Recruiting diverse emergency medicine residents: The influence of community diversity

There is limited understanding of factors influencing recruitment of emergency medicine (EM) residents identifying as races and ethnicities underrepresented in medicine (URM): Black/African American, Hispanic, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander. This study explored whether diversity of EM residents at the program level is associated with community diversity at the county level.

The proportion of URM residents in each EM residency program was determined using Association of American Medical Colleges academic year 2023-2024 data. We excluded newer programs without a full complement of residents and those not reporting race/ethnicity data. We used U.S. Census data to categorize each program's surrounding county as having lower diversity (<30% URM population), moderate diversity (≥30% to <49% URM population), or higher diversity (≥49% URM population). We used Kruskal-Wallis test with Dunn's procedure to determine whether the proportion of URM residents in a program was associated with the level of diversity in the surrounding county.

Among 247 included EM programs, 5% of residents were Black (range 0%-46% per program), 8% Hispanic (range 0%-43%), and 4% another URM race/ethnicity. The proportion of URM EM residents was significantly lower among programs in lower-diversity counties (median [IQR] 10% [6%-16%]) than among programs in moderate-diversity (median [IQR] 14% [8%-20%], p < 0.001) or higher-diversity (median [IQR] 15% [9%-22%], p < 0.001) counties. Similarly, programs in counties with higher Black populations had more Black EM residents, and programs in counties with higher Hispanic populations had more Hispanic EM residents.

EM residents at programs in lower-diversity counties are less likely to be URM than those in moderate- or higher-diversity counties. EM programs located in less diverse communities may require unique strategies to increase resident diversity.