PURPOSE
The proportions of individuals who are underrepresented in medicine (URiM) in ophthalmology lag behind their proportions within the US population. Diversity trends have been studied in other specialties, but literature examining trends in ophthalmology is lacking. In this study, we investigate trends in the racial and ethnic demographics of ophthalmology residents and residency applicants.
DESIGN
Trend study.
METHODS
Demographic data of all residency programs across all specialties were extracted from Accreditation Council for Graduate Medical Education yearly reports from 2011 to 2019. Data from 2016 to 2019 on ophthalmology match applicants were analyzed using the 2020 Ophthalmology Residency Match Summary Report and the 2020 Association of University Professors of Ophthalmology Residency Gender & Ethnicity Summary. Linear trends were examined by the Cochran-Armitage test.
RESULTS
From 2011 to 2019, the raw percentage of URiM ophthalmology residents increased from 4.7% (66/1419) to 5.8% (85/1473) ( P < .001) whereas that of surgical specialties decreased from 9.9% (2164/21,967) to 9.1% (2370/26,082) ( P < .001). The percentage of URiM ophthalmology match applicants increased from 5.9% (43/726) of all applicants to 11.8% (87/741) from 2016 to 2019 ( P < .001), and the percentage of URiMs matching into ophthalmology increased from 4.9% (23/467) of all participants to 10.8% (52/484) from 2016 to 2019 ( P < .001).
CONCLUSIONS
Although there has been a positive trend in the percentage of URiMs applying and matching into ophthalmology, a lack of racial and ethnic diversity relative to other specialties persists. Strategies are needed to increase diversity in the field.
T o meet the health needs of our increasingly diverse nation and ensure quality health care, a diverse medical workforce is critical. A diverse workforcewould improve the cultural competency of the medical workforce. Individuals from diverse backgrounds provide meaningful perspectives based on their experiences and observations and are often better equipped to understand the practices, hardships, and culture of their respective communities than someone who does not identify with that group. Moreover, they are also in a position to help educate their colleagues on how best to care for patients with values and experiences that differ from their own and adapt services to support the unique needs of each patient.
Unfortunately, many medical specialties, including ophthalmology, have demonstrated a lack of diversity among providers. Recent data show that only 7.7% of ophthalmology residents are underrepresented in medicine (URiM)—defined as Black/African American, Hispanic/Latinx, and Native American/Pacific Islander and American Indian/Alaskan Native by the Association of American Medical Colleges—and a mere 6% of practicing ophthalmologists are URiM. These proportions of URiMs lag behind the proportion of URiMs within the entire US population (33% URiM).
Although diversity trends have been studied in other specialties, there are no recent studies regarding diversity trends among ophthalmology residents. In this study, we explore how diversity has changed over time in ophthalmology, as well as compare trends in ophthalmology to surgical and nonsurgical specialties as an aggregate. Findings of this study will provide insight into the historical and current state of diversity of ophthalmology residency applicants and residents, which reflects the future of our workforce.
METHODS
DATA COLLECTION
This cross-sectional study (IRB00266647) was reviewed and qualified as exempt research by the Johns Hopkins University School of Medicine Institutional Review Board and adheres to the Declaration of Helsinki.
Using publicly available Accreditation Council of Graduate Medical Education (ACGME) yearly reports from 2011 to 2019, we collected data for the racial and ethnic demographics of all ACGME residency programs. We began our analysis with 2011 because this was the first year that the yearly report included a section categorizing residents according to race or ethnicity. To investigate diversity trends among ophthalmology match applicants, we extracted data on the race or ethnicity of all San Franciscoophthalmology match (SF Match) participants from the 2020 Ophthalmology Residency Match Summary Report and the 2020 SF Match/Association of University Professors of Ophthalmology (AUPO) Residency Gender & Ethnicity Summary. We analyzed data from 2016 to 2019 because these were the only years of data that were publicly available in the AUPO report during the year we performed our analysis.
Our analysis included all of the specialties mentioned in the ACGME Data Resource Books. All specialties were then divided into 2 categories: surgical and nonsurgical. Surgical specialties (not including Ophthalmology) in this study were Neurological Surgery, Obstetrics & Gynecology, Orthopedic Surgery, Otolaryngology, Plastic Surgery, Integrated Plastic Surgery, Surgery, Integrated Vascular Surgery, Integrated Thoracic Surgery, and Urology. Nonsurgical specialties in this study were Anesthesiology, Dermatology, Emergency Medicine, Family Medicine, Internal Medicine, Medical Genetics and Genomics, Neurology, Nuclear Medicine, Pathology, Pediatrics, Physical Medicine and Rehabilitation (PM&R), Psychiatry, Radiation Oncology, Radiology, and Internal Medicine/Pediatrics.
STATISTICAL TESTS
We used Stata/MP version 14.2 (Stata Corp) to analyze our data with the Cochran-Armitage test. Proportions for URiM residents were defined as the regression of URiM/(URiM + non-URiM); Δ% represents the r*slope of χ 2 trend analysis multiplied by 100%. P values were not adjusted for multiple analyses and all P values were 2-sided. P-values ≤ 0.05 were considered statistically significant.
RESULTS
OPHTHALMOLOGY RESIDENTS: ANALYSIS FROM 2011 TO 2019
From 2011 to 2019, the percentage of URiM residents in ophthalmology increased from 4.7% (66/1419) to 5.8% (85/1473) (% change, 0.26; 95% CI, 0.078-0.433; P < .001) whereas that of surgical specialties overall decreased from 9.9% (2164/21,967) to 9.1% (2370/26,082) (% change, –0.15; 95% CI, –0.206 to –0.09; P < .001). Additionally, the percentage of URiM residents in nonsurgical specialties increased from 9.6% (6871/71,791) to 10.2% (8880/87,078) (% change, 0.081; 95% CI, 0.049-0.123; P < .001) ( Figure 1 ).
OPHTHALMOLOGY MATCH APPLICANTS: ANALYSIS FROM 2016 TO 2019
As shown in Table 1 , the percentage of URiMs participating in the ophthalmology match increased from 5.9% (43/726) of all participants to 11.8% (87/741) of all participants from 2016 to 2019 (% change, 1.87; 95% CI, 0.92-2.82; P < .001). The percentage of URiMs matching into ophthalmology increased from 4.9% (23/467) to 10.8% (52/484) (% change, 1.77; 95% CI, 0.66-2.88; P =.002). The percentage of Black/African American participants increased from 2% (15/726) in 2016 to 3.6% (27/741) in 2019 (% change, 0.46; 95% CI, –0.09 to 1.01; P = .096), and the percentage of Black/African American applicants who matched increased from 1.9% (9/467) in 2016 to 3% (15/484) in 2019 (% change, 0.23; 95% CI, –0.37 to 0.83; P = .452). The percentage of Hispanic/Latinx participants increased from 3.9% (28/726) to 8.2% (61/741) over the study period (% change, 1.46; 95% CI, 0.66-2.26; P < .001), and the percentage of Hispanic/Latinx applicants who matched increased from 3% (14/467) to 7.8% (38/484) (% change, 1.62; 95% CI, 0.66-2.58; P < .001). The percentage of Native Hawaiian/Pacific Islander and American Indian/Alaskan Native participants and matched applicants remained at 0% across the entire study period.
| Category | Race/Ethnicity | 2016 | 2017 | 2018 | 2019 | % Change (95% CI) | P-Value |
|---|---|---|---|---|---|---|---|
| No. (%) | No. (%) | No. (%) | No. (%) | ||||
| All Participants | White | 309 (42.6) | 307 (46.5) | 315 (45.7) | 384 (51.9) | 2.72 (1.10, 4.34) | .001 |
| Asian | 180 (24.8) | 150 (22.8) | 173 (25.1) | 228 (30.8) | 2.03 (0.61, 3.45) | .005 | |
| Decline to State | 172 (23.7) | 93 (14.1) | 94 (13.6) | 25 (3.4) | -6.19 (-7.31, -5.07) | <.001 | |
| Hispanic/Latinx | 28 (3.9) | 40 (6.1) | 52 (7.6) | 61 (8.2) | 1.46 (0.66, 2.26) | <.001 | |
| 2 or More | 22 (3) | 47 (7) | 34 (5) | 16 (2.2) | -0.47 (-1.12, 0.18) | .159 | |
| Black/African American | 15 (2) | 20 (3.1) | 20 (2.9) | 27 (3.6) | 0.46 (-0.09, 1.01) | .096 | |
| American Indian/Alaskan Native | 0 (0) | 0 (0) | 0 (0) | 0 (0) | – | – | |
| Native Hawaiian/Pacific Islander | 0 (0) | 0 (0) | 0 (0) | 0 (0) | – | – | |
| All URiMs | 43 (5.9) | 61 (9.2) | 72 (10.5) | 87 (11.8) | 1.87 (0.92, 2.82) | <.001 | |
| Matched Participants | White | 220 (47.1) | 257 (55.6) | 219 (46.1) | 265 (54.7) | 1.60 (-0.40, 3.60) | .117 |
| Asian | 126 (27) | 58 (12.6) | 127 (26.7) | 137 (28.4) | 1.93 (0.23, 3.60) | .026 | |
| Decline to State | 84 (18) | 68 (14.8) | 62 (13.1) | 16 (3.4) | -4.49 (-5.80, -3.18) | <.001 | |
| Hispanic/Latinx | 14 (3) | 28 (6) | 36 (7.5) | 38 (7.8) | 1.62 (0.66, 2.58) | <.001 | |
| 2 or More | 14 (3) | 36 (7.9) | 25 (5.3) | 13 (2.7) | -0.33 (-1.2, 0.51) | .441 | |
| Black/African American | 9 (1.9) | 13 (2.9) | 7 (1.4) | 15 (3) | 0.23 (-0.37, 0.83) | .452 | |
| American Indian/Alaskan Native | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | – | – | |
| Native Hawaiian/Pacific Islander | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | – | – | |
| All URiMs | 23 (4.9) | 41 (8.9) | 42 (8.9) | 52 (10.8) | 1.77 (0.66, 2.88) | .002 |
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