Disparities in surgery: Women, residents from minority groups have higher rates of attrition

Female residents and trainees from underrepresented minorities have substantially higher rates of attrition in surgical subspecialties, according to a new study.

More women are entering surgical fields, but they also have a higher risk of attrition. And the percentage of residents from minority groups remained essentially flat over an 18-year span, researchers found. The findings were published Feb. 8 in Jama Surgery.

“These results highlight current racial and sex disparities in resident attrition and demonstrate the importance of developing strategies to recruit, retain, and support residents,” the researchers wrote.

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Some specialty groups are especially lagging in diversity, and have very wide gender gaps, the study found.

Healthcare leaders will likely find the disparity in attrition rates to be particularly troubling, as the industry continues to look at a physician shortage that could worsen in the coming years.

Researchers also point out that improving diversity will lead to better medical care.

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Attrition

The researchers examined data on residency programs from the Association of American Medical Colleges from 2001 through 2018. The overall rate of attrition among residents of all ethnicities was 6.9%.

The rate of attrition for residents from minority groups among all surgical specialties was 9.0%. Black residents had the highest rate of attrition (10.6%), while white residents had the lowest rate in attrition (6.2%).

Researchers pointed out that even though Black residents accounted for only 6.3% of all surgical residents, they represented 9.6% of all residents experiencing attrition. Black residents also made up 14.4% of all residents who were dismissed.

“This magnitude of disparity raises significant concern about the training environment of surgical residencies and what factors are contributing to this disproportionate rate,” researchers wrote.

Women had a 7.5% rate of attrition, compared to an attrition rate of 6.5% for men.

Neurosurgery had the highest rate of resident attrition (10.4%), the study found. It’s also one of the most male-dominated specialties.

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Diversity

Residents from underrepresented minority groups accounted for 14.9% of all surgical trainees from 2001 to 2018, and actually decreased 2% over the study period.

More women entered surgical specialties. The number of female trainees rose from 31.5% in 2001 to 43.1% in 2018.

The gender gap in surgical specialties remains problematic, since women account for more than half of all medical students, the researchers wrote.

Orthopedic surgery was the least diverse field, the study found. About three out of four residents (74.5%) were white, the highest percentage in the study.

There’s also a big gender gap in orthopedics, with women making up only 12.9% of trainees. Neurosurgery came just behind, as women accounted for only 15% of residents during the study period.

The study found women making substantial gains - increases over 100%  - in a few areas, including urology, integrated vascular surgery, otolaryngology, and thoracic surgery.

OB-GYN had the highest percentage of Black residents (10.9%) and Hispanic residents (4.8%). Otolaryngology had the highest percentage increase in trainees from minority groups (33%).

The lack of diversity in some surgical areas becomes cyclical in some respects, the study suggests. With few members of minority groups in some specialties, residents must face the rigors of medical training with “an absence of peers, mentors or identifiable figures,” the authors wrote.

The researchers wrote that retaining more women and residents from minority groups is critical to giving patients better care, closing disparities, and developing more trust in doctors.

“Physicians of minoritized groups are also more likely to practice in underserved communities,” the authors wrote. “To better serve our patients, the need to recruit and retain underrepresented minorities and women is paramount.”