Diversity Trends Among Dermatology Resident Trainees Remain Stagnant, Worse Compared With Other Specialties

Black and Latinx resident trainees were shown to be less represented in dermatology vs other specialties, with diversity trends remaining stagnant over the past 15 years, according to study findings published yesterday in JAMA Dermatology.

Disparities can be attributed to the “leaky pipeline,” said researchers, which is the disproportionate, stepwise reduction in racial and ethnic minority representation along the path to medicine.

Cited as the second-least diverse specialty, the field of dermatology has received calls in recent years to increase diversity among both trainees and patients included in clinical trials. Despite efforts by the FDA that aimed to support industry efforts at improving diversity in clinical trials, a recent study showed that inclusion of minority groups in dermatology clinical trials has remained unchanged over the past decade.

A retrospective, cross-sectional study was conducted to examine racial and ethnic diversity trends among dermatology resident trainees and applicants compared with other specialties.

The study assessed data from a special report by the Association of American Medical Colleges of trainees’ and applicants’ self-reported race and ethnicity by specialty from 2005 to 2020.

Ideal representation was defined as being proportionate to the US population, “because of the well-established benefits of achieving a physician work force reflective of patient diversity (eg, improved patient outcomes and satisfaction, heightened attention to mitigating disparities, and increased practice in underserved settings).”

A total of 851 and 1170 applicants from 2005 and 2019, respectively, were included, along with 342 and 456 matriculating trainees (postgraduate year [PGY]-2s) from 2006 and 2020, respectively.

Findings showed that Black and Latinx trainees were less represented in dermatology than in other specialties (mean [SD] annual rate ratio [RR]: Black trainees, dermatology, 0.32 [0.04]; primary care, 0.54 [0.04]; P < .001; specialty care, 0.39 [0.02]; P < .001; Latinx trainees, dermatology, 0.14 [0.09]; primary care, 0.23 [0.08]; P < .01; specialty care, 0.18 [0.07]; P = .14).

Moreover, the annual representation of Black trainees remained unchanged between 2005 and 2020 in dermatology (regression-coefficient, β = −0.001; P = .66), but down-trended for primary (β = −0.008; P < .001) and specialty care (β = −0.004; P = .001). The representation of Latinx trainees also remained unchanged between 2005 and 2020 in dermatology (β = −0.003; P = .61) and specialty care (β = 0.005; P = .24), but increased in primary care (β = 0.013; P < .001).

The proportions of each racial and ethnic demographic among dermatology residency applicants and matriculating trainees from 2005 to 2020 further showed that Black and Latinx race and ethnicity comprised a lower mean proportion of PGY-2s compared with applicants annually (Black, 4.01% [1.09%] vs 5.97% [0.69%]; P < .001; Latinx, 2.06% [1.47%] vs 6.37% [1.62%]; P < .001).

The mean proportion of White race among PGY-2 trainees was conversely larger than that of applicants annually (65.09% [3.91%] vs 51.71% [2.89%]; P < .001). Asian race was indicated to be represented proportionately across PGY-2s and applicants (19.26% [1.84%] vs 19.21% [1.77%]; P = .93).

Responding to these results, the study authors emphasized the need for dermatologists to intervene throughout the educational pipeline, including residency selection and mentorship, to effectively increase diversity.

“Dermatologists committed to increasing workforce diversity can advocate for equitable school policies and mentor underrepresented students of all ages to promote interest in dermatology and advancement throughout the educational pathway,” they added.

Reference

Williams JC, Valladares HC, Waul MA, Pandya AG, Mathes E, Amerson EH. 15-year diversity trends among dermatology resident trainees compared with other specialties. JAMA Dermatol. Published online November 16, 2022. doi:10.1001/jamadermatol.2022.4991