Changing Face of the Gastroenterology Workforce: Progress and Pitfalls

Background Diversity in a health care system has many benefits, especially in underserved communities. Providing care to a diverse population by diverse physicians may translate to better compliance and outcomes. There is limited knowledge about ethnicity and gender representation in the gastroenterology (GI) workforce in the U.S. In this study, we aimed to evaluate the trends in racial and gender diversity in GI fellowships. We also examined the impact of COVID on the female gender and racial representation. Methods Accreditation Council for Graduate Medical Education (ACGME) data were queried to identify GI trainees between 2014 and 2024. Trainees were identified based on self-reported race and gender. We defined 2014-2020 and 2021-24 as pre- and post-COVID years, respectively. We also analyzed the Electronic Residency Application Service (ERAS) application data from 2015 to 2024 for race and gender. Pearson's Chi-squared tests were used to compare proportions of female versus non-female fellows, and t-tests were used to compare the average Representation Quotients (RQ) within each racial group. Results We found a gender gap with the female fellows and male fellows representing 35.6% and 64.0% of the total, respectively (p<0.05). Female representation in GI fellowship increased significantly over the study period (2014-2015 to 2023-2024), with a notable rise observed in the post-COVID era compared with the pre-COVID era. The African-American population represented a lower proportion of GI fellows compared to the White and Asian populations. The Asian population had the highest representation in terms of female fellows, followed by White, Hispanic, and Black populations. Conclusions This study confirmed the disparities in gender and racial minority representation within ACGME-accredited GI fellowship programs. While there was an increase in the percentages of female fellows, the representation of the Black population remained stagnant.