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Smith TZ, DeYoung JK, Pum JM, Zurakowski D, Templeton K, Day CS. Odds of Attaining Orthopaedic Leadership Based on Race, Ethnicity, and Sex. J Am Acad Orthop Surg 2024; 32:1003-1010. [PMID: 39018573 DOI: 10.5435/jaaos-d-24-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/23/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Despite widespread acceptance of the importance of diversity in leadership, systemic challenges in leadership attainment in orthopaedic surgery still exist for several groups. We hypothesize that women, underrepresented in medicine groups, and Asians have decreased odds of achieving program director and chairperson positions compared with peers. METHODS Demographic data were collected from the Association of American Medical Colleges for faculty, program directors, and chairpersons in orthopaedic surgery. Odds ratios were calculated treating race, ethnicity, or sex as the predictor variables and attainment of a leadership position as the outcome, comparing the composition of program directors in 2020 and chairpersons in 2019 with faculty in 2019. RESULTS Significantly decreased odds were found for women at 0.37 (0.264 to 0.51 [ P < 0.0001]) and the Other category at 0.16 (0.065 to 0.3864 [ P = 0.0001]) while significantly increased odds were found for White and Black/African American faculty at 1.32 (1.02 to 1.71 [ P = 0.0314]) and 1.95 (1.17 to 3.26 [ P = 0.011]), respectively, in holding program director positions. Significantly decreased odds of attaining chairpersonship were found for women at 0.17 (0.07 to 0.41 [ P = 0.0075]) and Asian faculty at 0.33 (0.14 to 0.75 [ P = 0.0062]) while White faculty demonstrated significantly increased odds at 2.43 (1.41 to 4.19 [ P = 0.0013]). CONCLUSIONS Women showed markedly decreased odds of leadership attainment while Black/African American faculty had increased likelihood of becoming program directors but were not markedly more likely to become chairs. Asian faculty were less likely to become program directors and markedly less likely to become chairs. While decreased odds for women were expected based on current literature, decreased odds of Asians becoming chairs and an increased likelihood of Black/African American orthopaedic surgeons becoming program directors but not attaining the role of chairs at the same rate were novel findings, revealing concerning trends for these groups.
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Affiliation(s)
- Tobin Z Smith
- From the Wayne State University School of Medicine, Detroit, MI (Smith, DeYoung, and Pum), Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA (Zurakowski), Harvard Medical School, Cambridge, MA (Zurakowski), Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS (Templeton), Department of Orthopedic Surgery at Henry Ford Health, Wayne State University School of Medicine, Detroit, MI (Day), Michigan State University College of Human Medicine, East Lansing, MI (Day)
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Teke ME, Taveras LR, Meier J, Johnson CC, Marshall NJE, Hynan LS, Nwariaku FE, Zeh HJ, Abdelfattah KR. Burnout in Surgical Residents of Underrepresented in Medicine Backgrounds: Key Influencing Factors and Possible Solutions. J Surg Res 2023; 291:51-57. [PMID: 37348436 DOI: 10.1016/j.jss.2023.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Alarming rates of burnout in surgical training pose a concern due to its deleterious effects on both patients and providers. Datum remains lacking on rates of burnout in surgical residents based on race and ethnicity. This study aims to document the frequency of burnout in surgical residents of racially underrepresented backgrounds and elucidate contributing factors. METHODS A 35-question anonymized survey was distributed to general surgery residents from 23 programs between August 2018 and May 2019. This survey was designed from the validated Maslach Burnout Inventory, and included additional questions assessing participant demographics, educational, and social backgrounds. Responses were analyzed utilizing chi-square tests and Wilcoxon rank sum tests. There was also a free response portion of the survey which was evaluated using thematic analysis. RESULTS We received 243 responses from 23 general surgery programs yielding a 9% (23/246) program response rate and 26% (243/935) response rate by surgical residents. One hundred and eighty-five participants (76%) identified as nonunderrepresented in medicine and 58 (24%) of participants identified as underrepresented in medicine. Fifty-three percent were male and 47% female. Overall, sixty-six percent of all surgical residents (n = 161) endorsed burnout with racially underrepresented residents reporting higher rates of burnout at 76% compared to 63% in their nonunderrepresented counterparts (P = 0.07). CONCLUSIONS Although the generalizability of these results is limited, higher rates of reported burnout in racially underrepresented trainees noted in our study illuminates the need for continual dialogue on potential influencing factors and mitigation strategies.
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Affiliation(s)
- Martha E Teke
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Courtney C Johnson
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicholas J E Marshall
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Linda S Hynan
- Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fiemu E Nwariaku
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kareem R Abdelfattah
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Meadows AM, Skinner MM, Hazime AA, Day RG, Fore JA, Day CS. Racial, Ethnic, and Sex Diversity in Academic Medical Leadership. JAMA Netw Open 2023; 6:e2335529. [PMID: 37747731 PMCID: PMC10520740 DOI: 10.1001/jamanetworkopen.2023.35529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Importance For the past 50 years, significant gaps have existed in gender and racial diversity across various medical specialties, despite the many benefits of a diverse physician workforce. One proposed approach to increasing diversity is top-down diversification, in which diverse leadership results in increased minority and female workforce representation. Objective To investigate the changes in academic medical leadership diversity from 2007 to 2019 and to assess the recent leadership diversity of various specialties compared with the averages across all specialties. Design, Setting, and Participants This was a cross-sectional analysis of physicians in varying academic roles in 2007, 2019, and 2020. Demographic data were collected via specialized reports from the Association of American Medical Colleges. Included were 4 primary care specialties (internal medicine, family medicine, pediatrics, obstetrics/gynecology [OB/GYN] and 4 surgical specialties (orthopedic surgery, neurologic surgery, otolaryngology [ENT], general surgery). Study participants were faculty, program directors, and chairpersons. Data were analyzed for the years 2007, 2019, and 2020. Intervention Self-reporting of demographic information to residency programs collected via the Graduate Medical Education Track Survey. Main Outcomes and Measures Proportions of each race/ethnicity and sex among cohorts of participants and comparisons between them. Results The total number of individuals investigated included 186 210 faculty from 2019 (79 441 female [42.7%]), 6417 program directors from 2020 (2392 female [37.3%]), 1016 chairpersons from 2007 (89 female [8.8%]), and 2424 chairpersons from 2019 (435 female [17.9%]). When comparing chairperson diversity from 2007 to 2019, only internal medicine and general surgery experienced significant increases in minority (aggregate category used throughout the investigation to refer to anyone who self-identified as anything other than non-Hispanic White) representation (90% increase [11.7 percentage points, from 13.0% in 2007 to 24.7% in 2019]; P = .01 and 96% increase [13.0 percentage points, from 13.5% in 2007 to 26.5% in 2019]; P < .001), respectively; meanwhile, several specialties saw significant increases in female representation during this period (family medicine by 107.4%, P =.002; pediatrics by 83.1%, P =.006; OB/GYN by 53.2%, P =.045; orthopedic surgery by +4.1 percentage points, P =.04; general surgery by 226.9%, P =.005). In general, surgical specialties had lower leadership diversity than the average diversity of all residency programs, whereas primary care specialties had similar or increased diversity. Conclusions and Relevance Study results suggest that some specialties have made significant contributions toward bridging diversity gaps whereas others continue to lag behind. Our recommendations to improve academic medical leadership diversity include programs and institutions (1) publishing efforts and outcomes of diversity representation, (2) incorporating a representative demographic for leadership selection committees, and (3) actively promoting the importance of diversity throughout the selection process.
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Affiliation(s)
- Austin M. Meadows
- Henry Ford Health, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
| | | | | | | | | | - Charles S. Day
- Henry Ford Health, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
- Michigan State University College of Human Medicine, Grand Rapids
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Tolson HC, Raikar DAH, Morris BE, Ferguson EMN, Shahriary E. Ethnic and Sex Diversity in Academic Plastic Surgery: A Cross-sectional Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4991. [PMID: 37396840 PMCID: PMC10313300 DOI: 10.1097/gox.0000000000004991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/22/2023] [Indexed: 07/04/2023]
Abstract
Ethnic, racial, and sex disparities continue to persist in medicine despite efforts to diversify the profession. In competitive surgical specialties such as plastic surgery, those disparities are particularly pronounced. This study aims to evaluate racial, ethnic, and sex diversity in academic plastic surgery. Methods We compiled a list of major plastic surgery professional societies, plastic surgery journal editorial boards, and plastic surgery accreditation boards to evaluate ethnic and sex diversity in society, research, and accreditation domains, respectively. Demographic data were collected and analyzed using the Mann-Whitney U test and the Kruskal-Wallis test. Results White individuals are significantly overrepresented across the professional and research domains, and Asian individuals are overrepresented in the professional domain when compared to non-white races. White individuals make up a total of 74% of the society domain, 67% of the research domain, and 86% of the accreditation domain when compared to all non-white surgeons. Male surgeons made up 79% of the society domain, 83% of the research domain, and 77% of the accreditation domain when compared to all non-male surgeons. Conclusions Ethnic, racial, and sex disparities persist in academic plastic surgery. This study, which looked at societies, editorial boards, and accreditation boards, demonstrated a persistent ethnic, racial, and sex homogeneity among leadership. Changes are required to continue to diversify the field and provide women and underrepresented minorities the tools needed to succeed.
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Affiliation(s)
- Hannah C. Tolson
- From the University of Arizona College of Medicine Phoenix, Phoenix, Ariz
| | | | - Bryn E. Morris
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, Ariz
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Lim OZH, Chen Y, Dimmeler S, Yong AWJ, Singh H, Sim MLE, Kong G, Lim WH, Low TT, Park DW, Chew NWS, Foo R. Disparity in female and Asian representation amongst cardiology journal editorial boards members: a call for empowerment. QJM 2022; 115:830-836. [PMID: 35866641 DOI: 10.1093/qjmed/hcac176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While progress is evident in gender and ethnic representation in the workplace, this disparity remains prevalent in academic positions. OBJECTIVES We examined gender and Asian ethnic representation in editorial boards of cardiology journals. METHODS A cross-sectional analysis was conducted using publicly available data on Cardiology and Cardiovascular medicine journals in the first quartile of the 2020 Scimago Journal & Country Rank indicator. The proportions of female and Asian editorial board members, associate editors and editors-in-chief were assessed. Subgroup analyses were conducted based on the journal's geographical origin, subspecialty and demographic of the editor-in-chief. RESULTS Seventy-six cardiology journals, involving 8915 editorial board members, were included. Only 19.6% of editorial board members were female, 20.8% Asians and 4.0% Asian females. There were less female representation amongst editors-in-chief (9.9%) compared to associate editors (22.3%). European (18.1%) and North American-based journals (21.1%) had higher female representation compared to Asian-based journals (8.7%). There was lower Asian representation in European (18.1%) and North American-based journals (19.9%) compared to Asian-based journals (72.3%). Females were underrepresented in interventional (14.5%) journals, while Asians were underrepresented in general cardiology (18.3%) and heart failure (18.3%) journals. Journals led by female editors-in-chief had significantly higher female representation compared to male-led ones, while journals with Asian editors-in-chief had greater Asian representation compared to non-Asian led ones. CONCLUSION This study highlights the female and Asian ethnic underrepresentation in academic roles in cardiology journal editorial boards. Further analysis is needed for other ethnicities, while the community pushes towards gender-balanced and ethnic diversity across editorial boards.
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Affiliation(s)
- O Z H Lim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Y Chen
- Department of Cardiology, First Medical Centre of Chinese People's Liberation Army (PLA) General Hospital, Wanshoulu, 100036 Beijing, China
| | - S Dimmeler
- Institute for Cardiovascular Regeneration, Goethe University, Theodor-Stern-Kai 7 60590 Frankfurt am Main, Germany
| | - A W J Yong
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - H Singh
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - M L E Sim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - G Kong
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - W H Lim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - T T Low
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - D-W Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - N W S Chew
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - R Foo
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Cardiovascular Diseases Translational Research Programme, National University Health Systems, 1E Kent Ridge Rd, Singapore 119228, Singapore
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Wu J, In H, Dream S. Diversity, Equity, and Inclusion: The Asian Americans Experience. J Surg Res 2022; 279:296-298. [PMID: 35802944 DOI: 10.1016/j.jss.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- James Wu
- Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Haejin In
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sophie Dream
- Medical College of Wisconsin, Milwaukee, Wisconsin.
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Wang TS, Kim ES, Duh QY, Gosain A, Kao LS, Kothari AN, Tsai S, Tseng JF, Tsung A, Wang KS, Wexner SD. Proceedings From the Advances in Surgery Channel Diversity, Equity, and Inclusion Series: Lessons Learned From Asian Academic Surgeons. J Surg Res 2022; 278:14-30. [PMID: 35588571 DOI: 10.1016/j.jss.2022.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
In this series of talks and the accompanying panel session, leaders from the Society of Asian Academic Surgeons discuss issues faced by Asian Americans and the importance of the role of mentors and allyship in professional development in the advancement of Asian Americans in leadership roles. Barriers, including the model minority myth, are addressed. The heterogeneity of the Asian American population and disparities in healthcare and in research, specifically as relates to Asian Americans, also are examined.
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Affiliation(s)
- Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Eugene S Kim
- Department of Surgery, Children's Hospital of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Quan-Yang Duh
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Ankush Gosain
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas
| | - Anai N Kothari
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center and Boston University, Boston, Massachusetts
| | - Allan Tsung
- Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Kasper S Wang
- Department of Surgery, Children's Hospital of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
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Ethnic and Sex Diversity in Academic Orthopaedic Surgery: A Cross-sectional Study. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202203000-00009. [PMID: 35258489 PMCID: PMC8906469 DOI: 10.5435/jaaosglobal-d-21-00321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/20/2022]
Abstract
Introduction: Although the diversity in orthopaedic residency programs has been studied, the diversity within academic orthopaedics has not. Methods: The board of specialty societies, five leading journals and the National Institutes of Health RePORTER tool, and three accreditation organizations were explored. Results: The board of directors comprised 220 (72%) Caucasians, 36 (12%) Asians, 4 (1%) Hispanic/Latinos, 29 (9%) African Americans, and 18 (6%) Other individuals; 250 (81%) were men, and 57 (19%) were women. The editorial boards comprised 288 (77%) Caucasians, 62 (16%) Asians, 14 (4%) Hispanic/Latinos, 8 (2%) African Americans, and 4 (1%) Other individuals; 341 (91%) were men, and 35 (9%) were women. The National Institutes of Health grant recipients comprised 117 (64%) Caucasians, 58 (32%) Asians, 4 (2%) Hispanic/Latinos, and 3 (2%) African Americans; 128 (70%) were men, and 54 (30%) were women. On average, Caucasians, Asians, Hispanic/Latinos, and African Americans received $776,543, $439,600, $420,182, and $494,049, respectively. On average, men and women received $759,426 and $419,518, respectively. The accreditation boards comprised 45 (82%) Caucasians, 6 (11%) Asians, and 4 (7%) African Americans; 45 (82%) were men, and 10 (18%) were women. Conclusions: Academic orthopaedic surgery does not resemble the United States. Residency, fellowship committees, and professional organization boards need to become aware of these disparities.
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Morris-Wiseman LF, Cañez C, Romero Arenas MA, Hsu CH, Nfonsam VN. Race, Gender, and International Medical Graduates: Leadership Trends in Academic Surgical Societies. J Surg Res 2021; 270:430-436. [PMID: 34798425 DOI: 10.1016/j.jss.2021.09.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-White and female surgeons are underrepresented in academic surgery faculty. We hypothesized that the leadership of major U.S. regional and national general surgery societies reflects these same racial and gender disparities. We suspected that attending a medical school or residency program with academic prestige would be more common for surgeons from underrepresented backgrounds. MATERIALS AND METHODS Race/ethnicity and gender of the 2020-21 executive council members and 2012-21 society presidents of 25 major general surgery societies (7 regional, 18 national) was assessed. Academic prestige was determined by reputational top 25 programs, identified using U.S. News and World Report and Doximity rankings for medical school and residency, respectively. RESULTS Surgical society executive council members (n = 204) were predominantly White (75.5%) and male (67.2%). The 50 non-White council members were Asian (n = 37), Black (n = 7), and Latinx (n = 6). 14 (6.9%) were international medical graduates (IMGs). 56.4% attended a school or program ranked in the Top 25 (n = 115). Surgical society presidents 2012-21 (n = 242) have been mostly White (87.6%) and male (83.4%). Non-White, male surgical society presidents were Asian (n = 13), Black (n = 9), and Latino (n = 6). Of the 41 female surgery society presidents, 92.7% were White, 7.3% (n = 3) Asian, and none Black or Latina. 13 were IMGs (5.3%). 55.0% of society presidents attended Top 25 (n = 133) schools or programs. The three non-White, female presidents all attended Top 25 schools/programs (100%). Of the 15 unique individuals who were male, non-White presidents, 12 attended top 25 schools or programs (80%). CONCLUSION Women, non-White surgeons, and IMGs are underrepresented in U.S. surgical society leadership. Increasing racial diversity in U.S. surgical society leadership may require intentionality in mentorship and sponsorship, particularly for surgeons who did not attend prestigious schools or programs.
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Affiliation(s)
| | - Christina Cañez
- Department of Surgery, University of Arizona, College of Medicine Tucson, Arizona
| | - Minerva A Romero Arenas
- Department of Surgery, Weill Cornell Medicine/New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Chiu-Hsieh Hsu
- Department of Surgery, University of Arizona, College of Medicine Tucson, Arizona
| | - Valentine N Nfonsam
- Department of Surgery, University of Arizona, College of Medicine Tucson, Arizona
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Tran TB, Raoof M, Melstrom L, Kyulo N, Shaikh Z, Jones VC, Erhunmwunsee L, Fong Y, Warner SG. Racial and Ethnic Bias Impact Perceptions of Surgeon Communication. Ann Surg 2021; 274:597-604. [PMID: 34506314 DOI: 10.1097/sla.0000000000005060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction scores as a function of physician and patient race and sex. BACKGROUND Patient satisfaction is increasingly used as a surrogate for physician performance. How patient and surgeon race and ethnicity affect perceptions of surgeon communication and care is not widely explored. METHODS Press Ganey patient satisfaction surveys collected from January 2019 to September 2020 were studied. Multivariate logistic regressions were used to identify factors associated with favorable surgeon performance as a function of patient and surgeon demographics. RESULTS A total of 4732 unique outpatient satisfaction survey responses were analyzed. The majority of patients were White (60.5%), followed by Asian (8.6%), Black (4.2%), and Hispanic (4.3%). URM accounted for 8.9% of the 79 surgeons evaluated, and 34% were female. Black, Hispanic, and Asian patients were more likely to report unfavorable experiences than their White counterparts (P < 0.01). Spanish-speaking patients were most likely to perceive that surgeon show less respect for patient concerns (13.9% vs 9.3%, P = 0.004) and inadequate time spent explaining health concerns (12.6% vs 9.2%, P < 0.001). Female surgeons were more likely to achieve the highest overall ratings for effective communication, whereas Asian surgeons received lower scores. Asian surgeons were more likely than non-Asian surgeons to receive lower scores in explanation (37.3% vs 44.1%, P = 0.003). After adjusting for confounding factors, Asian surgeons had 26% lower odds of receiving favorable scores for overall communication (odds ratio: 0.736, 95% confidence interval: 0.619-0.877, P = 0.001). CONCLUSIONS Both patient and surgeon race and sex drive negative perceptions of patient-physician communication. As URM report more negative experiences, further studies should focus on effects of surgeon cultural awareness on underrepresented patient satisfaction.
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Affiliation(s)
- Thuy B Tran
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mustafa Raoof
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Laleh Melstrom
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Namgyal Kyulo
- Department of Patient Experience, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Zameer Shaikh
- Department of Patient Experience, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Veronica C Jones
- Department of Surgery, Division of Breast Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Loretta Erhunmwunsee
- Department of Surgery, Division of Thoracic Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yuman Fong
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Susanne G Warner
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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Kuo LE, Chu DI, Gao T, Brahmbhatt TS, Wang TS. Asian American and Pacific Islander experiences and challenges in academic surgery. Am J Surg 2021; 223:211-213. [PMID: 34353621 DOI: 10.1016/j.amjsurg.2021.07.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Lindsay E Kuo
- Department of Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
| | - Daniel I Chu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Terry Gao
- Department of Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Tejal S Brahmbhatt
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Barceló NE, Shadravan S. Race, Metaphor, and Myth in Academic Medicine. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:100-105. [PMID: 33089430 DOI: 10.1007/s40596-020-01331-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
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Dream S, Olivet MM, Tanner L, Chen H. Do male chairs of surgery have implicit gender bias in the residency application process? Am J Surg 2020; 221:697-700. [PMID: 32843230 DOI: 10.1016/j.amjsurg.2020.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/25/2020] [Accepted: 08/11/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Medical students applying for general surgery residencies often require a letter of recommendation (LOR) from the Surgical Chair. However, LORs may reveal gender and ethnic bias. This study examines the presence of implicit bias in general surgery resident selection by evaluating chair LORs. METHODS A retrospective study of 149 LORs for categorical general surgery residents, at an academic institution, written by surgery chairs from 1980 to 2013 was performed. Two independent reviewers scored each letter for overall quality, mention of personality, academic deficiencies, technical skills, and standout adjectives. Scores were compared across gender and race and statistical analysis performed using SPSS. RESULTS Males comprised 85% of the applicants; racial makeup was Caucasian (90%), black (4%), Asian (4%), and Hispanic (2%). Male chairs wrote all letters. Letters for female students received higher overall scores than males (4.13 ± 0.16, 3.59 ± 0.08, p = 0.005). Discussion of personality was significantly less for Asian students (1.28 ± 0.08, 1.83 ± 0.48, 0.5 ± 0.224, 1.67 ± 0.67, p 0.050). No difference was present in mention of academic deficiencies, technical skills, or standout adjectives. DISCUSSION Female medical students invited to interview at a top academic general surgery residency had higher quality LORs than their male counterparts. Asian applicants had statistically significant less discussion of personality. Further examination of residency selection processes is necessary to implement changes that mitigate implicit bias in trainee selection.
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Affiliation(s)
- Sophie Dream
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, 53226, WI, USA.
| | | | - Lauren Tanner
- University of Alabama at Birmingham, 1808 7th Ave S, Birmingham, 35233, AL, USA.
| | - Herbert Chen
- University of Alabama at Birmingham, 1808 7th Ave S, Birmingham, 35233, AL, USA.
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Mehta LS, Fisher K, Rzeszut AK, Lipner R, Mitchell S, Dill M, Acosta D, Oetgen WJ, Douglas PS. Current Demographic Status of Cardiologists in the United States. JAMA Cardiol 2020; 4:1029-1033. [PMID: 31509160 DOI: 10.1001/jamacardio.2019.3247] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Increasing cardiology workforce diversity will expand the talent of the applicant pool and may reduce health care disparities. Objective To assess US cardiology physician workforce demographics by sex and race/ethnicity in the context of the US population and the available pipelines of trainees. Design, Setting, and Participants This cross-sectional study used data from the Association of American Medical Colleges, the American Medical Association, and the American Board of Internal Medicine to stratify medical students, resident physicians, fellows, and cardiologists by sex and race/ethnicity. Additionally, proportional changes from 2006 through 2016 were assessed for adult and pediatric cardiology. Data analysis took place from August 2018 to January 2019. Main Outcomes and Measures Percentage of cardiologists and trainees by sex and race/ethnicity in 2016, as well as changes in proportions between 2006 and 2016. Results Despite a high percentage of female internal medicine resident physicians (10 765 of 25 252 [42.6%]), female physicians were underrepresented in adult general cardiology fellowships (584 of 2720 [21.5%]) and procedural subspecialty fellowships (interventional cardiology, 30 of 305 [9.8%]; electrophysiology, 24 of 175 [13.7%]). The percentage of female adult cardiologists slightly increased from 2006 through 2016 (from 8.9% to 12.6%; slope, 0.36; P < .001) but remained low. Female physicians made up a disproportionately higher number of pediatric residency positions (6439 of 8832 [72.9%]). Trends showed an increase in female pediatric cardiology fellows (from 40.4% to 50.5%; slope, 1.25; P < .001), which resulted in an increase in the percentage of female pediatric cardiologists (from 27.1% to 34.0%; slope, 0.64; P < .001). The percentages of members of underrepresented minority groups in adult and pediatric cardiology fellowships (from 11.1% to 12.4%; slope, 0.15; P = .01; and from 7.7% to 9.9%; slope, 0.29; P = .009; respectively) were low and increased only slightly over time. Additionally, members of underrepresented minorities made up less than 8% of practicing adult and pediatric cardiologists. Although Asian individuals are 5.2% of the US general population, they are not considered underrepresented because they are 22.1% of US medical school graduates (n = 4202 of 18 999), 38.1% of internal medicine resident physicians (n = 9618 of 25 252), 40.4% of adult cardiology fellows (n = 1098 of 2720), 19.9% of adult cardiologists (n = 5973 of 30 016), 22.6% of pediatric resident physicians (n = 1998 of 8832), 28.0% of pediatric cardiology fellows (n = 122 of 436), and 20.1% of pediatric cardiologists (n = 574 of 2860). Conclusions and Relevance Female physicians remain underrepresented in adult cardiology, despite a robust pipeline of female medical students and internal medicine resident physicians. Women in pediatric cardiology are underrepresented but increasing in number. Members of several racial/ethnic minority groups remain underrepresented in adult and pediatric cardiology, and the percentages of trainees and medical students from these groups were also low. Different strategies are needed to address the continuing lack of diversity in cardiology for underrepresented minority individuals and women.
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Affiliation(s)
| | - Kara Fisher
- Association of American Medical Colleges, Washington, DC
| | | | - Rebecca Lipner
- American Board of Internal Medicine, Philadelphia, Pennsylvania
| | | | - Michael Dill
- Association of American Medical Colleges, Washington, DC
| | - David Acosta
- Association of American Medical Colleges, Washington, DC
| | | | - Pamela S Douglas
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina
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16
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Let That Be Your Battlefield: Society of Asian Academic Surgeons Presidential Address. J Surg Res 2019; 241:A1-A5. [DOI: 10.1016/j.jss.2019.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Garcia LC, Chung S, Liao L, Altamirano J, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians. JAMA Netw Open 2019; 2:e190027. [PMID: 30794297 PMCID: PMC6484609 DOI: 10.1001/jamanetworkopen.2019.0027] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Patient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients. OBJECTIVE To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians. DESIGN, SETTING, AND PARTICIPANTS This population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018. EXPOSURES Physician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken. MAIN OUTCOMES AND MEASURES The highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey. RESULTS Of the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity. CONCLUSIONS AND RELEVANCE This study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.
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Affiliation(s)
- Luis C. Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Lily Liao
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Bonnie Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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18
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Kuo LE, Parangi S, Cho NL. Diversity and inclusion in a surgical society: A longitudinal investigation. Surgery 2018; 165:808-813. [PMID: 30509749 DOI: 10.1016/j.surg.2018.10.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/12/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although the presence of women and minorities is increasing in academic surgery, inclusion at the highest levels appears to continue to lag in many aspects of leadership and participation. Participation in medical societies is an opportunity in career development but may also propagate disparities. We investigated the presence of women and minorities within one subspecialty society, the American Association of Endocrine Surgeons, to better understand the presence of these groups in the leadership of this society. METHODS Publicly available data regarding American Association of Endocrine Surgeons membership and leadership were obtained. North American active members in 2007, 2012, and 2017 were identified. Gender and race/ethnicity were determined via internet query. We analyzed the number and proportion of active members and members in leadership positions who were female, East/South/Middle Eastern Asian American ("Asian"), Hispanic/Latin/South American, or African American in each year throughout this period. RESULTS The American Association of Endocrine Surgeons was established in 1981. From 2007 to 2017, active membership in the American Association of Endocrine Surgeons increased from 178 to 276. The percentages of female (17.4%-35.1%), Asian (9.0%-17.4%), and Hispanic/Latin/South American (3.9%- 4.7%) members increased during this time. The percentage of African American members did not increase (1.7%-1.8%). In 2017, women and Asians composed disproportionately high percentages of council members (50% and 67%, respectively) and committee chairs (46%, 23%) and were inconsistently represented as officers (40%, 20%). Hispanic/Latin/South American and African American members were disproportionately underrepresented at every level of leadership. CONCLUSION Diversity in the American Association of Endocrine Surgeons has improved for all groups of diversity that were explored except African American members. Women and Asians are not consistently well represented throughout the organizational leadership, and Hispanic/Latin/South American and African American members are underrepresented. Opportunity exists to improve the diversity opportunities in this organization.
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Affiliation(s)
- Lindsay E Kuo
- Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
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Silvestre J, Serletti JM, Chang B. Racial and Ethnic Diversity of U.S. Plastic Surgery Trainees. JOURNAL OF SURGICAL EDUCATION 2017; 74:117-123. [PMID: 28041605 DOI: 10.1016/j.jsurg.2016.07.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Increased diversity of U.S. physicians can improve patient communication and mitigate health disparities for racial minorities. This study analyzes trends in racial and ethnic diversity of plastic surgery residents. METHODS Demographic data of surgical residents, medical students, and integrated plastic surgery residency applicants were obtained from the Association of American Medical Colleges. Data for college students and the general population were obtained from the U.S. Census for comparison with plastic surgery. Interspecialty differences and temporal trends in racial composition were analyzed with chi-square tests. RESULTS From 1995 to 2014, Asian and Hispanic plastic surgery residents increased nearly 3-fold (7.4%-21.7%, p < 0.001) and 2-fold (4.6%-7.9%, p < 0.001), respectively. African American plastic surgery residents did not increase significantly (3.0%-3.5%, p = 0.129). Relative to the U.S. population, Hispanics (range: 0.1-0.5-fold) and African Americans (range: 0.1-0.4-fold) were underrepresented, whereas Asians (range: 2.2-5.3-fold) were overrepresented in plastic surgery. A "bottleneck" existed in the pipeline of African American and Hispanic plastic surgery residents. Significant differences in racial composition existed between plastic surgery and other surgical disciplines, which varied over time. The percentage of Hispanic (10.6% vs 7.0%, p = 0.402) and African American (6.4% vs 2.1%, p < 0.001) plastic surgery residency applicants exceeded those in residency. CONCLUSIONS Hispanics and African Americans are underrepresented in plastic surgery residency relative to whites and Asians. This study underscores the need for greater initiatives to increase diversity in plastic surgery residency.
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Affiliation(s)
- Jason Silvestre
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph M Serletti
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Chang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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20
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Nakayama DK, Dalton ML. Department of Surgery, Mercer University School of Medicine, and the Medical Center of Central Georgia. Am Surg 2012. [DOI: 10.1177/000313481207800527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Don K. Nakayama
- Medical Education–Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, Georgia
| | - Martin L. Dalton
- Medical Education–Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, Georgia
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