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

Current diversity in radiology: A comparative study

PURPOSE

To compare the demographic characteristics of active physicians, trainees, medical school clinical sciences faculty, and department chairs in radiology with those in other medical specialties.

METHODS

An analysis was conducted using publicly available deidentified aggregate data from the Association of American Medical Colleges (AAMC). Our data collection included information from the 2022 AAMC Physician Specialty Data Report, the 2022 AAMC Report on Residents, and the 2022 AAMC Faculty Roster. We examined factors such as graduation country, gender, and self-identified race/ethnicity. MedCalc software was used for the analyses.

RESULTS

Compared to other specialties, active radiologists exhibited a significantly lower percentage of females, International Medical Graduates (IMGs), individuals of American Indian/Alaska Native (AIAN) descent, Black/African-American individuals, and individuals of Hispanic/Latino/Spanish origin. Conversely, the proportion of White active radiologists was higher. Among radiology trainees, there was a notably lower percentages of females, IMGs, individuals of Black/African-American descent, and individuals of Hispanic/Latino/Spanish origin, while the percentage of Asians was significantly higher. Furthermore, medical school radiology faculty showed a significant lower proportion of females, Black/African-American individuals, Hispanic/Latino/Spanish individuals, and individuals categorized under the white race/ethnicity, with Asians having a higher representation. As radiology department chairs, Asians were noted at significantly lower percentages compared to their proportions among medical school radiology faculty, while Black/African-American individuals were observed at significantly higher percentages in the same comparison.

CONCLUSION

This study revealed a notable underrepresentation of females, individuals of Black/African-American descent, and those of Hispanic/Latino/Spanish origin among active radiologists, radiology trainees, and medical school radiology faculty when compared to their counterparts in other medical specialties. Given these findings, further investigation into the underlying causes of these disparities is warranted.

Changes in the attractiveness of medical careers and career determinants during the bachelor's program at Zurich medical schools

BACKGROUND

Monitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor's studies.

METHODS

The design was cross-sectional, recruiting all medical students who started a bachelor's program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students' perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option.

RESULTS

We surveyed 354 medical students at the beginning and 433 at the end of the bachelor's program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice.

CONCLUSIONS

During the bachelor's program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession.

TRIAL REGISTRATION

Not applicable.

The National MD-PhD Program Outcomes Study: career paths followed by Black and Hispanic graduates

Previous studies on attrition from MD-PhD programs have shown that students who self-identify as Black are more likely to withdraw before graduating than Hispanic students and students not from groups underrepresented in medicine (non-UIM). Here, we analyzed data collected for the National MD-PhD Program Outcomes Study, a national effort to track the careers of over 10,000 individuals who have graduated from MD-PhD programs over the past 60 years. On average, Black trainees took slightly longer to graduate, were less likely to choose careers in academia, and were more likely to enter nonacademic clinical practice; although, none of these differences were large. Black graduates were also more likely to choose careers in surgery or internal medicine, or entirely forego residency, and less likely to choose pediatrics, pathology, or neurology. Among those in academia, average research effort rates self-reported by Black, Hispanic, and non-UIM alumni were indistinguishable, as were rates of obtaining research grants and mentored training awards. However, the proportion of Black and Hispanic alumni who reported having NIH research grants was lower than that of non-UIM alumni, and the NIH career development to research project grant (K-to-R) conversion rate was lower for Black alumni. We propose that the reasons for these differences reflect experiences before, during, and after training and, therefore, conclude with action items that address each of these stages.

What Goes In, Must Come Out: Generative Artificial Intelligence Does Not Present Algorithmic Bias Across Race and Gender in Medical Residency Specialties

Objective Artificial Intelligence (AI) has made significant inroads into various domains, including medicine, raising concerns about algorithmic bias. This study investigates the presence of biases in generative AI programs, with a specific focus on gender and racial representations across 19 medical residency specialties. Methodology This comparative study utilized DALL-E2 to generate faces representing 19 distinct residency training specialties, as identified by the Association of American Medical Colleges (AAMC), which were then compared to the AAMC's residency specialty breakdown with respect to race and gender. Results Our findings reveal an alignment between OpenAI's DALL-E2's predictions and the current demographic landscape of medical residents, suggesting an absence of algorithmic bias in this AI model. Conclusion This revelation gives rise to important ethical considerations. While AI excels at pattern recognition, it inherits and mirrors the biases present in its training data. To combat AI bias, addressing real-world disparities is imperative. Initiatives to promote inclusivity and diversity within medicine are commendable and contribute to reshaping medical education. This study underscores the need for ongoing efforts to dismantle barriers and foster inclusivity in historically male-dominated medical fields, particularly for underrepresented populations. Ultimately, our findings underscore the crucial role of real-world data quality in mitigating AI bias. As AI continues to shape healthcare and education, the pursuit of equitable, unbiased AI applications should remain at the forefront of these transformative endeavors.

Understanding clerkship experiences in emergency medicine and their potential influence on specialty selection: A qualitative study

Objectives

The specialty of emergency medicine (EM) is experiencing a significant decrease in student interest. In addition, women are historically underrepresented within the specialty at all levels of training and practice. We sought to understand how clinical experiences and perceptions of EM influence specialty selection by medical students, particularly women.

Methods

Using a constructivist grounded theory approach, we analyzed semistructured interviews with senior medical students who considered EM as a specialty. We used purposive sampling to recruit from diverse learning environments and represent a variety of experiences. Participants reflected on their specialty selection process and experiences in EM including their perceived acceptance in the work environment.

Results

Twenty-five medical students from 11 geographically diverse schools participated. A total of 68% (17/25) identified as women. The majority (21/25, 84%) planned on applying to EM residency. We identified four major themes: (1) distressing interpersonal interactions with patients and the ED care team negatively affect students; (2) EM culture includes behaviors that are perceived as exclusionary; (3) beliefs about the attributes of an ideal EM physician and the specialty itself have a gendered nature; and (4) ease of access to mentors, representation, and early exposure to EM environment increased interest in specialty.

Conclusions

Our participants express that EM causes challenges for students to accept the norms of behavior in the field, which is an essential element in joining a group and professional identity formation. In addition, we raise concern that gendered perceptions and language may send exclusionary environmental cues that may negatively impact recruitment of a diverse physician workforce.

The 2021 ACR/Radiology Business Management Association Workforce Survey: Diversity in Radiology

The landscape of the radiology workforce is changing, especially in the diversity of the demographics of practicing radiologists across subspecialties, practice types, and leadership positions in both academic and nonacademic settings. The 2021 ACR/Radiology Business Management Association Workforce Survey examines these facets in detail and contributes to our understanding of the current state of diversity in the radiology workforce and potential barriers to change. The results suggest opportunities and future directions for improving diversity, equity, and inclusion.

Diversity in Radiology Residents Relative to Other Specialties- Trends Over the Past Decade

RATIONALE AND OBJECTIVES

The objective of this study was to assess diversity among radiology residents relative to other specialties and compare it with historical trends.

MATERIALS AND METHODS

The Graduate Medical Education results from 2010-2011 to 2020-2021 were accessed for demographic information for major medical specialties (number of residents > 500 as of the 2020-2021 report). Subspecialties and fellowship programs were not included in this analysis. The racial and ethnicity breakdowns were extracted, including Black, White/Caucasian, Asian, Hispanic, and others. The changes in racial and ethnicity composition of residents in radiology was compared to other specialties using the Chi Squared test using a significance level of p < 0.05.

RESULTS

In 2020-2021, radiology ranked ninth in total resident enrollment among the 21 largest ACGME training programs, unchanged when compared to 2010-2011. Amongst all specialties, Radiology ranked 10th for Black and 9th for Hispanic representation in 2020-2021.The percentage of Black residents increased from 3.07% in 2010-2011 to 3.83% in 2020-2021. The percentage of Hispanic Radiology residents increased from 4.83% to 7.35%, constituting the third largest increase amongst all specialties.

CONCLUSION

The representation of Blacks and Hispanics in Radiology has improved relative to other medical specialties in the last decade.

Survey of clinical informatics fellows graduating 2016-2024: experiences before and during fellowship

OBJECTIVE

To describe experiences and activities of Clinical Informatics (CI) fellows since the first fellowships were accredited in 2014.

MATERIALS AND METHODS

We performed a voluntary and anonymous survey of 394 alumni and current clinical informatics fellows from the graduating classes of 2016-2024 in the summer of 2022.

RESULTS

We received 198 responses; 2% declined to participate. Most were male (62%), White (39%), 31-40 years old (72%), from primary care specialties (54%) and nonprocedural specialties (95%), and without prior informatics experience or any careers before medicine. Most fellows (87-94%) participated significantly in operations, research, coursework, quality improvement, and clinical care activities during fellowship.

DISCUSSION

Women, underrepresented racial and ethnic minorities, and procedural physicians were underrepresented. Many incoming CI fellows did not have an informatics background. During CI fellowship, trainees earned Master's degrees and certificates, were exposed to many different types of CI activities, and were able to spend most of their time pursuing projects that supported their personal career goals.

CONCLUSION

These findings represent the most comprehensive report to date of CI fellows and alumni. Physicians without prior informatics experience who are interested in CI should be encouraged to apply because CI fellowship provides a strong foundation of informatics knowledge while supporting fellows' personal career goals. There remains a lack of women and underrepresented minorities in CI fellowship programs; efforts to expand the pipeline are needed.

Recruitment of women in neurosurgery: a 7-year quantitative analysis

OBJECTIVE

The authors aimed to characterize which US medical schools have the most female neurosurgery residents and to identify potential associations between medical school characteristics and successful recruitment of women pursuing a neurosurgery career.

METHODS

The authors evaluated a total of 1572 residents in US neurosurgery programs accredited by the Accreditation Council for Graduate Medical Education as of February 2021, representing match cohorts from 2014 to 2020. The authors extracted US medical school characteristics and ranked schools based on the percentages of women graduates entering neurosurgery. They additionally studied yearly trends of the percentage of women constituting incoming neurosurgery resident cohorts as well as associations between female recruitment percentage and medical school characteristics using univariable and stepwise multivariable linear regression (including significant univariable factors).

RESULTS

The cohort consisted of 1255 male and 317 (20%) female residents. Yearly trends indicated a significant drop in incoming female residents in 2016, followed by significant increases in 2017 and 2019. On multivariable analysis, the following factors were associated with a higher average percentage of female graduates entering neurosurgery: total affiliated neurosurgery clinical faculty (β = 0.006, 95% CI 0.001-0.011, p = 0.01), allopathic versus osteopathic schools (β = 0.231, 95% CI 0.053-0.409, p = 0.01), and top 10 U.S. News & World Report ranking (β = 0.380, 95% CI 0.129-0.589, p < 0.01). When the number of female clinical faculty was added to the model, the variable was not statistically significant. Multivariable bibliometric analyses indicated a higher mean preresidency H-index for men, with an even greater gender difference identified in the 2021 H-index.

CONCLUSIONS

This study characterizes which medical schools are most successful at recruiting female students who constituted the total neurosurgery resident workforce of the 2020-2021 academic year. The overall number of clinical neurosurgery faculty rather than faculty gender was independently associated with female recruitment. Gender differences in research productivity persisted with control for confounders and increased between preresidency and 2021 time points. Such understanding of factors that influence the recruitment of women can help improve female representation in neurosurgery residency training moving forward.

Influence of Preventive Medicine Residency Programs and Combined Master of Public Health Programs on Specialty Selection

INTRODUCTION

To determine medical school characteristics that may result in graduates entering the specialty of public health and general preventive medicine (PH&GPM), the authors conducted an analysis comparing the presence of affiliated preventive medicine residency programs and combined Master of Public Health degree programs with the likelihood of graduates entering the specialty of PH&GPM.

METHODS

Using data from the American Board of Preventive Medicine and publicly available information on medical schools and residencies, in spring 2022, the authors compared medical schools that produced PH&GPM physicians with the presence of a PH&GPM residency program, the presence of any preventive medicine residency (public health and general preventive medicine or occupational medicine or aerospace medicine), and the presence of a combined Doctor of Medicine‒Master of Public Health or Doctor of Osteopathic Medicine‒Master of Public Health program.

RESULTS

Between 2017 and 2021, there were 385 physicians newly board certified in PH&GPM, 210 medical schools, and 75 preventive medicine residencies. The 385 physicians graduated from 110 of the 210 medical schools. Analyses showed statistically significant associations between medical schools that graduated PH&GPM physicians and the presence of PH&GPM residencies (OR=3.74; 95% CI=1.61, 8.69), all preventive medicine residencies (OR=2.75; 95% CI=1.37, 5.51), and combined degree programs (OR=4.37; 95% CI=2.45, 7.79).

CONCLUSIONS

Because PH&GPM residency programs affiliated with medical schools are a significant factor associated with PH&GPM physicians obtaining board certification, such analyses may provide critical guidance in the utilization of resources intended to produce more physicians certified in this specialty.

Interest in Serving the Underserved: Role of Race, Gender, and Medical Specialty Plans

Introduction

Medical students often express their plans to care for medically underserved populations, but little is known about how this interest remains during medical school (MS). This study examined how self-reported interest in working with medically underserved communities may change during MS training based on several student characteristics.

Methods

A secondary data analysis of all student records in the Electronic Residency Application Service (ERAS) from 2005 to 2010 is presented. Predictors included gender, under-represented in medicine (URiM) status, age, academic metrics, career interest, and medical specialty choice. Outcomes included interest in caring for medically underserved populations when entering MS, graduating MS, and graduating MS controlling for entering interest.

Results

The total population included 6890 student records (49.5% women and 18.2% URiM). Women had a higher likelihood of being interested in practicing in underserved communities when entering and graduating MS (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.37-1.77; OR 1.24, 95% CI 1.09-1.40). For all outcomes, URiM students had a higher likelihood of planning on a career with underserved populations compared with their non-URiM peers. Compared with Emergency Medicine, Internal Medicine/Pediatrics and Family Medicine had a higher likelihood of plans to work with underserved populations upon entering, graduating, and at graduation controlling for entering interest.

Discussion

Gender, race, and specialty choice all had meaningful associations with a student's plans on practice in an underserved community. This study's findings can help support efforts to improve MS diversity nationally and drive study on cultural effects embedded within medical specialty identity.

Attractiveness of medical disciplines amongst Swiss first-year medical students allocated to different medical education tracks: cross-sectional study

BACKGROUND

As most countries, Switzerland is experiencing a shortage of physicians especially in general practice and new medical education tracks with respective focusses have been started in response. This study investigated Swiss medical students' career openness and attractiveness of different medical disciplines as well as the concordance of students' career intentions with assigned medical education tracks.

METHODS

Cross-sectional study surveying first year medical students assigned to four different Swiss medical education tracks with distinctive additional education focuses (ETH Zurich: medical technology and engineering, University of St. Gallen and University of Lucerne: primary healthcare and University of Zurich: no distinctive focus).

RESULTS

We surveyed 354 medical students (response rate across all included medical education tracks 71.1%), 64.8% female, mean age 20 years. Regarding career openness, we found that 52.8% of medical students had neither a strong commitment nor a strong reservation for any of the proposed career options and 17.0% had a strong commitment. Among medical disciplines, medical subspecialties were attractive to the largest part of students (inpatient subspecialties attractive for 71%, outpatient for 58%), attractiveness of general practice was moderate (30%), academic (22%) and industrial sector (17%) careers were least attractive. Proportions of medical students attracted to general practice were similar at medical education tracks with focus on primary healthcare compared to other medical education tracks (32.2% vs. 25.8%, p = 0.391). Conversely, proportions of medical students attracted to academic or industry careers were significantly higher at the ETH Zurich compared to other medical education tracks (37.2%, vs. 13.1%, p < 0.001 and 31.9%, vs. 8.8%, p < 0.001 respectively).

CONCLUSION

While most first-year medical students were open to careers in many medical disciplines, attractiveness of disciplines varied strongly. Students attracted to academic or industrial careers accumulated at the medical education track with concordant teaching focus but students attracted to general practice did not accumulate at medical education tracks focused on primary healthcare. For medical education tracks with primary care teaching focus this is both a challenge and an opportunity to specifically counteract the shortage of general practitioners in Switzerland.