A Call to Action to Train Underrepresented Minorities in Surgical Subspecialties and Fellowships.

OBJECTIVE: With each succession along the surgical career pathway, from medical school to faculty, the percentage of those who identify as Underrepresented in Medicine (URiM) decreases. We sought to evaluate the demographic trend of surgical fellowship applicants, matriculants, and graduates over time.

METHODS: The Electronic Residency Application Service (ERAS) and the Graduate Medical Education Survey for general surgery fellowships in colorectal surgery, surgical oncology, pediatric surgery, thoracic surgery, and vascular surgery were retrospectively analyzed (2005-2020). Data were stratified by race and gender, descriptive statistics were performed, and time series were evaluated. Race/ethnicity groups included White, Asian, Other, and Underrepresented in Medicine (URiM), defined as Black/African American, Hispanic/Latino(a), Alaskan or Hawaiian Native, and Native American.

RESULTS: From 2005 to 2020, there were 5,357 ERAS applicants, 4,559 matriculants, and 4,178 graduates to surgery fellowships. Whites, followed by Asians, represented the highest percentage of applicants (62.7% and 22.3%, respectively), matriculants (65.4% and 23.8% respectively), and graduates (65.4% and 24.0%, respectively). For URiMs, the applicants (13.4%), matriculants (9.1%), and graduates (9.1%) remained significantly low (p < 0.001). When stratified by both race and gender, only 4.6% of the applicants, 2.7% of matriculants, and 2.4% of graduates identified as both URiM and female compared to white female applicants (20.0%), matriculants (17.9%), and graduates (16.5%, p <0.001).

CONCLUSION: Significant disparities exist for URiMs in general surgery subspecialty fellowships. These results serve as a call to action to re-examine and improve the existing processes to increase the number of URiMs in the surgery subspecialty fellowship training pathway.