Asian American Representation in Surgical Training in the United States
Christina L Cui1, William Y Luo2, Crystal Jing3
1Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Introduction:
Asians are considered an over-represented minority in medicine, making up 7% of the US national population but 17.1% of active physicians. However, representation trends are different across surgical specialties, and many surgical residency programs, most notably plastic surgery, otolaryngology, and orthopedic surgery, are less racially diverse than nonsurgical residency programs. Asian representation in surgical residency programs, in particular, has not been previously reported. The purpose of this study is to review demographic data among all surgical trainees to understand trends in Asian representation in surgical residency programs.
Methods:
Annual Graduate Medical Education data reports were collected and retrospectively analyzed for demographic data on surgical trainees from 2013 to 2022. Sixteen surgical specialties were examined. All demographic data were self-reported. Linear regression analysis was used to examine annual trends in Asian representation over the study period.
Results:
The study population included 1,296,204 resident physicians from 108,193 training programs over a 10-y study period. Of these, 350,417 (27.0%) individuals self-identified as Asian race. In fifteen out of sixteen surgical specialties, the proportion of Asian trainees was below the American Council on Graduate Medical Education (ACGME) average (P < 0.05 each). Asian representation was lowest in orthopedic surgery (12.9 ± 0.4%), surgical critical care (13.1 ± 2.2%), and pediatric surgery (15.4% ± 2.6%) (P < 0.0001 versus all programs). Only ophthalmology had a higher Asian representation (31.0 ± 1.9%, P < 0.0001) compared with the aggregate trainee population. On linear regression analysis, Asian representation has declined among total ACGME-accredited programs at a rate of 0.2% annually (R2 = 0.82, P < 0.0001). Seven surgical specialties experienced an annual decline in Asian representation over the past decade, including cardiothoracic surgery (traditional), colorectal surgery, complex general surgical oncology, general surgery, ophthalmology, plastic surgery (traditional), and vascular surgery (traditional) (P < 0.05 each). Similar trends in representation are reported among the current surgical workforce.
Conclusions:
The percentage of Asians in almost all surgical residency training programs falls below the ACGME average, indicating low matriculation rates into surgical specialties. Trend analysis suggests that these disparities have only grown wider over the past decade. Future initiatives should focus on recruitment and mentorship of Asians surgeons, in order to best care for the large and growing Asian demographic in the United States.
