Ophthalmology Fellowship Match Rates Differ by Underrepresented in Medicine Status

Fasika Woreta, MD, MPH

Credit: Johns Hopkins University

Subspecialty fellowship match rates in ophthalmology were lower for applicants considered underrepresented in medicine (URiM) than for non-URiM applicants, according to an analysis of the 2021 San Francisco Match.¹

Among more than 500 applicants, study data showed an underrepresentation of female applicants in the retina and glaucoma subspecialty, with racial and ethnic differences identified across all examined subspecialty fellowships.

“These results may provide valuable information to fellowship programs and subspecialty societies that are striving to increase representation and diversity,” wrote the investigative team, led by Fasika Woreta, MD, MPH, of the Wilmer Eye Institute at Johns Hopkins University.¹

In medicine, URiM is used to describe individuals who identify as Black, Hispanic, Native Hawaiian, Native American, or multiracial. Across specialties, ophthalmology has reportedly the second-lowest number of URiM residents, and the percentage of female residents has also experienced a decrease in the past decade.

Woreta and colleagues indicate these trends are in opposition to the increasing proportion of females and URiM students in medical schools in the US, as well as the changing racial and ethnic makeup of the wider US population.

Importantly, there is a lack of knowledge on the state of diversity in ophthalmology fellowships in the US. Using data from the 2021 San Francisco Match, investigators examined sex, racial, and ethnic diversity among ophthalmology subspecialty fellowship applications, assessed match rates, and determined the factors associated with successful matching.

For the purpose of analysis, applicant characteristics were stratified by sex and URiM status and compared using X2, Mann-Whitney U, or median tests for categorical and continuous variables, respectively. The team calculated the percentage of female and URiM applicants who successfully matched into each specialty; a multivariable logistic regression was used to assess the association of these characteristics and the match outcome.

A total of 537 candidates applied for an ophthalmology subspecialty fellowship in 2021. Of this application population, 224 applicants (42.6%) were female and 60 applicants (12.9%) had URiM status.

Female applicants showed a higher median (IQR) US Medical Licensing Examination (USMLE) Step 2 Clinic Knowledge score than their male counterparts (248 vs. 245; P = .01). However, match rates for female and male applicants were shown to be very similar (70.5% [n = 158] and 69.2% [n = 209], respectively; P = .74).

Upon analysis, pediatric ophthalmology was observed to have the highest percentage of female-matched applicants (67.5%; 27 of 40). Meanwhile, male applicants made up most of the matched applicants in the retina specialty (68.9%; 84 of 122).

Overall, URiM applicants showed lower match rates (55.0%, n = 33) than non-URiM applicants (72.2%, n = 293; P = .007). In addition, URiM applicants had lower median scores on the USMLE Step 1 (IQR, 238), compared with Asian (IQR, 246) and White applicants (IQR, 243; P = .04).

Investigators also found URiM applicants submitted fewer applications (IQR, 10) compared with Asian (IQR, 21) and White (IQR, 17; P = .001) applicants, as well as completed fewer interviews (IQR, 2) than Asian (IQR, 12) and White applicants (IQR, 8; P = .001). Among those matched in each subspecialty, URiM applicants comprised 13.9% (11 of 79) of glaucoma fellowships, 10% (4 of 40) in pediatric ophthalmology, 7.3% (6 of 82) in cornea, and 6.6% (8 of 122) in retina.

In an accompanying editorial, Jayanth Sridhar, MD, of the Bascom Palmer Eye Institute, noted the first step to addressing disparities is to understand the current makeup of diversity in ophthalmic subspecialties.² From there, the eye care field can work to address overall diversity, particularly in subspecialties that lack diverse representation, including surgical retina and cornea.

“Based on the data presented, the issue may not be that URiM residents are unsuccessful in obtaining fellowship positions once they apply (as all 14 candidates matched), but rather may be a shortage of URiM candidates applying in the first place,” Sridhar wrote.²

References

1. Ali M, Menard M, Zafar S, Williams BK, Knight OJ, Woreta FA. Sex and Racial and Ethnic Diversity Among Ophthalmology Subspecialty Fellowship Applicants. JAMA Ophthalmol. Published online August 31, 2023. doi:10.1001/jamaophthalmol.2023.3853
2. Sridhar J, Cavuoto KM. Swimming Upstream—Why Diversity in Ophthalmology Subspecialists Matters. JAMA Ophthalmol. Published online August 31, 2023. doi:10.1001/jamaophthalmol.2023.4045