculum vitae database, 32% (n = 962) were women. Women were more likely (p < 0.001) to be assistant professor (54% vs. 42.7%) and less likely to be associate (18.1% vs. 20.3%) or full professor (14.6% vs. 29.1%). Women assistant professors published 22% fewer articles (ratio estimate = 0.78, p < 0.001), associate professors 18% less (coefficient = 0.82, p < 0.001), and full professors 23% less (coefficient = 0.77, p < 0.001). Fewer women were program directors for residencies (1.6% vs. 2.9%, p = 0.02) or fellowships (5.4% vs. 7.4%, p = 0.04), and held fewer division or department leadership positions (OR 0.8, 95% CI as [0.6, 1.0], p = 0.03).

CONCLUSION

Women physicians do not outperform men across any education, leadership, or publication category. A cultural shift is needed to redefine traditional metrics for leadership appointments if academic medicine hopes to achieve equity.

Descriptive analysis of cornea and anterior segment fellowship program directors in 2020

PURPOSE

To investigate demographic characteristics, educational backgrounds, and academic achievements among program directors (PDs) of cornea and external disease and anterior segment fellowships in the United States in 2020.

SETTING

Database study of U.S. fellowship programs.

DESIGN

Cross-sectional study.

METHODS

PDs of cornea and external disease and anterior segment fellowships were identified using the San Francisco Match website. Fellowship program features reviewed included academic or private practice type, number of cornea faculty, and sex of chairperson. PD demographic characteristics, educational and training background, and academic productivity were analyzed using publicly available profiles and databases.

RESULTS

76 cornea and external disease and 10 anterior segment fellowships were reviewed. Of 86 reviewed programs, 55 (64.0%) were considered academic, 30 (34.9%) were private practice, and 1 (1.2%) was hybrid. 76 cornea and external disease PDs and 12 anterior segment PDs were identified. Overall, 21 (23.9%) of PDs were women, and the mean age for all PDs was 52.6 ± 11.5 years. Of the 88 PDs, the average number of publications was 45.1 ± 55.9. The mean h-index was 16.7 ± 15.4 and was higher among cornea and external disease than anterior segment PDs (18.2 ± 15.5 vs 7.1 ± 11.4, P = .008) and also higher among academic than private practice PDs (19.9 ± 15.1 vs 11.2 ± 14.7, P = .011). More female PDs were in departments with a female chairperson compared with male PDs (6 [28.6%] vs 4 [6.0%], P = .011).

CONCLUSIONS

Cornea and external disease and anterior segment fellowship PDs represent a wide array of backgrounds and scholarly achievements. Female PDs remain in the minority and are more common in departments with female chairpersons.

A snapshot of contemporary leadership at pediatric neurosurgery fellowships

OBJECTIVE

Many pathways to positions of leadership exist within pediatric neurological surgery. The authors sought to investigate common trends in leadership among pediatric neurosurgery fellowship directors (FDs) and describe how formalized pediatric neurosurgical training arrived at its current state.

METHODS

Fellowship programs were identified using the Accreditation Council for Pediatric Neurosurgery Fellowships website. Demographic, training, membership, and research information was collected via email, telephone, curricula vitae, and online searches.

RESULTS

The authors' survey was sent to all 35 identified FDs, and 21 responses were received. Response data were supplemented with curricula vitae and online data prior to analysis. FDs were predominantly male, self-identified predominantly as Caucasian, and had a mean age of 53 years. The mean duration from residency graduation until FD appointment was 13.4 years. The top training programs to produce future FDs were New York University and Washington University in St. Louis (residency) and Washington University in St. Louis (fellowship).

CONCLUSIONS

This study characterizes the current state of pediatric neurosurgery fellowship program leadership. The data serve as an important point of reference to compare with future leadership as well as contrast with neurosurgery and other surgical disciplines in general.

A descriptive analysis of general surgery residency program directors in the United States

BACKGROUND

Women remain underrepresented in surgery. We analyzed the demographics of general surgery program directors (PDs) and compared gender differences.

METHODS

A search of online resources was conducted, including 344 general surgery residencies.

RESULTS

340 residencies were included. 261 PDs (76.8%) were male and 79 (23.2%) were female. Females were appointed at a younger age (p < 0.0001), were appointed sooner after residency (p < 0.0001) and have served similar term lengths compared to males (p = 0.556). There was no difference in academic position, fellowship training, or scholarly output between genders. Residencies with a female PD had a greater percentage of female residents (p = 0.04).

CONCLUSION

General surgery PDs are predominately male with fellowship training; however the percentage of female PDs is similar to the percentage of practicing female general surgeons in the US. Gaining a better understanding of the characteristics of general surgery PDs can aid female surgeons in attaining academic leadership positions.

Diversity in American Society of Transplant Surgeons Governance: Equitable but Unequal

OBJECTIVES

The diversity in the governance of the American Society of Transplant Surgeons has not been described. We aimed to quantify the present state of its leadership as a baseline to inform future research.

MATERIALS AND METHODS

Lists of leaders on the American Society of Transplant Surgeons Council, the COVID-19 Strike Force, and 20 different American Society of Transplant Surgeons committees were obtained from the Society's website. Demographic and training information for the members were compiled through internet searches and analyzed.

RESULTS

The American Society of Transplant Surgeons Council included 15 members, with 20% women. It was 93.3% non-Hispanic White. The COVID-19 Strike Force included 12 surgeons, 16.7% of whom were female, with 75% non-Hispanic White. Of the 198 committee members, 23.7% were women, 68.7% were nonHispanic White, 16.6% were Asian, 8.1% were Hispanic, and 6.6% were Black. Among female committee members, underrepresented minorities comprised 23.6%. Committee chairs included 23% women, 23% underrepresented minorities, and 2.3% minority women. International medical graduates were more likely men (P = .02).

CONCLUSIONS

Representation of women in the American Society of Transplant Surgeons leadership has kept pace with their membership in the transplant surgery workforce. There is a deficiency of female under - represented minorities in leadership positions at the Society. Further interventions are required to recruit underrepresented minorities to transplant surgery, catalog their footprint in the workforce, and champion their role as leaders within the American Society of Transplant Surgeons.

Trends in leadership at breast surgical oncology fellowships

Introduction

Breast surgical oncology is a defined sub-specialty of general surgery that focuses on the surgical management of breast disease and malignancy within a multidisciplinary context. The fellowship directors (FD) that lead these programs have been selected for their abilities. As programs do research to ensure proper training for the next generation of breast surgical oncologists, we wanted to look into the FDs responsible for their training.

Methods

The Breast Surgical Oncology care program list was compiled via the Society of Surgical Oncology and American Society of Breast Surgeons Accredited programs (n = 60). The demographic information that was of interest included, but was not limited to, gender, age, ethnicity/background, past residency training, past fellowship training, year graduated from residency and fellowship, year since graduation to FD appointment, time at institution till FD appointment, and Hirsch index (h-index).

Results

Data were collected on all 60 FDs. The average age of FDs was 52 years old, 27% of FDs are men and 73% of FDs are women. The average H-index, number of publications, and number of citations were 19, 67, and 2648, respectively. The mean graduation year from residency was 2003, and from fellowship was 2006; with a mean of 9 years post fellowship graduation until becoming an FD. The most frequently attended residency was Rush (n = 4), and the most common fellowships were Memorial Sloan Kettering (n = 8), MD Anderson Cancer Center (n = 7), and John Wayne Cancer Institute (n = 4). Nine of the FDs stayed at the same institution after doing both residency and fellowship there (15%).

Conclusion

This is the first study to examine the demographics of those in FD positions in Surgical Breast Oncology, which is a relatively young fellowship. We found that FDs in Breast Surgical Oncology are defined by their high output of research. This qualification may be why the average age, and the number of years to FD are higher compared to other specialties where this research has been undertaken. Initial evaluation of FDs suggest more diversity in this field is needed. Further insight into the leaders training our next generation of surgeons is warranted.

Discrimination Towards Women in Surgery: A Systematic Scoping Review

BACKGROUND

Over the past twenty years explicit gender bias towards women in surgery has been replaced by more subtle barriers, which represent indirect forms of discrimination and prevents equality.

OBJECTIVE

The aim of our scoping review is to summarize the different forms of discrimination towards women in surgery.

METHODS

The database search consisted of original studies regarding discrimination towards female surgeons.

RESULTS

Of 3,615 studies meeting research criteria, 63 were included. Of these articles, 11 (18%) were focused on gender-based discrimination, 14 (22%) on discrimination in authorship, research productivity and research funding, 21 (33%) on discrimination in academic surgery, 7 (11%) on discrimination in surgical leadership positions and 10 (16%) on discrimination during conferences and in surgical societies. The majority (n = 53, 84%) of the included studies were conducted in the U.S.A. According to our analysis, female surgeons experience discrimination from male colleagues, healthcare workers, but also from patients and trainees. Possible solutions may include acknowledgement of the problem, increased education of diversity and integration for the younger generations, mentorship, coaching and more active engagement by male and female partners to support women in the surgical field.

CONCLUSIONS

Gender-based discrimination toward women in the field of surgery has evolved over the past twenty years, from an explicit to a more subtle attitude. A work-environment where diversity and flexibility are valued would allow female surgeons to better realize their full potential.

Diversity among transplant surgery fellowship program directors: a call to action

BACKGROUND

The diversity among general surgery residency, HPB and other fellowship program directors has been previously analyzed. However, the diversity in abdominal transplant surgery fellowship program directors remains unknown.

METHODS

Abdominal transplant fellowship programs and the corresponding program directors were identified from the American Society of Transplant Surgeons website. Demographic and training information for the members was compiled through internet searches and analyzed.

RESULTS

72 program directors were included. 83.33% were male. 63.9% were non-Hispanic White, 25% were Asian, along with 5.56% Hispanic and Black each. Male program directors were more likely to be Associate Professor (p = 0.041), while females were more likely to be Assistant Professor (p = 0.021). 66% of female program directors were non-Hispanic White.

CONCLUSION

Transplant surgery fellowship programs are primarily led by male and non-Hispanic White surgeons. Female representation as leaders is on par with their membership in the transplant surgery workforce. There is a deficiency of both male and female underrepresented minorities in program director positions.

Gender trends of military general surgery residency applicants

BACKGROUND

Despite the fact that women comprise half of medical school graduates, women remain under-represented in General Surgery. We aimed to identify the trend in military general surgery applicants based on gender.

METHODS

A retrospective review of the Medical Operational Data System (MODS) applicants from 2014 to 2019 was performed. Demographic data included age, gender, average board scores, applied and matched specialty.

RESULTS

204 students applied and 167 applicants matched into Army General Surgery programs from 2014 to 2019. The percentage of all students applying to General Surgery was statistically higher in females (13.4% vs 9.0%, p = 0.04), with females matching at a statistically higher rate (77% vs 57%, p = 0.02). Over the last 6 years, 55% of residents in training are men and 45% are women.

CONCLUSION

Army General Surgery programs have increased the amount of women in training over the last six years. We believe that this will ultimately translate to more female surgeons contributing to military medicine.

Perspectives of General Surgery Program Directors on Paternity Leave During Surgical Training

Importance

Although men are increasingly involved in childrearing, little is known about paternity leave in surgical residency. Conflict between professional and family duties contribute to burnout and decreased career satisfaction for surgeons of both sexes. With men more likely than women to have children during their clinical years of surgical training, understanding the issues surrounding paternity leave is imperative to ensuring the longevity of our workforce.

Objective

To explore surgical program directors' perspectives on the challenges of providing paternity leave.

Design, Setting, and Participants

This qualitative descriptive study of transcripts collected from semistructured interviews of US surgical program directors was performed from October 2018 to June 2019. Program directors were selected using purposive-stratified criterion-based sampling. Interviews were audio-recorded and transcribed verbatim, with emergent themes identified using content analysis.

Exposure

Paternity leave.

Main Outcomes and Measures

Program directors' perspectives on paternity leave were categorized into common themes.

Results

A total of 40 US general surgery program directors were interviewed (28 male [70%]; mean [SD] age, 49.7 [6.8] years; 36 [90%] were university-based programs). Twenty (50%) reported providing paternity leave of 1-week duration. Five major themes were identified: (1) paternity leave policies are poorly defined by many programs and require self-initiation by residents; (2) residents often do not take the full amount of time offered for leave; (3) stigma against male residents taking parental leave is common and may be even greater than that facing women taking maternity leave; (4) paternity leave has little to no impact on colleagues' workload owing to the brevity of time taken; and (5) men desire longer leave than what they are currently offered and wish to receive equal time off compared with childbearing parents.

Conclusions and Relevance

Surgical program directors report male residents take brief paternity leave despite a desire for more time off, which may be influenced by fear of stigma and surgical culture that avoids handing off work, even for short periods of time. A cultural shift toward supporting family planning as a normal part of young adult life, rather than a medical condition to be accommodated, is necessary to promote life balance and behaviors that will sustain a long career in surgery. Implementation of defined leave policies at individual programs for the nonchildbearing parent is critical to make parental leave socially acceptable among surgical residents.

Career barriers for women in surgery

BACKGROUND

Despite the increasing numbers of female medical students, surgery remains male-dominated.

PURPOSE

To highlight the principal career obstacles experienced by aspiring female surgeons.

METHODS

A narrative review of literature on the position and career barriers of female surgeons has been conducted, using the MEDLINE and EMBASE databases.

MAIN FINDINGS

Implicit and even explicit biases against female surgeons remain prevalent, negatively impacting their training performance and overall professional trajectory. Female surgeons are globally underrepresented in leadership positions and senior academic rankings, especially that of a full professor. They feel hampered by lack of effective mentorship, whose value for a successful career has been acknowledged by all medical students, surgeons and surgical leaders. Their work-life imbalance is sometimes expressed as lower likelihood than their male contemporaries of getting married or having children and may be attributed to their conventional association with the role of caretaker, their personal desire to accommodate occupational and family duties and the inadequate implementation of parental leave and childcare policies. Female surgeons' "infertility" may be further explained by direct and indirect pregnancy-related difficulties. Female surgeons are also financially undercompensated compared to their male contemporaries. Finally, specialty-specific challenges should not be overlooked.

CONCLUSIONS

While encouraging steps have been made, women in surgery feel still hindered by various obstacles. The qualitative, interview-based nature of current literature requires more meticulous studies on these barriers with a more quantitative and objective approach. Attenuation of gender imbalance in surgical specialties requires further changes in mentality and more targeted modifications in relevant policies.

Comparison between Medical Student Educators and Program Directors in 2010 and 2019

Objective Over the last decade, prominence of the Directors of Medical Student Education in Ophthalmology (DMSEs) within the Association of University Professors of Ophthalmology (AUPO) has increased. With increased recognition of this important leadership position, an examination of the trending demographic differences between DMSEs and the Ophthalmology Program Directors (PDs) may be helpful, especially in regard to the potential for academic promotion from each track.

Design Present study is a database study.

Methods The AUPO directory was used to ascertain the DMSE and the PD members between 2010 and 2019. The demographic profile for each member was determined using publicly available resources. Chi-square analysis of the data was performed.

Main Outcome Measures Number of DMSE and PD AUPO from 2010 to 2019 in AUPO Directory, sex, geographic location, and graduation year were measured through this study.

Results There has been a steady increase in the number of DMSEs from 2010 to 2019, whereas the number of PDs have remained stable. The number of DMSEs have increased in all regions of the United States. The year of ophthalmology residency graduation was similar in the DMSE and PD cohorts in 2010 and 2019. The number of women have increased in the DMSEs in 2019 compared with 2010; the number of women who were PDs in 2019 were similar to 2010. Finally, more PDs in 2010 became Chairs in 2019, whereas no DMSEs in 2010 became Chair in 2019.

Conclusion There are a growing number of DMSEs, overall, with an increasing proportion of women in the 2019 DMSE group compared with 2010. In contrast, the overall number of PDs have remained stable, as has the proportion of female PDs in 2019 compared with 2010. DMSEs, compared with PDs, are less likely to become Chairs. The increased opportunity for academic leadership with the growing DMSE group may help change leadership patterns overall in academic ophthalmology.

Diversity Matters: A 21-Year Review of Trends in Resident Recruitment into Surgical Specialties

Background

Diversity within the healthcare workforce is essential to improve quality of care, although evaluation of diversity within surgical training remains limited. This study analyzed diversity in recruitment of residents into surgical subspecialties at a large academic medical institution and national trends.

Methods

A 21-year cross-sectional study of medical school graduates accepted into all surgical subspecialty training programs was performed. The institutional cohort was divided into two groups (1997-2006, 2007-2017). Subspecialty acceptance rates were determined between 2011 and 2018. Data on candidate demographics including gender, race, ethnicity, citizenship, and origin of medical education at a single institution and nationally were extracted.

Results

Two thousand found hundred seventy-two residents were included in this study. From 1997 to 2018, female acceptances increased from 21.1% to 29.7% (p < 0.01), non-White increased from 27.9% to 31.8% (p = 0.01), and international medical graduates decreased from 28.8% to 25.5% (p = 0.02). There was no significant change in accepted Hispanic and Non-US candidates. Female subspecialty rates for subspecialties increased nationally and was comparable to our cohort, except in general surgery. Hispanic subspecialty acceptance rates were less than 10% and Black/African American acceptance rates remained less than 5% across subspecialties nationally and at our institution.

Conclusion

Diversity in surgical training has modestly progressed over the last two decades, but the degree of positive change has not been universal and highlights the critical need for improvement and action. Continued institution driven and collaborative strategies are essential to promote diversity in recruitment across all surgical specialties that has implications on our future workforce and surgical leadership.

Gender disparities in gastrointestinal surgery fellowship programs

BACKGROUND

Gender disparities in surgical leadership have come under increased scrutiny, and in order to better understand why these disparities exist, it is important to study the disparities across surgical fellowship programs.

METHODS

Data derived from the Fellowship Council (FC) database for fellows completing training from academic years 2015-2019 were analyzed. Available information included institution, fellowship type, program director (PD), associate program director (APD), faculty, and fellow names for all FC Fellowships. Faculty and fellow gender were determined from personal knowledge or publicly available online biographical information.

RESULTS

A total of 1023 fellows and 221 programs were analyzed. The advanced gastrointestinal (GI)/minimally invasive surgery (MIS) fellowship programs included 321 fellows, with a small increase in the percentage of female fellows from 28 to 31% over 5 years. Advanced GI/MIS/bariatric fellowship programs had a total of 262 fellows, also with a small increase in the percent of female fellows, from 29 to 38% in the study period. The gender of program directors, assistant program directors, and faculty for the fellowship programs studied were analyzed as well. Of the 221 programs in the Fellowship Council data, 13.6% of program directors, 18.3% of associate program directors, and 19.9% of faculty were female. Advanced GI/MIS fellowship programs had the lowest percentage of female PDs, with only 9.3% of the program directors being female. Colorectal surgery fellowships had the highest percentage of female PDs, with 33% being female.

CONCLUSIONS

In conclusion, women are underrepresented in gastrointestinal surgery fellowships among both trainees and educators. It is likely that a significant contributing factor to this underrepresentation of female fellows is the underrepresentation of female program directors and faculty; although neither our study nor any previously published study has proven that statistically.

Gender imbalance amongst promotion and leadership in academic surgical programs in Canada: A cross-sectional Investigation

BACKGROUND

Women are underrepresented at higher levels of promotion or leadership despite the increasing number of women physicians. In surgery, this has been compounded by historical underrepresentation. With a nation-wide focus on the importance of diversity, our aim was to provide a current snapshot of gender representation in Canadian universities.

METHODS

This cross-sectional online website review assessed the current faculty listings for 17 university-affiliated academic surgical training departments across Canada in the 2019/2020 academic year. Gender diversity of academic surgical faculty was assessed across surgical disciplines. Additionally, gender diversity in career advancement, as described by published leadership roles, promotion and faculty appointment, was analyzed.

RESULTS

Women surgeons are underrepresented across Canadian surgical specialties (totals: 2,689 men versus 531 women). There are significant differences in the gender representation of surgeons between specialties and between universities, regardless of specialty. Women surgeons had a much lower likelihood of being at the highest levels of promotion (OR: 0.269, 95% CI: 0.179-0.405). Men surgeons were statistically more likely to hold academic leadership positions than women (p = 0.0002). Women surgeons had a much lower likelihood of being at the highest levels of leadership (OR: 0.372, 95% CI: 0.216-0.641).

DISCUSSION

This study demonstrates that women surgeons are significantly underrepresented at the highest levels of academic promotion and leadership in Canada. Our findings allow for a direct comparison between Canadian surgical subspecialties and universities. Individual institutions can use these data to critically appraise diversity policies already in place, assess their workforce and apply a metric from which change can be measured.

Racial disparities in vascular surgery: An analysis of race and ethnicity among U.S. medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce

The ever-increasing diversity of the U.S. population has resulted in a challenge to a vascular surgery workforce that does not represent the national demographics. Educational institutions, medical organizations, and medical agencies, through initiatives and programs, have attempted to increase the number of underrepresented minorities, with, however, only modest changes during the past 30 years. Several obstacles have been identified, some of which include racism, issues of finances, lack of mentors and scholarly activities, and inequity in promotion. In the present study, we have reviewed the reported data addressing these concerns and provided guidance toward the amelioration of these issues with the hope of constructive change toward encouraging a diverse vascular surgery workforce.

Trending diversity: Reviewing four-decades of graduating fellows and the current leadership in pediatric surgery

PURPOSE

Diversity in the physician workforce remains a priority in healthcare as it has been shown to improve outcomes. Decisions for choosing specific fields in medicine are partly influenced by mentors, which tend to be the same sex or ethnicity. Females are starting to outnumber males in medical school and minorities are targeted for recruitment. We hypothesized that diversity in pediatric surgery has increased over time.

METHODS

The recently published A Genealogy of North American Pediatric Surgery was utilized to identify graduating pediatric surgery fellows from 1981 to 2018. Organization websites were used to identify past and current leaders. A web-based analysis, including online facial recognition software, was performed. A year-to-year and decade-to-decade demographic comparison was completed.

RESULTS

1217 pediatric surgery fellows graduated between 1981 and 2018. When comparing graduates from the first and last decades, an increase from 16.9% to 39.5% for female graduates was observed (p = 0.046). A significant increase in nonwhite graduates was seen for all races (p < 0.05). Representation in leadership was White and male dominant.

CONCLUSION

There was a significant increase in diversity in pediatric surgery fellowship graduates. There were increasing trends in female graduates and all nonwhite racial groups. Focusing on enhancing the pipeline and mentoring underrepresented minorities will continue to enhance this trend for the field of pediatric surgery.

LEVEL OF EVIDENCE

III; Retrospective Review.

Women representation in academic and leadership positions in surgery in Brazil

We aimed to analyze the representativeness of women surgeons in academic and leadership positions in Brazil. We investigated women representativeness across surgical departments of 25 Brazilian universities (2020); across boards of 10 Brazilian surgical societies (2020), and, as speakers, in 281 surgical events (Jan-2014 to Dec-2020). From 383 individuals in university departments, 43 (11.2 %) were women (p < 0.001). Only three universities had women as department chairs. From 163 positions in surgical societies, only 14 positions (8.6 %) were held by women (p < 0.001). The underrepresentation is worse in prestigious positions (presidency and vice-presidency), in which only 1 (5 %) were women. In 281 surgical events, there were 6686 speakers, of which only 886 (13.3 %) of these were women (p < 0.001). Further studies are needed to elucidate the possible causes for the gender gap in these scenarios in Brazil, so as to implement effective strategies to improve gender representativeness in surgery in the country.

Does Chair of Surgery Gender Influence Divisional or Residency Program Director Gender Diversity?

BACKGROUND

Workplace diversity is beneficial and results in new ideas and improved performance. Within surgery leadership, the gender gap is improving, but still present. Given the increasing number of women surgery department chairs, we aimed to examine the association of surgery chair gender with division and residency program director gender. We hypothesized that surgery departments with female leadership would have an increase in gender diversity compared to departments led by male chairs.

MATERIALS AND METHODS

A list of all surgery departments were compiled from the Society of Surgical Chairs website. Gender of department chair, division director and residency program director were examined and compared. Chair position term length was determined based on online public announcements, publicly available curriculum vitae, and institutional profile biographies.

RESULTS

Of 178 department chairs included, 10.7% were female, and 89.3% were male. There was no difference in female residency program director leadership between female versus male led programs (42.1 versus 26.1%, P= 0.147). Of the programs with female department chairs, only 29.4% had any female division directors compared to 54.6% led by male chairs (P= 0.055). When examining departments with ≥5 division directors, there was no difference in the average number of female division directors within departments led by female versus male chairs. There was a significant difference in length of surgery chairship, with female chairs holding the position for fewer years than male chairs (median time 5.3 (IQR = 3.4-5.8) versus 7.0 (IQR=4.3-12.3) years, P= 0.032).

CONCLUSIONS

Female department chair leadership was not associated with increased diversity in divisional leadership compared to departments of surgery led by males.

Demographics of Surgical Specialty Residency Program Directors in the United States: A Cross-sectional Analysis

OBJECTIVE

To evaluate program director (PD) demographics, training background, and academic productivity in 11 surgical specialties.

SUMMARY BACKGROUND DATA

There is currently no comprehensive study comparing educational background, research output, and gender differences between PDs of surgical residencies in the United States.

METHODS

The Accreditation Council for Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) websites were used to identify residency PDs. Age, information related to service as PD, educational background, and research output were collected utilizing online searches including Doximity, PubMed, and Scopus.. The ACGME Data Resource Book was used to obtain data on the gender makeup of residents in each surgical specialty. Data collection occurred between December 14, 2019, and May 9, 2020.

RESULTS

1571 residency PDs across 11 surgical specialties were included. Significant differences between specialties were found with respect to PD gender, current age, age at appointment, years between residency and assignment, term duration, number of PubMed publications, and Scopus h-index. The current age (mean ± SD) ranged from 46.8 ± 8.5 years among Interventional Radiology (IR) PDs to 53.4 ± 9.1 years among Neurological Surgery (NEUROSURG) PDs. The proportion of female PDs ranged from 5.9% in NEUROSURG to 63.5% in Obstetrics and Gynecology (OB-GYN). Completion of a post-residency fellowship was least common for OB-GYN PDs at 9.1%, and most common for IR PDs at 98.8%. The number (mean ± SD) of PubMed publications and Scopus h-index ranged from 13.1 ± 22.3 publications and h index 4.5 ± 5.7 among OB-GYN PDs to 112.5 ± 103.0 publications and h index 27.4 ± 16.7 among Thoracic Surgery PDs. Age and academic productivity as measured by PubMed publications and Scopus h-index were significantly lower among female PDs in multiple surgical specialties.

CONCLUSIONS

There were significant variations in the PDs of surgical specialties, particularly with respect to gender and academic productivity. Efforts should be made to support and encourage greater female representation in the role of surgical residency PD.

Gender and ethnic diversity in academic general surgery department leadership

BACKGROUND

Diversity in surgery has been shown to improve mentorship and patient care. Diversity has improved among general surgery (GS) trainees but is not the case for departmental leadership. We analyzed the race and gender distributions across leadership positions at academic GS programs.

METHODS

Academic GS programs (n = 118) listed by the Fellowship and Residency Electronic Interactive Database Access system were included. Leadership positions were ascertained from department websites. Gender and race were determined through publicly provided data.

RESULTS

Ninety-two (79.3%) department chairs were white and 99 (85.3%) were men. Additionally, 88 (74.6%) program directors and 34 (77.3%) vice-chairs of education were men. A higher proportion of associate program directors were women (38.5%). Of 787 division-chiefs, 73.4% were white. Only trauma had >10% representation from minority surgeons. Women represented >10% of division chiefs in colorectal, thoracic, pediatric, and plastic/burn surgery.

CONCLUSION

Diversity among GS trainees is not yet reflected in departmental leadership. Effort is needed to improve disparities in representation across leadership roles.

The Changing Face of Academic Surgery: Overrepresentation of Women among Surgeon-Scientists with R01 Funding

BACKGROUND

There has been a recent focus on sex-based disparities within the field of academic surgery. However, the proportion of female surgeons conducting NIH-funded research is unknown.

STUDY DESIGN

The NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) was queried for R01 grants from surgery departments for which the principal investigator (PI) had a primary medical degree, as of October 2018. Characteristics of the PI and their respective grants were collected. Institutional faculty profiles were reviewed for PI and departmental characteristics. PIs were stratified by sex and compared using standard univariate statistics.

RESULTS

There were a total of 212 R01 grants in surgery departments held by 159 PIs. Of these, 26.4% (n = 42) of R01-funded surgeons were female compared with the reported 19% of academic surgery female faculty (as reported by the Association of American Medical Colleges; p = 0.02). Women with R01 grants were more likely to be first-time grant recipients with no concurrent or previous NIH funding (21.4% vs 8.6%; p = 0.03) and less likely to have a previous R01 or equivalent grant (54.8% vs 73.5%; p = 0.03). Women were more likely to be from departments with a female surgery chair (31.0% vs 13.7%; p = 0.01) or a department with > 30% female surgeons (35.0% vs 18.2%; p = 0.03).

CONCLUSIONS

Although female surgeons remain a minority in academic surgery, they hold a greater than anticipated proportion of NIH funding, with a high number of first-time grants, forming a crucial component of the next generation of surgeon-scientists.

Where is the leak in the surgeon pipeline?

INTRODUCTION

In order to care for an increasingly diverse population, the surgical workforce must improve in gender, racial, and ethnic diversity. We aim to identify deficiencies in the surgical pipeline.

METHODS

Data from the United States Census, Bureau of Labor Statistics, and Association of American Medical Colleges were collected from 2004 to 2018, and evaluated for changing population over time.

RESULTS

Women comprise 51% of the population, 32% of surgeons, and representation is increasing at a rate of 0.4% per year. 13% of the population and 6% of surgeons are black, and representation is decreasing at a rate of -0.1% per year. Hispanics represent 18% of the population, 6% of surgeons, and representation is increasing at a rate of 0.04% per year.

CONCLUSIONS

While the proportion of women and Hispanic surgeons is slowly increasing, the proportion of black surgeons is decreasing. Recruitment methods need to be focused to improve surgical workforce diversity.