Diversity in Plastic Surgery Trainees: Trends in Minority Representation Among Applicants and Residents

Introduction

While the American population grows increasingly diverse each year, the physician workforce fails to reflect a similar change.¹ Prior studies have shown plastic surgery residents demonstrate a lower representation of racial, ethnic, and gender minorities than other surgical fields.^{2, 3} With its inherently diverse patient population, plastic surgery stands to benefit from increased diversity in surgeons, which begins by recruiting interested applicants to training from various backgrounds. We sought to evaluate trends in minority representation among applicants to plastic surgery compared with other specialties, and subsequently how these correlate with minority proportions of practicing residents.

Methods

AAMC Electronic Residency Application Service (ERAS) data was used to assess applicants to integrated and independent plastic surgery, internal medicine, family medicine, obstetrics and gynecology, and general surgery from 2010-2016. Corresponding resident data was attained from JAMA Graduate Medical Education annual reports, and medical student data from AAMC graduate student questionnaires. Groups analyzed included self-identified Black, Hispanic, and females. Binomial distribution analysis was used to assess differences in minority proportions of applicants and residents each year. Best-fit trend lines were compared amongst groups and across specialties.

Results

In integrated and independent plastic surgery, females have seen an increase in resident representation (+2.23% and +0.7% per year, respectively) over the last 7 years, despite a relative decrease in applicants (-0.23% and -0.8% per year, respectively). The proportion of female applicants and residents correlated yearly for all specialties (p>0.05). Black representation among both sets of applicants is increasing, however integrated residents fail to reflect this trend, with a -0.42% decrease in representation per year. Similarly, for all years and most specialties, the black proportion of applicants was significantly higher than the same year’s resident representation (p<0.05). Hispanic applicant and resident representation has seen a minimal change, <1% for both independent and integrated plastics. 

Conclusions

Overall, female representation in plastic surgery residents has increased greatly with near constant applicant representation in the integrated track, indicating better match success. There appears to be waning interest among females in applying the independent pathway. Despite increased Black representation in graduating medical school classes and accordingly applicants to plastic surgery, there has been a decline in Black representation of integrated plastics residents. No significant changes were seen among Hispanics. The data highlights a discrepancy between the population of applicants and those that continue on as residents, consistent across many specialties and deserving of our attention. Barriers to minority recruitment, including an absence of mentors and lack of resources, may exist starting from medical school and must be addressed in order to increase minority representation in plastic surgery.

 

References

1. Association of American Medical Colleges. Diversity in the Physician Workforce: Facts & Figures 2014. Available at < http://aamcdiversityfactsandfigures.org/>.
2. Silvestre J, Serletti JM, Chang B. Racial and Ethnic Diversity of U.S. Plastic Surgery Trainees. J Surg Educ 2017;74:117-123
3. Silva AK, Preminger A, Slezak S, et al. Melting the Plastic Ceiling: Overcoming Obstacles to Foster Leadership in Women Plastic Surgeons. Plast Reconstr Surg 2016;138:721-729