Diversity and Career Goals of Graduating Allopathic Medical Students Pursuing Careers in Dermatology

Abstract

ImportanceDermatology is one of the least diverse specialties, while patients from minority racial and ethnic groups and other underserved populations continue to face numerous dermatology-specific health and health care access disparities in the US.ObjectivesTo examine the demographic characteristics and intended career goals of graduating US allopathic medical students pursuing careers in dermatology compared with those pursuing other specialties and whether these differ by sex, race and ethnicity, and/or sexual orientation.Design, Setting, and ParticipantsThis secondary analysis of a repeated cross-sectional study included 58 077 graduating allopathic medical students using data from the 2016 to 2019 Association of American Medical Colleges Graduation Questionnaires.Main Outcomes and MeasuresThe proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology vs pursuing other specialties. The proportions and multivariable-adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties and by sex, race and ethnicity, and sexual orientation among students pursuing dermatology.ResultsA total of 58 077 graduating students were included, with 28 489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students. Female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27 660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). In multivariable-adjusted analyses, students pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56 343 [34.0%]; adjusted odd ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001), practice in underserved areas (172 [12.7%] vs 14 570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001), and practice public health (230 [17.0%] vs 17 028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001) but increased odds of pursuing research (874 [64.7%] vs 29 121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers. Among students pursuing dermatology, female, URM, and SM identities were independently associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31). URM students compared with non-URM students pursuing dermatology had increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students compared with heterosexual students pursuing dermatology had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98).Conclusions and RelevanceThe findings of this cross-sectional study suggest that diversity gaps continue to exist in the dermatology workforce pipeline. Efforts are needed to increase racial and ethnic and sexual orientation diversity and interest in careers focused on underserved care and public health among students pursuing dermatology.

Contextualizing the Landscape of Diversity, Equity, and Inclusion in Dermatology

“…In the Gao et al study, 11.2% of those pursuing dermatology identified as URM individuals compared with an average of 6.1% who matriculated in medical school as reported by Williams et al Approximately 7.4% of dermatology faculty identify as URM compared with nearly 37% of the US population . The paucity of racial and ethnic diversity in medicine, especially for Black or African American individuals, can be traced to the Flexner report of 1910, which prompted the closure of 5 of 7 Black medical schools.…”

“…This had ramifications on health care delivery by restricting medical training to predominantly upper-class, White, male individuals. A century after the Flexner report, the physician workforce remains disproportionately upper class and White …”

“…In this issue of JAMA Dermatology , cross-sectional studies by Gao et al and Williams et al examine diversity among medical students pursuing dermatology and their career goals. Per Gao et al, individuals who identified as underrepresented in medicine (URM) (including Black or African American, Hispanic or Latino, American Indian or Alaska Native) and sexual minority groups were less likely to pursue careers in dermatology.…”

“…In this issue of JAMA Dermatology , cross-sectional studies by Gao et al and Williams et al examine diversity among medical students pursuing dermatology and their career goals. Per Gao et al, individuals who identified as underrepresented in medicine (URM) (including Black or African American, Hispanic or Latino, American Indian or Alaska Native) and sexual minority groups were less likely to pursue careers in dermatology. Per Williams et al, among those who pursue dermatology, there has been only a gradual increase in the proportions of URM students who matriculated in the past 15 years compared with non-URM students, although the absolute number of students remains low.…”

“…Per Williams et al, among those who pursue dermatology, there has been only a gradual increase in the proportions of URM students who matriculated in the past 15 years compared with non-URM students, although the absolute number of students remains low. Taken together, these articles are meaningful in providing both cross-sectional (Gao et al) and longitudinal views (Williams et al) of trends that are concerning for the future of the field, not least of which are the well-established benefits of diversity as pointed out by Williams et al and the fact that URM individuals, sexual and gender minority (SGM) individuals, or female students are more likely to pursue careers of public health and the underserved …”