Where is the leak in the surgeon pipeline?

Trends in Race/Ethnicity Among Applicants and Matriculants to US Surgical Specialties, 2010-2018

“…A diverse physician workforce would not only better reflect the increasingly racially/ethnically diverse population of the US but also contribute toward addressing health care disparities, improving patient outcomes and satisfaction, and fostering greater innovation in medicine. 1 , 2 , 3 Despite these observations and numerous initiatives, the percentage of individuals who identify as belonging to racial/ethnic minority groups in medicine has continued to remain below that in the general US population. 4 , 5 For example, in 2019, the percentage of the population who identified as Black or African American, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and Hispanic or Latino was more than 33%, 6 while these same groups constituted approximately 12% of US medical school graduates in the class of 2019, without including those who identified as multiracial.…”

“…Multiple studies have shown that underrepresentation based on race/ethnicity is also specifically present in surgical fields both among trainees and faculty. 3 , 8 , 9 , 10 In response, surgical training programs across the US have engaged in initiatives aimed at increasing the number of individuals underrepresented in medicine (URM) based on the definition by the Association of American Medical Colleges (AAMC) as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” 11 However, the impact of these efforts remains unclear. 12 , 13 , 14 , 15 This study used data from the AAMC to assess trends in the race/ethnicity of applicants and matriculants to surgical specialties between 2010 and 2018.…”

Critically reviewing the policies used by colleges to select doctors for specialty training: A kink in the rural pathway

“…Further, this downplays the value of prevocational doctors who contribute to and are committed to rural areas as doctors that should be included in the college in the first place. The literature notes that surgery's focus on selecting the ‘best’ surgeon is likely to occur at the expense of a diverse workforce that addresses community needs 43,44 . AMC's latest accreditation report for RACS states their ‘disappointment’ (pg 81) at a lack of strategies to increase the intake of trainees from a rural background or Indigenous status 45 .…”

“…The literature notes that surgery's focus on selecting the 'best' surgeon is likely to occur at the expense of a diverse workforce that addresses community needs. 43,44 AMC's latest accreditation report for RACS states their 'disappointment' (pg 81) at a lack of strategies to increase the intake of trainees from a rural background or Indigenous status. 45 Selection to general surgery adds weighting to rural postgraduate experience, though its impact on enrolling rural applicants is unknown.…”

The current state of pediatric transplant hepatology fellowships: A survey of recent graduates

“…It is well known that a diverse physician workforce increases patient satisfaction, improves patient outcomes, helps address health disparities, and broadens perspectives to decrease implicit and explicit bias. [22][23][24][25] Initiatives are underway by SPLIT to engage, recruit, and retain diverse pediatric hepatologists at all levels of training to enact real change and increase the pipeline and opportunities for diverse applicants. Synergistic efforts by the North American Society for Gastroenterology Hepatology and Nutrition Public Affairs and Advocacy Committee to support NIH loan repayment programs for pediatric subspecialists would offset the financial burden and subsequent deterrent of an additional year of specialty training.…”