Despite recent efforts to improve the landscape of diversity, equity, and inclusion in medicine, advances in the field of dermatology have been unremarkable to date, results from two cross-sectional studies recently published in JAMA Dermatology suggest.
To evaluate diversity and career goals of graduating allopathic medical students pursuing careers in dermatology, corresponding author Matthew Mansh, MD, of the department of dermatology at the University of Minnesota, Minneapolis, and colleagues drew from the 2016-2019 Association of American Medical Colleges Graduation Questionnaire for their study. The main outcome measures were the proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology versus those pursuing other specialties, as well as the proportions and multivariable adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties, and by sex, race, and ethnicity, and sexual orientation among students pursuing dermatology.
Of the 58,077 graduating students, 49% were women, 15% were URM, and 6% were SM. The researchers found that women pursuing dermatology were significantly less likely than women pursuing other specialties to identify as URM (11.6% vs. 17.2%; P < .001) or SM (1.9% vs. 5.7%; P < .001).
In multivariable-adjusted analyses of all students, those pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (18.3% vs. 34%; adjusted odd ratio, 0.40; P < .001), practice in underserved areas (12.7% vs. 25.9%; aOR, 0.40; P < .001), and practice public health (17% vs. 30.2%; aOR, 0.44; P < .001). The odds for pursuing research in their careers was greater among those pursuing dermatology (64.7% vs. 51.7%; aOR, 1.76; P < .001).
“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,” the authors concluded. They acknowledged certain limitations of the analysis, including lack of data delineating sex, sex assigned at birth, and gender identity, and lack of intersectional analyses between multiple minority identities and multiple career goals. “Importantly, diversity factors and their relationship to underserved care is likely multidimensional, and many students pursuing dermatology identified with multiple minority identities, highlighting the need for future studies focused on intersectionality,” they wrote.
Trends Over 15 Years
In a separate study, Jazzmin C. Williams, a medical student at the University of California, San Francisco, and coauthors drew from an Association of American Medical Colleges report of trainees’ and applicants’ self-reported race and ethnicity by specialty from 2005 to 2020 to evaluate diversity trends over the 15-year period. They found that Black and Latinx trainees were underrepresented in all specialties, but even more so in dermatology (mean annual rate ratios of 0.32 and 0.14, respectively), compared with those in primary care (mean annual RRs of 0.54 and 0.23) and those in specialty care (mean annual RRs of 0.39 and 0.18).
In other findings, the annual representation of Black trainees remained unchanged in dermatology between 2005 and 2020, but down-trended for primary (P < .001) and specialty care (P = .001). At the same time, representation of Latinx trainees remained unchanged in dermatology and specialty care but increased in primary care (P < .001). Finally, Black and Latinx race and ethnicity comprised a lower mean proportion of matriculating dermatology trainees (postgraduate year-2s) compared with annual dermatology applicants (4.01% vs. 5.97%, respectively, and 2.06% vs. 6.37% among Latinx; P < .001 for all associations).
“Much of these disparities can be attributed to the leaky pipeline – the disproportionate, stepwise reduction in racial and ethnic minority representation along the path to medicine,” the authors wrote. “This leaky pipeline is the direct result of structural racism, which includes, but is not limited to, historical and contemporary economic disinvestment from majority-minority schools, kindergarten through grade 12.” They concluded by stating that “dermatologists must intervene throughout the educational pipeline, including residency selection and mentorship, to effectively increase diversity.”
Solutions to Address Diversity
In an editorial accompanying the two studies published in the same issue of JAMA Dermatology, Ellen N. Pritchett, MD, MPH, of the department of dermatology at Howard University, Washington, and Andrew J. Park, MD, MBA, and Rebecca Vasquez, MD, of the department of dermatology at the University of Texas Southwestern Medical Center, Dallas, offered several solutions to address diversity in the dermatology work force.
Go beyond individual bias in recruitment. “A residency selection framework that meaningfully incorporates diversity, equity, and inclusion (DEI) will require more than strategies that address individual bias,” they wrote. “Departmental recruitment committees must become familiar with systems that serve to perpetuate individual bias, like institutional racism or practices that disproportionately favor non-URM versus URM individuals.”
Challenge the myth of meritocracy. “The inaccurate notion of meritocracy – that success purely derives from individual effort has become the foundation of residency selection,” the authors wrote. “Unfortunately, this view ignores the inequitably distributed sociostructural resources that limit the rewards of individual effort.”
Avoid tokenism in retention strategies. Tokenism, which they defined as “a symbolic addition of members from a marginalized group to give the impression of social inclusiveness and diversity without meaningful incorporation of DEI in the policies, processes, and culture,” can lead to depression, burnout, and attrition, they wrote. They advise leaders of dermatology departments to “review their residency selection framework to ensure that it allows for meaningful representation, inclusion, and equity among trainees and faculty to better support URM individuals at all levels.”
Omar N. Qutub, MD, a Portland, Ore.–based dermatologist who was asked to comment on the studies, characterized the findings by Mansh and colleagues as sobering. “It appears that there is work to do as far as improving diversity in the dermatology workforce that will likely benefit greatly from an honest and steadfast approach to equitable application standards as well as mentorship during all stages of the application process,” such as medical school and residency, said Qutub, who is the director of equity, diversity, and inclusion of the ODAC Dermatology, Aesthetic & Surgical Conference. “With a focused attempt, we are likely to matriculate more racial minorities into our residency programs, maximizing patient outcomes.”
As for the study by Williams and colleagues, he told this news organization that efforts toward recruiting URM students as well as sexual minority students “is likely to not only improve health inequities in underserved areas, but will also enrich the specialty as a whole, allowing for better understanding of our diverse patient population and [for us to] to deliver quality care more readily for people and in areas where the focus has often been limited.”
In an interview, Chesahna Kindred, MD, a Columbia, Md.–based dermatologist and immediate past chair of the National Medical Association dermatology section, pointed out that the number of Black physicians in the United States has increased by only 4% in the last 120 years. The study by Mansh and colleagues, she commented, “underscores what I’ve recognized in the last couple of years: Where are the Black male dermatologists? NMA Derm started recruiting this demographic aggressively about a year ago and started the Black Men in Derm events. Black male members of NMA Derm travel to the Student National Medical Association and NMA conference and hold a panel to expose Black male students into dermatology. This article provides the numbers needed to measure how successful this and other programs are to closing the equity gap.”
Williams reported having no financial disclosures. Mansh reported receiving grants from National Institute of Environmental Health Sciences outside the submitted work. Pritchett and colleagues reported having no relevant financial disclosures, as did Qutub and Kindred.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.