Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training

Abstract

BackgroundRacial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows.MethodsNames and photos of graduated fellows for the past 10 years (2012–2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population.ResultsAmong 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons.ConclusionThis study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.

Women in Microsurgery Fellowships: Trends and Impact on Future Practice Patterns

“…This is consistent with a recent study on females pursuing different plastic surgery fellowship training using a similar methodology. 11 It is worth noting that the increase in female-held fellowship positions is primarily attributed to the rise in total fellowship positions, rather than an increase in the proportion of female-held positions. These results do not quite parallel the consistent increase we see in females matching into integrated plastic surgery residencies but instead mimic the lag observed with women in academic plastic surgery (►Fig.…”

“…This is consistent with a recent study on females pursuing different plastic surgery fellowship training using a similar methodology. 11 It is worth noting that the increase in female-held fellowship positions is primarily attributed to the rise in total fellowship positions, rather than an increase in the proportion of female-held positions.…”

“…Currently, despite similar qualifications, women account for 22 percent of faculty members within plastic surgery, 9 percent of plastic surgery chairs, and 13 percent of program directors. [9][10][11] Subspecialty training after initial residency training has been an additional trend observed in United States Medical School Graduates. A recent study by Silvestre et al demonstrated that 61.8 percent of integrated plastic surgery residents pursue fellowship training after residency.…”

Diversity, Equity, and Inclusion in Plastic Surgery

“…Some studies cited an "overrepresentation" of Asians among plastic surgery fellows and authors. 114,122 Noel et al 35 reported that 17% of plastic surgeons are Asian versus 1% of patients. Tolson et al 125 concluded that Whites and Asians are overrepresented in plastic surgery societies and on editorial boards.…”

“…22,60,78,92,125 Photographs available online were reviewed. 22,47,60,[78][79][80]92,114,120,123,125 A judgment was made regarding gender and race based on these photographs.…”