Study underscores racial disparities in US residency training programs
The proportion of Black and Hispanic OB/GYN residents was higher than those in surgical and nonsurgical specialties, a cross-sectional study showed.
However, the overall proportion of Black OB/GYN residents dropped and the proportion of Hispanic and Native American or Alaska Native OB-GYN residents remained unchanged during the same period.
“There are drastic disparities in health outcomes for minority women within OB/GYN,” Claudia López, MD, an obstetrics and gynecology resident at University of California, Davis, told Healio Primary Care. “Since one way to address these disparities is to increase diversity within the OB/GYN workforce, we wanted to assess our current demographics among trainees, how we compare with other medical specialties and how our workforce reflects our patient population.”
López and colleagues analyzed data from 520,116 OB/GYN, surgical and nonsurgical residents from the JAMA Medical Education reports from 2014 to 2019, when “multiracial” first appeared as a racial category. They combined Native Hawaiian or Pacific Islander with Native American or Alaskan Native into a single category (“Native”), given the small number of residents. They also separated Hispanic ethnicity from race.
The researchers reported that for each year, OB/GYN, surgical and nonsurgical residents most commonly identified as white. For example, from 2014 to 2015, 59.5% of residents identified as white, followed by 26.6% who identified as Asian (26.6%). Native residents were the least represented across all residency categories, making up 0.3% from 2014 to 2015.
The researchers found that the racial and ethnic composition of residents varied across specialties. For example, in 2014 to 2015, there were higher proportions of Black (10.2%; P < .001) and Hispanic OB/GYN residents (9.6%; P < .001) compared with Black (4.7%; P < .001) and Hispanic surgical residents 7%; P < .001) and Black (5.8%; P < .001) and Hispanic nonsurgical residents (7.6%; P < .001). These trends held steady through 2019, according to the researchers.
Across the 5-year study period, the researchers found a decrease in the number of white (OR = 0.96; 95% CI, 0.94-0.98) and Black OB/GYN residents (OR = 0.93; 95% CI, 0.9-0.96) and an increase among those classified as other or unknown race/ethnicity (OR = 1.26; 95% CI, 1.22-1.31). Similarly, among surgical residents, there were declines in white (OR = 0.97; 95% CI, 0.97-0.98) and Black residents (OR = 0.97; 95% CI, 0.95-0.99) and increases in multiracial (OR = 1.04; 95% CI, 1.02-1.07) and other or unknown residents (OR = 1.14; 95% CI, 1.12-1.16). Among nonsurgical residents, there was also a decrease in white (OR = 0.97; 95% CI, 0.96-0.97) and Asian residents (OR = 0.98; 95% CI, 0.97-0.98), whereas there was an increase in multiracial residents (OR = 1.07; 95% CI, 1.06-1.08), other or unknown residents (OR = 1.17; 95% CI, 1.16-1.18), and Hispanic residents (OR = 1.02; 95% CI, 1.02-1.03).
“Despite the overall larger proportions of Black and Hispanic residents in OB/GYN, the larger trends of stagnant or decreasing rates of underrepresented minority residents are concerning, indicating that we need to do more work to recruit and retain these residents,” López said.
In an editorial published alongside the study, Brian T. Nguyen, MD, MSc, an assistant professor of clinical obstetrics and gynecology at the University of Southern California Keck School of Medicine, and colleagues wrote that the findings reflect “a failure of the medical education system to adapt to the changing demographic needs of its patients and cultivate diversity within the academic pipeline.”