DEI in U.S. anesthesiology residency programs
Myron Yaster MD, Alan Jay Schwartz MD, MSEd, and Odinakachukwu Ehie, MD, FASA
When I (MY) entered SUNY Downstate medical school in 1973, my class of 220 had approximately 20 women, which at the time was amongst the highest number and percentages of women in medical school in the United States. Today, with almost half of all medical school graduates being women, so much has changed or has it? In today’s PAAD, Sumarli et al.1 used data from the Electronic Residency Application Service (ERAS) system between 2011-2022, stratified applicants by self-reported gender, race, and ethnicity to compare these numbers to acceptances to residency using data obtained from the Accreditation Counsel of Graduate Medical Education (ACGME) databases. The authors wondered how did women as well as racial and ethnic minoritized applicants do in anesthesiology residency acceptances?
For those of you who are outside of the United States, the national resident matching program (“the match”) is a program to fill residency positions. In essence, after applying to and interviewing with programs, applicants and programs rank each other through a blinded process. A computer program analyzes the ranked-order lists and assigns students to open residency spots.
I’ve asked a new member of the PAAD’s executive council Dr. Odinakachukwu (Odi) Ehie to assist. Odi is an Associate Professor of Anesthesia and Perioperative Care, Division of Pediatric Anesthesia, Vice Chair of Diversity, Equity, and Inclusion, Department of Anesthesia and Perioperative Care, University of California, San Francisco. She is also Faculty Director of Student Support, UCSF School of Medicine, Head of Clinical Skills, UC Berkeley - UCSF Joint Medical Program, Vice Chair of Diversity, Equity, and Inclusion Committee, Society of Pediatric Anesthesia, Chair of Global Health Committee, Society of Education in Anesthesia, Immediate Past Chair of Justice, Equity, Diversity, and Inclusion Committee, California Society of Anesthesiologists. Myron Yaster MD
Original article
Sumarli AN, Pineda LS, Vacaru A, Novak E, Brandt Z, Reynoso EE, Applegate RL 2nd, McCabe MD. Diversity, Equity, and Inclusion in US Anesthesiology Residency Matching. Anesth Analg. 2024 Nov 1;139(5):913-920. doi: 10.1213/ANE.0000000000007102. Epub 2024 Aug 19. PMID: 39159255.
“Patient-physician racial and ethnic concordance improves health care utilization, reduces care delays,2,3 and contributes to patients’ perceptions of health care professionals.4 The impact of concordance on anesthesiology outcomes is unknown but potentially similar. In 2023, women accounted for nearly 50% of medical school graduates, 47% of general surgery, and 87% of obstetrics and gynecology residents.5 Despite marginal growth of women anesthesiologists in the last 10 years,6 the number of women in anesthesiology remains lower than medical school proportions in 2023. Similarly, Black, Hispanic or Latino, Native Hawaiian-Pacific Islander (NH-PI), and American Indian-Alaskan Native (AI-AN) physicians are underrepresented in medicine (URiM).7 In 2021 only 6% of full-time academic physicians identified as Black, Hispanic, or Latino, although 31% of the population in the United States is Black, Hispanic, or Latino. In 2018, nearly 12% of medical school graduates and 10% of academic anesthesiologists were considered URiM.8”1
“The aim of this study was to evaluate anesthesiology residency application and match rates among women and URiM applicants using publicly reported information from the Electronic Residency Application Service (ERAS) and the Accreditation Council of Graduate Medical Education (ACGME) Data Resource Books. We hypothesized underrepresentation may result from proportionally fewer women and URiM populations applying or matching into anesthesiology residency.”1
What did they find? “A total of 546,298 residency applicants were identified from the ERAS Statistic Database between 2011 and 2022, including 47,117 (8.62%) anesthesiology residency applicants. Women had lower odds of applying to anesthesiology compared to men overall (OR, 0.55; 95% CI, 0.54–0.56, P < .0001) and maintained significantly lowered odds of applying within each epoch. Women had similar odds of matching into anesthesiology residency compared to men (OR, 1.10; 95% CI, 1.06–1.14, P < .0001). Black, Hispanic or Latino, Asian and NH-PI, and AI-AN applicants had similar odds to White applicants of applying to anesthesiology but odds of matching were significantly lower overall ( P < .0001) for Asian and NH-PI (OR, 0.66; 95% CI, 0.63–0.70), Black (OR, 0.49; 95% CI, 0.45–0.53), Hispanic or Latino (OR, 0.50; 95% CI, 0.46–0.54), and AI-AN (OR, 0.20; 95% CI, 0.15–0.28) applicants. The odds of matching among some minoritized applicants increased in the ACGME 2022 to 2023 report year.”
OK, what does this mean? “From 2011 to 2022, women had lower odds of applying to anesthesiology residency than men yet had similar odds of matching. Racial and ethnic minoritized groups had significantly lower odds of matching compared to White applicants despite similar odds of applying.”
The authors conclude that “their findings highlight disparities in the anesthesiology match and may help identify opportunities to promote workforce diversity within the field. More detailed reporting of gender, race, and ethnicity in annual match data may better define barriers to entry and identify opportunities for improvement.”1
Are these results or the authors' conclusions surprising? For us, they’re not. It’s time to address the reality: structural racism exists at both institutional and departmental levels. A straightforward solution may lie in holding departmental chairs and the deans who appoint them accountable. Just as we rank institutions and departments by their number of federal research grants—driving departments to prioritize recruitment of top researchers—why not also rank them on workforce diversity? Such accountability could be a catalyst for meaningful change in building a more diverse and inclusive environment. After all, isn’t our overall goal health equity - where we strive to achieve equitable representation of medical providers for the communities we serve?
Send your thoughts and comments to Myron who will post in a Friday reader response.
References
1. Sumarli AN, Pineda LS, Vacaru A, et al. Diversity, Equity, and Inclusion in US Anesthesiology Residency Matching. Anesthesia and analgesia 2024;139(5):913-920. (In eng). DOI: 10.1213/ane.0000000000007102.
2. Jetty A, Jabbarpour Y, Pollack J, Huerto R, Woo S, Petterson S. Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations. J Racial Ethn Health Disparities 2022;9(1):68-81. (In eng). DOI: 10.1007/s40615-020-00930-4.
3. Street RL, Jr., O'Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Annals of family medicine 2008;6(3):198-205. (In eng). DOI: 10.1370/afm.821.
4. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Archives of internal medicine 1999;159(9):997-1004. (In eng). DOI: 10.1001/archinte.159.9.997.
5. Mensah MO, Owda D, Ghanney Simons EC, et al. US Postgraduate Trainee Racial, Ethnic, and Gender Representation and Faculty Compensation By Specialty. Jama 2023;330(9):872-874. (In eng). DOI: 10.1001/jama.2023.14139.
6. Bissing MA, Lange EMS, Davila WF, et al. Status of Women in Academic Anesthesiology: A 10-Year Update. Anesthesia and analgesia 2019;128(1):137-143. (In eng). DOI: 10.1213/ane.0000000000003691.
7. Lett E, Murdock HM, Orji WU, Aysola J, Sebro R. Trends in Racial/Ethnic Representation Among US Medical Students. JAMA network open 2019;2(9):e1910490. (In eng). DOI: 10.1001/jamanetworkopen.2019.10490.
8. Toledo P, Lewis CR, Lange EMS. Women and Underrepresented Minorities in Academic Anesthesiology. Anesthesiology clinics 2020;38(2):449-457. (In eng). DOI: 10.1016/j.anclin.2020.01.004.