Recent levels and trends in participation attrition in academic medicine

Medical schools have increased attention to diversity and inclusion, supported by accreditation standards from national organizations, yet it is unclear whether gains at matriculation extend through residency and into academic faculty. We examined representation of groups underrepresented in medicine across the academic medicine pathway to identify stages where attrition is greatest.

We used publicly available data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education for academic years 2022 to 2023 and 2023 to 2024. We calculated the percentage of women and of individuals who identified as Black, Latino, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander among medical students, residents, and faculty, averaging values across years. In a secondary analysis, we classified residency programs as predominantly medical or surgical and compared representation of these groups between categories. We then examined combined categories of gender and race or ethnicity to identify the largest absolute declines in representation across stages.

Female representation declined from students to faculty (54.59 percent, 48.36 percent, and 44.40 percent, respectively). For each group underrepresented in medicine, representation was generally highest among medical students and declined or remained flat at the resident and faculty stages. Black representation decreased from 5.69 percent among students to 3.29 percent among residents and 2.06 percent among faculty, and Latino representation from 4.13 percent to 4.97 percent and 1.89 percent, respectively. Representation of American Indian or Alaska Native and Native Hawaiian or other Pacific Islander individuals remained very low at all stages. The largest losses across stages occurred among Black and Latino women, followed by Black and Latino men.

Diversity gains at medical school entry are not sustained into academic faculty positions, indicating a leaky pipeline in academic medicine. The transition from residency to faculty appears to be a critical point for intervention through intentional recruitment, mentorship, sponsorship, and retention efforts, particularly for Black and Latino women and men. Structural and institutional changes will be necessary to prevent ongoing attrition and to ensure that the physician workforce reflects the diversity of the populations served.