Distribution of General Surgery Residencies in the United States and Gender Inequality: Are We There Yet?

Geographical Distribution and Trends Analysis of Osteopathic General Surgery Residents

In recent years, the number of Doctor of Osteopathic Medicine (DO) residents entering general surgery has increased. As DOs continue to solidify their role within the surgical domain, understanding their distribution, preferences, and the dynamics of their integration into residency programs becomes crucial for general surgery applicants. Publicly available data were gathered for each DO general surgery resident from residency programs across the nation, including details such as post-graduate year, degrees held, and residency program location. A comprehensive cross-sectional analysis was conducted to determine the geographical distribution and match trends of DO residents in these residency programs. Analysis revealed a significant rise in the number of DOs entering general surgery residencies, from 153 DO trainees beginning their residency training in 2019 to 274 DO trainees beginning their residency training in 2024. This upward trend indicates a growing presence of DOs in surgical practice. Examination of the geographical locations of programs for which DO applicants have matched showed variations nationwide. This analysis allows for a deeper understanding of the evolving match trends for DOs in surgery. It highlights the importance of addressing disparities in access to surgical training opportunities for osteopathic physicians nationwide.

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.

Women in Surgical Residency Programs in Brazil: A Trend Analysis

INTRODUCTION

There is a gender gap in the surgical field worldwide. Brazil and low- and middle-income countries generally tend to have a more profound gap. Therefore, we aim to assess the gender distribution in Brazilian surgical residencies.

METHODS

From a national residencies' database, we collected residency entering years, names, and surgical subspecialties. We classified gender from the names using Gender API software and performed linear regression, binomial, and chi-square tests.

RESULTS

From 81,979 doctors (1931-2020), 36.6% were women (P < 0.001). Of 13 subspecialties, regarding the absolute numbers of women, only neurosurgery and plastic surgery did not significantly differ between gender per year. There was a statistically significant growth in the proportional rates of female representation among most of the surgical residencies analyzed. Overall, the least women's representation was in urology (3.8%). From all subspecialties analyzed, both genders had a significant linear absolute increase over the years (P < 0.05), except for obstetrics-gynecology and pediatric surgery for men. Until 1990, all surgical programs had at least one woman resident, except for colorectal surgery.

CONCLUSIONS

Although there is an overall lack of women surgeons in Brazil, we observed an increase in women in surgical residencies. Therefore, the study may demonstrate a future change in the Brazilian gender equity scenario and reflect the growing representation of women in medicine in Brazil, except for some surgical specialties.

Coverage of Fertility Preservation and Treatment Among Surgical Trainees in the United States of America

INTRODUCTION

Surgery trainees spend their prime fertility years in training, which leads to delays in childbearing, accompanying infertility challenges, and high-risk pregnancies. Literature report of institutional support for fertility preservation (egg/sperm freezing) and treatment is lacking. The cost is particularly prohibitive while receiving a resident physician salary. This study aimed to assess availability of fertility resources and institutional coverage of fertility services to US General Surgery Residents (GSR) and Breast Fellows.

METHODS

We composed and distributed a 26-question survey to GS residency and fellowship program directors nationwide to survey residents and fellows. Summary and descriptive statistics were tabulated, and categorical variables were analyzed using Pearson's chi square test.

RESULTS

A total of 234 US surgical trainees (male n = 75, female n = 155, unreported n = 4) completed the survey. Total of 12 % of trainees reported having been counseled on family planning/fertility treatment during training, and only 5.1% were counseled on fertility preservation. Perceived lack of support from program (p = 0.027) and counseling of fertility preservation (p = 0.009) were significantly associated with female gender. A minority (12.5%) reported having insurance coverage for fertility preservation and 26% had coverage of fertility treatment. In addition, 2.6% respondents pursued fertility preservation while in training and 33% reported they would pursue fertility preservation if it was covered by insurance.

CONCLUSIONS

Fertility preservation is rarely discussed in US General Surgery residency programs. The large majority of GSR lacks awareness of insurance coverage of fertility preservation and treatment. Strong efforts are necessary to improve fertility education for GSR and insurance coverage to meet trainee's needs.

On the Eve of Integration: Community and Affiliated Residency Programs Pave the Way Towards the Assimilation of Osteopathic Surgery Residents

OBJECTIVE

The 2020 match integrated former osteopathic and allopathic residency programs under single Graduate Medical Education accreditation. We describe the composition of general surgery residency programs prior to the 2020 integration and provide a baseline to monitor future progress.

DESIGN

Retrospective, cross-sectional data provided by the Association of American Medical Colleges for the 2018 academic year were analyzed. Descriptive analyses were used to summarize the characteristics of residents by program type and program location. Logistic regression was used to estimate factors associated with the presence of osteopathic (DO) residents. An alpha of 0.05 defined statistical significance.

SETTING

Data were collected and analyzed at a United States osteopathic medical school.

PARTICIPANTS

All civilian surgery residencies that approved the 2018 Program Survey.

RESULTS

Out of 285 programs, the percentages with at least one DO resident were significantly different among university (44.0%), university-affiliated (62.7%) and community (78.4%) programs (p < 0.001). DO residents made up 41.4% of community residents, 13.3% of university-affiliated residents, and 2.8% of university residents (p < 0.001). A significant regional difference was observed, as DO residents made up 16.9% of residents in the central region, compared to 10.4% in the northeast, 7.0% in the south and 8.9% in the west (p = 0.004). The logistic regression analysis found that the presence of DO residents at a program was significantly related to the type of program (Affiliated vs University OR = 3.1, 95% CI 1.5-6.5; Community vs University OR = 5.2, 95% CI 1.9-14.4) and the presence of DO faculty (OR = 2.7, 95% CI 1.6-4.8) (all p < 0.05).

CONCLUSIONS

We observed significant differences in the presence of DO residents in different program types. As surgical education transitions to single accreditation, this study identifies opportunities for greater integration between osteopathic and allopathic surgery training programs.

Diversity of the physician workforce: Specialty choice decisions during medical school

Background

Despite efforts to increase the overall diversity of the medical student body, some medical specialties have a less diverse applicant pool based on both gender and race than would be expected based on medical graduate demographics.

Objectives

To identify whether women and Underrepresented in Medicine (URiM) medical students have baseline differences in their career interests or if their career plans change more during medical school when compared to men and non-URIM students.

Methods

Secondary data analyses of all medical students who applied through ERAS from 2005–2010 was conducted. Binary logistic regression models with the response being a planned career in one of four medical specialties (internal medicine, pediatrics, OB/GYN, and general surgery/surgical specialties) at medical school entry and graduation. Regression models included demographics, student attitudes, debt, academic metrics, and medical school experiences.

Results

Comparatively, women were less likely to be interested in internal medicine and surgery and more interested in pediatrics and OB/GYN at matriculation. URiM students expressed more interest in OB/GYN and surgery when starting medical school. At graduation, women were less likely to plan for internal medicine and surgery and were more interested in pursuing OB/GYN and pediatrics. URiM students were more likely to plan for a career in internal medicine and less likely to choose pediatrics.

Conclusions

From matriculation to graduation, women have relatively stable preferences regarding planned medical specialties. In contrast, URiM students’ specialty plans shifted over time among the four specialties, with variation in preferences occurring between matriculation and graduation.

Regional Population-Based Workforce Shortages in General Surgery by Practicing Surgeon and Resident Trainee

BACKGROUND

The physician shortage in the United States (US) continues to become more apparent. We aimed to evaluate the relationship between the US physician distribution from 2012-2019 by specialty at the state/regional level relative to the corresponding population growth.

METHODS

US matched residents and practicing physicians from 2012-2019 were extracted from the National Resident Matching Program and Association of American Medical College databases, respectively. Residents and practicing physicians were divided by geographic regions (West, Midwest, South, Northeast), states, and specialties (anesthesiology, emergency medicine, family medicine, general surgery (GS), internal medicine, obstetrics/gynecology and pediatrics).

RESULTS

Entering residents and physicians increased across 7 specialties from 2012-2019 with the exception of GS, which showed .2% decrease in practicing physicians. GS experienced decreases in entering residents in all US regions except the South. All specialties showed a decrease in the people-per-physician (PPP) except GS and pediatrics, which had a 4.1% and 71.3% increase, respectively. EM showed the largest growth overall, both in entering residents and overall workforce.

CONCLUSION

GS experienced slow growth of residents, decreases in practicing physicians and workforce overall, and an increase in PPP from 2012-2019. Our findings suggest that current population growth rate is exceeding the rate of physicians entering the field of GS and highlights the need for interventions to promote the recruitment of GS residents and retainment of attending physicians, particularly for rural areas. Future research to measure surgeon distribution in relation to patient outcomes and the efficacy of recent policy to address shortages can help define additional interventions to address physician shortages moving forward.

Nevertheless, They Persisted: How Women Experience Gender-Based Discrimination During Postgraduate Surgical Training

OBJECTIVE

More women than ever are pursuing surgical specialties despite historical dominance by men. The objective of this study was to examine how surgical residents experience gender-based discrimination during their residency training, including the common sources, settings, and implications of these experiences.

DESIGN

A sequential explanatory mixed methods design was used to combine results from an initial quantitative survey of surgical residents of all genders at the University of Calgary with qualitative data derived from interviews with surgical residents who identified as women.

PARTICIPANTS

Thirty-seven surgical residents of all genders completed a survey. Fourteen women completed a one-to-one, semistructured interview.

RESULTS

Women reported significantly more frequent experiences of gender-based discrimination than men, particularly regarding lack of respect from others, inappropriate jokes or comments, and hostile or humiliating behaviors. Nursing staff and patients were reported as prominent sources of discrimination, and the emergency and operating rooms were the most common settings. The qualitative findings highlighted the additional challenges for women during surgical residency, including navigating the relationships with nursing, having to work "twice as hard" to receive respect from patients and nurses, reports of persistent harassment and bullying, becoming desensitized to mistreatment and discrimination, and the influence of their gender on the quality of their education as well as their well-being.

CONCLUSIONS

Despite the increasing number of women entering surgical specialties, women surgical residents report frequent and severe experiences of gender-based discrimination during their training, even at an academic institution where over half of residents are women.