Trends in Underrepresented Race and Ethnicity Among Internal Medicine-Pediatrics Residents and Related Specialties: 2005-2020

TL;DR

This study examines how the representation of underrepresented racial and ethnic groups in internal medicine-pediatrics and related specialties has changed from 2005 to 2020.

Contribution

The study provides new insights into trends of underrepresented minorities in med-peds residencies compared to related fields and the general US population.

Findings

There was a significant increase in underrepresented minority (URiM) residents in med-peds, FM, IM, and pediatrics from 2005 to 2020.

Hispanic representation in med-peds increased significantly, while African American representation decreased slightly.

URiM representation in med-peds remained below that of related specialties and the US population.

Abstract

Background

Increased diversity of race and ethnicity in internal medicine-pediatrics (med-peds) and related specialties may improve health disparities in the United States (US). Family medicine (FM), internal medicine (IM), and pediatric residencies have demonstrated variable and inconsistent trends in the representation of underrepresented minorities in medicine (URiM), but information about URiM med-peds trainees is limited. The primary aim was to compare trends in URiM representation from 2005 to 2020 among US med-peds residents to FM, IM, and pediatrics. The secondary aim was to compare these trends to the US population.

Methods

Self-reported race and ethnicity data was obtained from annual graduate medical education census reports and the US Census Bureau. A cross-sectional analysis of African American/Black (AA), American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, and Hispanic representation among the US population and med-peds, FM, IM, and pediatric residents was performed. Trends in proportions of URiM representation among residents and the US population were evaluated using the Cochran-Armitage test.

Results

There was a significant positive trend in the proportion of total URiM residents in med-peds (11.0% (n = 156) to 15.1% (n = 226), p = 0.01), FM (16.5% (n = 1,550) to 18.7% (n = 2,565), p = 0.04), IM (12.3% (n = 2,688) to 15.5% (n = 4,455), p < 0.001), and pediatrics (14.9% (n = 1,187) to 18.4% (n = 1,670), p < 0.001). Total URiM med-peds representation remained below other specialties throughout the study. Med-peds residencies demonstrated a significant positive trend in Hispanic representation (3.3% (n = 47) to 7.7% (n = 116), p < 0.001) and a significant negative trend in AA representation (6.9% (n = 98) to 7.1% (n = 107), p = 0.01). Total URiM representation remained below the US population for all specialties throughout the study.

Conclusion

The total proportion of URiM med-peds, FM, IM, and pediatric residents improved. For med-peds, this improvement was largely due to increased Hispanic resident representation. However, URiM med-peds resident representation is consistently below related specialties. URiM resident representation in med-peds and related specialties poorly reflects the diversity of the US population and should be urgently addressed.

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