A Century of Progress: Evolving Racial and Ethnic Diversity in U.S. and Canadian Pediatric Surgery Training

Diversity among pediatric surgery trainees plays a critical role in shaping the future workforce and the quality of care delivered to children. This study presents the first comprehensive analysis of all pediatric surgery graduates in the U.S. and Canada, evaluating racial and ethnic representation over time and identifying areas where progress remains limited.

A retrospective review was conducted of all pediatric surgery fellowship graduates, both official and unofficial, across the U.S. and Canada from 1919 to 2025. Data sources included The Genealogy of North American Pediatric Surgery, APSA membership listings, and correspondence from program directors. The final cohort included 2,235 graduates. Race and ethnicity were classified using a structured hierarchical review process based on public information, and self-identification when available; these included a combination of name analysis, photographs, professional affiliations, personal contacts, and the Namsor.app tool. Race and ethnicity were classified according to U.S. Census categories and graduates were grouped into five time periods to assess temporal trends. Graduates for whom the classification framework did not identify sufficient evidence of a prespecified minority racial or ethnic identity constituted the residual reference category ('no minority identity identified'). Chi-square and Fisher's exact tests were used for analysis, with significance set at p<0.05.

Across 79 programs, 2,235 graduates were identified (1,673 men [74.9%], 562 women [25.1%]). Racial and ethnic diversity increased significantly over time (p < 0.0001). Asian representation increased from 1.8% to 15.4% (p<0.001), Hispanic/Latino representation from 1.8% to 6.0% (p=0.0017), and Black representation from 0.0% to 3.7% (p=0.002). AI/AN representation remained negligible throughout the study period. Racial distribution differed significantly by sex (p<0.001): Black pediatric surgeons were more likely to be female (4.8% vs 1.6%, p<0.001), Asian pediatric surgeons were slightly more likely to be female (13.3% vs 10.5%, p=0.0690), and Hispanic/Latino representation was similar between sexes (4.2% vs 4.4%, p=0.8080).

Pediatric surgery training in the U.S. and Canada has become increasingly diverse in terms of race and ethnicity. Notable gains among Asian, Hispanic/Latino, and Black surgeons reflect progress, though AI/AN representation remains nearly absent, and sex-based disparities persist. Continued efforts in equitable recruitment, mentorship, and career advancement are needed to ensure that the pediatric surgical workforce mirrors the diversity of the children and families it serves.

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