Surgeon Intersectionality and Academic Promotion and Retention in the US

Area of Science:

• Medical Education
• Surgical Faculty Diversity
• Health Equity

Background:

• Surgery has historically lacked diversity, with slow progress in increasing representation for women and underrepresented in medicine (UIM) physicians.
• Limited data exist on how intersectionality (combined effects of race, ethnicity, and sex) influences career progression in academic surgery.

Purpose of the Study:

• To analyze the combined impact of race/ethnicity and sex on promotion rates and attrition among faculty in US academic medical surgery departments.
• To identify disparities in career advancement and retention within academic surgery based on intersecting demographic factors.

Main Methods:

• Retrospective cohort study utilizing Association of American Medical Colleges faculty roster data from 2005-2020.
• Analysis included 31,045 full-time academic surgery faculty, examining trends in promotion and attrition using Kaplan-Meier and Cox time-to-event analyses.
• Data were analyzed for associations between race, ethnicity, sex, and career outcomes.

Main Results:

• Underrepresented in medicine (UIM) females were least likely to be promoted and had the highest risk of attrition compared to other groups.
• Hispanic females faced a 32% lower likelihood of promotion, while non-Hispanic White females had a 25% lower likelihood compared to non-Hispanic White males.
• Non-UIM males had the shortest median time to promotion (6.9 years), whereas UIM females had the shortest mean time to attrition (8.2 years).

Conclusions:

• Intersectionality significantly affects promotion and attrition rates in academic surgery, with UIM females experiencing the most substantial disadvantages.
• Targeted interventions are crucial to address the unique vulnerabilities of UIM females and promote equitable career advancement in surgery.
• Further research is needed to fully understand and mitigate these disparities in academic surgical departments.