Sex and Race/Ethnicity Based Trends in Matriculation to General Surgery Residency and Associated Fellowship Programs

The changing landscape of the surgical workforce and the dynamics of sex and racial/ethnic inequality have been heavily publicized in the surgical community. We sought to report on current sex- and race/ethnicity-based trends in matriculation to general surgery residencies and surgical fellowships.

Data were provided by the Association of American Medical Colleges from the Electronic Residency Application Service and were stratified by matriculant-reported sex and race/ethnicity. The Association of American Medical Colleges definition of Underrepresented in Medicine (URiM) was used for the purpose of the analysis. Thus, all matched applicants who self-identified as Asian or White were classified as non-URiM, and any other self-identified race/ethnicity was classified as URiM. Four cohorts (males, females, URiM, and non-URiM) were created for each of the five analyzed disciplines: all general surgery residencies, all surgical fellowships, and specifically complex general surgical oncology (CGSO), pediatric surgery, and colorectal surgery fellowships. Statistical analyses were performed using SAS (version 9.4; SAS Institute, Cary, NC).

From 2008 to 2020, the gap between match rates for male and female matriculants for general surgery residency narrowed from 58% (n = 621) males versus 42% (n = 451) females in 2008, to 51% (n = 708) males versus 49% (n = 670) females in 2020. There was a similar trend toward gender parity in match rates to all surgical fellowships from 2007 to 2018, with males comprising 78% (n = 210) versus 22% (n = 59) females in 2007, compared to 63% (n = 199) males versus 37% (n = 117) females in 2018; albeit a significant disparity remains. Upon further analysis specifically into CGSO, pediatric surgery, and colorectal surgery fellowships, no statistically significant difference between sex-based match rates existed in the most recently analyzed cohort. However, from 2008 to 2020, the proportions of matched URiM and non-URiM applicants in general surgery residency remained unchanged (16% versus 84% respectively). In addition, there were significant discrepancies between match rates for URiM versus non-URiM for CGSO fellowship in the most recently matched cohorts (match rates: 54% URiM versus 78% non-URiM, P = 0.03).

Overall, sex-based breakdown of applicants matching into general surgery residency and surgical fellowships reveals relative parity between males and females. However, recruitment of URiM applicants remains underwhelming with no significant changes in the racial/ethnic distribution of matched applicants in general surgery residency or surgical fellowships for the last 12 y. A re-examination of the current policies and initiatives geared toward promoting diversity and inclusion in surgery is needed to identify areas of improvement that result in improved representation.