Diversification of Academic Surgery, Its Leadership, and the Importance of Intersectionality

• Published in: JAMA surgery Vol. 156; no. 8; pp. 748 - 756
• Main Authors: Riner, Andrea N, Herremans, Kelly M, Neal, Daniel W, Johnson-Mann, Crystal, Hughes, Steven J, McGuire, Kandace P, Upchurch, Gilbert R, Trevino, Jose G
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.08.2021
• Subjects: African Americans - statistics & numerical data; Asian Americans - statistics & numerical data; Cross-Sectional Studies; Cultural Diversity; Databases, Factual; Faculty, Medical - statistics & numerical data; Female; General Surgery - education; General Surgery - statistics & numerical data; Hispanic or Latino - statistics & numerical data; Humans; Intersectional Framework; Leadership; Longitudinal Studies; Male; Minority Groups - statistics & numerical data; Online First; Original Investigation; Racial Groups - statistics & numerical data; Schools, Medical - statistics & numerical data; Sex Factors; United States; Whites - statistics & numerical data; United States
• ISSN: 2168-6254; 2168-6262
• DOI: 10.1001/jamasurg.2021.1546

IMPORTANCE: Diversity in academic surgery is lacking, particularly among positions of leadership. OBJECTIVE: To evaluate trends among racial/ethnical minority groups stratified by gender along the surgical pipeline, as well as in surgical leadership. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional and longitudinal analysis assessed US surgical faculty census data obtained from the Association of American Medical Colleges faculty roster in the Faculty Administrative Management Online User System database. Surgical faculty members captured in census data from December 31, 2013, to December 31, 2019, were included in the analysis. Faculty were identified from the surgery category of the faculty roster, which includes general surgeons and subspecialists, neurosurgeons, and urologists. MAIN OUTCOMES AND MEASURES: Gender and race/ethnicity were obtained for surgical faculty stratified by rank. Descriptive statistics with annual percentage of change in representation are reported based on faculty rank. RESULTS: A total of 15 653 US surgical faculty, including 3876 women (24.8%), were included in the data set for 2019. Female faculty from racial/ethnic minority groups experienced an increase in representation at instructor and assistant and associate professorship appointments, with a more favorable trajectory than male faculty from racial/ethnic minority groups across nearly all ranks. White faculty maintain most leadership positions as full professors (3105 of 3997 [77.7%]) and chairs (294 of 380 [77.4%]). The greatest magnitude of underrepresentation along the surgical pipeline has been among Black (106 of 3997 [2.7%]) and Hispanic/Latinx (176 of 3997 [4.4%]) full professors. Among full professors, although Black and Hispanic/Latinx male representation increased modestly (annual change, 0.07% and 0.10%, respectively), Black female representation remained constant (annual change, 0.00004%) and Hispanic/Latinx female representation decreased (annual change, −0.16%). Overall Hispanic/Latinx (20 of 380 [5.3%]) and Black (13 of 380 [3.4%]) representation as chairs has not changed, with only 1 Black and 1 Hispanic/Latinx woman ascending to chair from 2013 to 2019. CONCLUSIONS AND RELEVANCE: A disproportionately small number of faculty from minority groups obtain leadership positions in academic surgery. Intersectionality may leave female members of racial/ethnic minority groups more disadvantaged than their male colleagues in achieving leadership positions. These findings highlight the urgency to diversify surgical leadership.