Female Surgical Applicants Not Equivalent to Med School Graduates

In a recent analysis, investigators see the percentage of female surgical applicants over the last decade is not equivalent to female medical school graduates.

Krystina Choinski, MD, and a team of investigators examined the trends in sex and racial/ethnic diversity of the applicant pool to US surgical residency and fellowship programs over the last decade. The team collected applicant and US medical school graduating class demographics from the Electronic Residency Application Service database and Association of American Medical College records. Also included were Accreditation Council for Graduate Medical Education-accredited surgical residencies and fellowships from January 2008-December 2018.

The investigators collected the number of males, females, and total applicants and graduates in each surgical specialty and graduating class. Self-reported data on race and ethnicity were categorized by Asian, black/African American, Hispanic, white, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, other, and unknown.

Overall, the percentage of US female medical graduates stayed stable, from 46% in 2008 to 47% in 2018 (P <.001). Some surgical residency programs saw an increase in female applicants, including integrated thoracic surgery (13% to 27%; P <.001), integrated vascular surgery (16% to 27%; P <.001), categorical general surgery (27% to 38%; P <.001), and urology (24% to 28%; P=.03) programs. There was still a low number of female applicants to orthopedics (14% to 16%; P=.003). Choinski and the team saw that there was no decrease in female applicants in any surgical residency program from 2008-2018.

When the team looked at fellowship programs, there was an increase in the percentage of female applicants to colorectal (28% to 44%; P=.03) and pediatric surgery (50% to 54%; P=.002). The investigators did not see the trend as significant for female applicants for vascular (18% to 30%; P=.09), thoracic (13% to 26%; P=.06), and plastic surgery fellowships (32% to 39%; P=.08).

Among the data collected on US medical school graduating classes, the investigators noted a significant increase in Asian (22% to 24%; P=.02) and Hispanic (8% to 9%; P <.001) graduates. What’s more, there was a decrease in black (7 % to 6.5%; P <.001) and white (68% to 62%; P <.001) graduates. For specialties, there was no significant change in Hispanic and black applicants, while there was a decrease in the percentage of Asian applicants to surgical residency and fellowship programs.

The study authors noted the representation of women and minority populations has been historically low in surgery. In fact, in 1964, 93% of all US medical students were male and 97% were non-Hispanic white. Women only began being recognized in surgery in the late 20th century. Now, women make up <25% of multiple surgical specialties.

Although there is an increase in diversity among US medical school graduates, the raise did not translate to increased diversity in the surgical training program applicant pool, Choinski and the team found. The increase in female medical students was outpaced by the increase in applicants to surgical training programs. Only pediatric and colorectal specialties saw an equivalent number of applicants to graduates.

To address this, there could be more recruitment strategies, which could be investigated in future research. It is also important to address the potential barriers of medical students.

The study, “Trends in Sex and Racial/Ethnic Diversity in Applicants to Surgery Residency and Fellowship Programs,” was published online in JAMA Surgery.