Low Diversity Shown Among Medical Students Pursuing Dermatology

Racial/ethnic and sexual orientation diversity is lower among female allopathic medical students pursuing careers in dermatology vs other specialties, with low interest in dermatology careers focused on underserved care and public health shown overall. Findings were published in JAMA Dermatology.

Diversity is a longstanding issue in the field of dermatology that pertains to both trainees and patients included in clinical trials. A recent study showed that despite several calls to action to improve these issues, Black and Latinx resident trainees remain less represented in dermatology vs other specialties, with diversity trends stagnant over the past 15 years.

Researchers of the present study note that physicians from minority racial and ethnic groups and other underserved populations, such as sexual minorities (SM) identifying as lesbian, gay, bisexual, and transgender (LGBT), continue to face numerous professional hurdles, many of which are systemic in nature, related to mistreatment, bias, and discrimination.

“A diverse physician workforce has been shown to reduce health care disparities, enhance patient satisfaction, improve population health, reduce health care costs, and improve the well-being of clinicians,” they said.

Seeking to evaluate diversity trends of the dermatology workforce training pipeline, as well as the association of diverse identities with the intended career goals of trainees, the study authors conducted a secondary analysis of a repeated cross-sectional study using data from the 2016 to 2019 Association of American Medical Colleges (AAMC) Graduation Questionnaires (GQs).

Graduating US allopathic medical students pursuing careers in dermatology were compared with those pursuing other specialties on the proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and SM students, as well as whether intended career goals differed by sex, race and ethnicity, and/or sexual orientation.

A total of 58,077 graduating allopathic medical students were examined, of which 28,489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students were included.

Findings indicated that female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27,660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). Conversely, male students pursuing dermatology compared with other specialties were more likely to identify as SM (64 of 532 [12.0%] vs 1997 of 29,056 [6.9%]; P < .001) but did not differ significantly by URM identity.

Multivariable-adjusted analyses further showed distinct differences regarding intended career goals among students pursuing careers in dermatology vs other specialties:

• Decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56,343 [34.0%]; adjusted odds ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001)
• Decreased odds of intending to practice in underserved areas (172 [12.7%] vs 14,570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001)
• Decreased odds of intending to practice public health (230 [17.0%] vs 17,028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001)
• But increased odds of pursuing research (874 [64.7%] vs 29,121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers

Female sex, URM, and SM identities were cited as independent variables among students pursuing dermatology that were associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31).

Among the study cohort of students pursuing dermatology, URM students vs non-URM students reported increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students vs heterosexual students had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98).

Researchers concluded that addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline.

“These efforts may help reduce health disparities faced by underserved populations by increasing the collective engagement of all dermatologists in underserved care and by enriching training and practice environments.”

Reference

Gao Y, Fulk T, Mori W, et al. Diversity and career goals of graduating allopathic medical students pursuing careers in dermatology. JAMA Dermatol. Published online November 16, 2022. doi:10.1001/jamadermatol.2022.4984