ABSTRACT
Objective
To examine the historical trends and factors underlying the current state of racial/ethnic
representation within the urology workforce at each stage of the educational pipeline.
Methods
Using data from the US Census Bureau and the Association of American Medical Colleges,
trends in racial/ethnic distribution for 2007−2008 to 2019−2020 were tracked in the
educational pipeline for academic urologists. This pipeline was defined as progressively
diminishing cohorts, starting with the US population, leading to medical school application,
acceptance, and graduation, through to urology residency application, matching, and
graduation, and ending with urology faculty appointment. A comparative cohort analysis
was performed for academic year 2018−2019 for differences in racial/ethnic distribution
across cohorts by binomial tests.
Results
From 2007−2008 to 2019−2020, while the proportion of Latinx/Hispanic urology applicants
increased by 0.38% per year (95% CI 0.24, 0.52), their proportion in the urology resident
population remained unchanged (0.07% per year, 95% CI -0.20, 0.06) from 2011−2012
to 2019−2020. There was a decrease in the proportion of Black urology applicants (−0.13%
per year, 95% CI −0.24, −0.02) and no change in the resident population (−0.03% per
year, 95% CI −0.11, 0.05), despite an increase in total number of residents (n = 1043 to n = 1734) from 2009−2010 to 2019−2020. In 2018−2019, there were step-wise decreases
in proportion of Black and Latinx/Hispanic members represented at critical stages
of the educational pipeline (P <0.0001).
Conclusion
Attrition in URM urologists occur at key educational stages. This paper offers opportunities
for the design of interventions to diversify the urology workforce.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity CDC. Accessed 15 March 2021. Available at:https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
- Physician race and care of minority and medically indigent patients.JAMA. 1995; 273: 1515-1520
- The role of black and Hispanic physicians in providing health care for underserved populations.N Engl J Med. 1996; 334: 1305-1310
- Patient-centered communication, ratings of care, and concordance of patient and physician race.Ann Intern Med. 2003; 139: 907-915https://doi.org/10.7326/0003-4819-139-11-200312020-00009
- The case for diversity in the health care workforce.Health Aff. 2002; 21: 90-102https://doi.org/10.1377/hlthaff.21.5.90
- Race, gender, and partnership in the patient-physician relationship.JAMA. 1999; 282: 583-589https://doi.org/10.1001/jama.282.6.583
- Patient-physician racial concordance associated with improved healthcare use and lower healthcare expenditures in minority populations.J Racial Ethn Heal Disparities. 2021; https://doi.org/10.1007/s40615-020-00930-4
- Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050.1992
- Inequalities in racial access to health care [1](multiple letters).J Am Med Assoc. 2000; 284: 2053
- Racial and ethnic disparities in the quality of health care.Annu Rev Public Health. 2016; 37: 375-394https://doi.org/10.1146/annurev-publhealth-032315-021439
- Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.J Am Coll Surg. 2013; 216 (Epub 2013 Jan 11. PMID: 23318117; PMCID: PMC5995336): 482-492https://doi.org/10.1016/j.jamcollsurg.2012.11.014
- Differential access to care: the role of age, insurance, and income on race/ethnicity-related disparities in adult perforated appendix admission rates.Surg (United States). 2016; 160: 1145-1154https://doi.org/10.1016/j.surg.2016.06.002
- Student body racial and ethnic composition and diversity-related outcomes in US medical schools.JAMA. 2008; 300: 1135-1145https://doi.org/10.1001/jama.300.10.1135
- Physician-patient racial concordance and disparities in birthing mortality for newborns.Proc Natl Acad Sci U S A. 2020; 117: 21194-21200https://doi.org/10.1073/pnas.1913405117
Underrepresented in Medicine Definition AAMC. Accessed 17 January 2021. Available at: https://www.aamc.org/what-we-do/diversity-inclusion/underrepresented-in-medicine
- The State of the Urology Workforce and Practice in the United States.2019: 5 (Available at:)
- Gender and racial disparities in early urology exposures during medical school.Urol Pract. 2019; 6: 129-134https://doi.org/10.1016/j.urpr.2018.06.001
- Assessing the female and underrepresented minority medical student experience in the urology match: where do we fall short?.Urology. 2021; 147: 57-63https://doi.org/10.1016/j.urology.2020.08.076
- Examining trends in underrepresented minorities in urology residency.Urology. 2019; 127: 36-41https://doi.org/10.1016/j.urology.2018.10.061
- Racial distribution of urology workforce in United States in comparison to general population.Transl Androl Urol. 2018; 7: 526-534https://doi.org/10.21037/tau.2018.05.16
- Strategies for attracting women and underrepresented minorities in urology.Curr Urol Rep. 2019; 20 (PMID: 31478091): 61https://doi.org/10.1007/s11934-019-0921-5
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.PLoS Med. 2007; 4: e296https://doi.org/10.1371/journal.pmed.0040296
Digest of Education Statistics-Most Current Digest Tables. Accessed 17 June 2021. Available at: https://nces.ed.gov/programs/digest/current_tables.asp
AAMC Applicant Matriculant Data File and AAMC Data Warehouse, STUDENT_IND and IND_IDENT tables as of August 31 2020. No Title.
ACGME Data Resource Book. Accessed 2 February 2021. Available at: https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book
Table 12. Practice Specialty, Females by Race/Ethnicity, 2018 AAMC. Accessed 13 April 2021. Available at: https://www.aamc.org/data-reports/workforce/data/table-12-practice-specialty-females-race/ethnicity-2018
Table 13. Practice Specialty, Males by Race/Ethnicity, 2018 AAMC. Accessed 13 April 2021. Available at: https://www.aamc.org/data-reports/workforce/data/table-13-practice-specialty-males-race/ethnicity-2018
- Science achievement gaps begin very early, persist, and are largely explained by modifiable factors LK -.Educ Res TA - TT -. 2016; 45: 18-35
Medical Association A. HOD ACTION: Council on Medical Education Report 6 Adopted and the Remainder of the Report Filed. REPORT OF THE COUNCIL ON MEDICAL EDUCATION laid a framework for a reconsideration of how diversity can be considered in the context of recruitment and retention of medical students. 2 based on these decisions, medical schools could.
- Board Statement on Diversity, Equity, and Inclusive Excellence.Published 2013 (Available at:)https://www.aacu.org/about/statements/2013/diversityDate accessed: March 17, 2021
- The continued decline of formal urological education of medical students in the United States: does it matter?.J Urol. 2006; 175: 2243-2248https://doi.org/10.1016/S0022-5347(06)00314-4
- The current status of medical student urological education in the United States.J Urol. 2008; 179: 1087-1091https://doi.org/10.1016/j.juro.2007.10.068
- An update on the current status of medical student urology education in the United States.Urology. 2014; 84: 743-747https://doi.org/10.1016/j.urology.2014.06.003
- Increasing resident diversity in an emergency medicine residency program: a pilot intervention with three principal strategies.Acad Med. 2016; 91: 958-961https://doi.org/10.1097/ACM.0000000000000957
- Leading from the front: an approach to increasing racial and ethnic diversity in surgical training programs.Ann Surg. 2019; 269: 1012-1015https://doi.org/10.1097/SLA.0000000000003197
- Trends in race/ethnicity among applicants and matriculants to US surgical specialties, 2010-2018.JAMA Netw open. 2020; 3e2023509https://doi.org/10.1001/jamanetworkopen.2020.23509
- Mentorship and pursuit of academic medicine careers: amixed methods study of residents from diverse backgrounds.BMC Med Educ. 2014; 14 (PMID: 24512599; PMCID: PMC3922304): 26https://doi.org/10.1186/1472-6920-14-26
- Reversing the decline in urology residency applications: an analysis of medical school factors critical to maintaining student interest.Urology. 2020; 136: 51-57https://doi.org/10.1016/j.urology.2019.10.028
- Racial disparities in medical student membership in the alpha omega alpha honor society.JAMA Intern Med. 2017; 177: 659-665https://doi.org/10.1001/jamainternmed.2016.9623
- Can better selection tools help us achieve our diversity goals in postgraduate medical education? Comparing use of USMLE step 1 scores and situational judgment tests at 7 surgical residencies.Acad Med. 2020; 95: 751-757https://doi.org/10.1097/ACM.0000000000003092
- Prevalence and predictors of US medical graduates’ federal F32, mentored-K, and R01 awards: anational cohort study.J Investig Med. 2018; 66: 340-350https://doi.org/10.1136/jim-2017-000515
- Minority faculty development programs and underrepresented minority faculty representation at US Medical Schools.JAMA - J Am Med Assoc. 2013; 310: 2297-2304https://doi.org/10.1001/jama.2013.282116
- The majority subsidy.Ann Intern Med. 2019; 171: 845-846https://doi.org/10.7326/M19-1923
- Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace.JAMA Netw open. 2018; 1e182723https://doi.org/10.1001/jamanetworkopen.2018.2723
- A novel approach to fostering diversity in graduate medical education: chief residents for diversity and inclusion.Acad Psychiatry. 2019; 43: 344-345https://doi.org/10.1007/s40596-019-01055-5
- Development of professionalism in graduate medical education: a case-based educational approach from the College of American Pathologists’ Graduate Medical Education Committee.Acad Pathol. 2018; 52374289518773493https://doi.org/10.1177/2374289518773493
Article info
Publication history
Published online: August 29, 2021
Accepted:
July 29,
2021
Received:
April 16,
2021
Footnotes
Financial Disclosure: The authors have no disclosures relevant to this work.
Ethical approval: Institutional Review Board (IRB) exemption was obtained at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).
Funding Support: The authors gratefully acknowledge the critical funding support of the Office of the Vice Dean for Education and the Executive Director of the David Geffen School of Medicine (DGSOM) at UCLA Anti-racism Roadmap. This funding supported the purchase of data from the AAMC. Supplemental funds to support data analysis was provided by the Department of Urology at DGSOM at UCLA.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
