Gender, Race, and Ethnicity Representation Among Gastroenterologists: A Review of Recent Trends

Higher Inpatient Racial and Ethnic Diversity Is Associated with Better Outcomes in Hispanic and Native American Patients for Gastrointestinal Diseases

BACKGROUND

Evidence suggests that outcomes are poorer among patients from historically marginalized racial and ethnic backgrounds. The impact of patient racial and ethnic diversity on gastrointestinal outcomes is understudied.

AIMS

To investigate the impact of patient racial/ethnic diversity on gastrointestinal disease (GI) outcomes.

METHODS

Using the 2019 National Inpatient Sample (NIS), hospital inpatient racial/ethnic diversity was defined as the percentage of Hispanic or Native American discharges. We included gastrointestinal bleeding, inflammatory bowel diseases, gastrointestinal obstruction, cirrhosis, and alcohol-associated hepatitis. Logistic regression was used to predict outcomes [major complications (MCC), long length of stay, high total charges], controlling for age, gender, location, income quartile, hospital size, and region.

RESULTS

Our cohort included 537,830 hospitalizations. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Native American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to Whites, Hispanic [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28] and Native American patients [OR 1.25, (95% CI) 1.09-1.43] had higher MCC rates. As hospital Hispanic diversity increased, MCC for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14] and were even better among Native American patients as their diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar trend was observed in the 2018 validation cohort.

CONCLUSION

Increasing hospital inpatient Hispanic and Native American diversity is associated with better outcomes for these groups. Further research is needed on the impact cultural competence and linguistic concordance on gastrointestinal outcomes.

The Evolving Plastic Surgery Applicant: How Far Have We Come in 30 Years?

BACKGROUND

Plastic surgery training has undergone tremendous change and transitioned through many models over the years, including independent, combined, and integrated. This study evaluates how these changes and others have affected plastic surgery applicants' demographics and academic qualifications over the last 30 years.

METHODS

Data on applicant demographics and academic qualifications were extracted from multiple sources including the National Resident Matching Program, the American Association of Medical Colleges, and cross-sectional surveys of plastic surgery applicants for the years 1992, 2005, 2011, and 2022. Data were compared using pairwise χ2 goodness of fit tests.

RESULTS

The sex distribution of plastic surgery applicants changed significantly over the last 30 years: whereas men predominated in 1992 (86% male vs 14% female), by 2011, the distribution was nearly equal (54% male vs 46% female in both 2011 and 2022, P < 0.001).The racial makeup of applicants also changed over time (P < 0.05). White applicants decreased from 73% in 1992 to 55% in 2011, and 53% in 2022. While there was an increase in Asian (7% to > 17% to > 20%) and other (13% to > 14% to > 21%) applicants over time, whereas the proportion of Black applicants remained stagnant (5% to > 6% to > 8%).Applicants with prior general surgery experience declined precipitously over the years: 96% in 1992, 64% in 2005, 37% in 2011, and 26% in 2022 (P < 0.001). When compared with 1992, Alpha Omega Alpha status increased significantly in 2011 (36% vs 12%, P < 0.05) but did not change considerably in 2005 (22%) and 2022 (23%). Research experience increased dramatically over the years, with the proportion of applicants with at least one publication going from 43% in 1992, to 75% in 2005, to 89% in 2011, and to 99% in 2022 (P < 0.001). Applicant interest in academic plastic surgery did not change considerably over the years at roughly ranging from 30% to 50% of applicants (P = ns).

CONCLUSIONS

There has been a shift in the demographics and academic qualifications of plastic surgery applicants over the last 3 decades. Understanding this evolution is critical for reviewing and evaluating the makeup of our specialty, and enacting changes to increase representation where necessary.