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Little has changed in the way of representation for Black surgeons over the last 13 years, according to a nationwide multicenter study.

While the number of applications to surgical residency programs among Black women increased from 2005 to 2018 (2.2% to 3.5%, P<0.001), the number of Black male applicants remained unchanged, and their first-year matriculation rates significantly decreased, from 3% to 2.4% (P=0.04), reported Cherisse Berry, MD, of NYU Grossman School of Medicine, and colleagues.

A similar trend was observed with graduation rates, with the overall rate for Black male surgical residents decreasing from 4.3% to 2.7% (P=0.03), and the rate among Black women remaining unchanged, Berry's group wrote in .

"When the percentage of UIM [underrepresented in medicine] surgeons does not reflect the percentage of UIM individuals in the population, health care suffers," Berry and colleagues wrote. "It has been shown that patients choose physicians of similar race and ethnicity and are more likely to follow the physician's instructions and therefore more likely to maintain good health."

They said that the disparities uncovered in their study are likely a result of implicit and explicit biases in medicine, especially in the surgical field. Citing a that examined experiences of race-based discrimination in 301 general surgery residency programs, they noted a high prevalence of discrimination against Black residents, at a rate of 70%.

In August 2020, the Association of American Medical Colleges (AAMC) and National Medical Association announced a to address medicine's overall lack of representation of Black men.

"The academic medicine community must take even more aggressive steps to attract and engage talent from all segments of our society to address public health needs. We are dealing with historically entrenched systems of exclusion and oppression for racial and ethnic minorities in the United States," said David Skorton, MD, president and CEO of the AAMC, in a statement. "Systemic changes are necessary to make a lasting change in the representation of Black men in medicine, and this will require us to build a coalition of voices and collaborators across multiple communities."

In this study, Berry and colleagues retrospectively reviewed data from the Electronic Residency Application Service (ERAS) for the general surgery residency match and Graduate Medical Education (GME) surveys of graduating general surgery residents. Data were collected from 2005 to 2018 and were stratified by race, ethnicity, and sex.

Primary outcomes included the rates of application, matriculation, and graduation from general surgery residency programs.

Over the study period, there were 71,687 applicants (34.3% women, 8.3% Black, 23.2% Asian, 3.4% Latino), 26,237 first-year matriculants, and 24,893 graduates.

Application rates increased among Latinos and Asian women, but remained relatively unchanged for white women and decreased yearly among white men (32.8% to 28.5%, P=0.001).

The rates of first-year matriculation increased over time among Latina (0.4% to 1.6%), white (19.1% to 21.8%), and Asian (5.4% to 8.1%) women. There was a significant annual increase among Latino men (1.2% to 3%, P<0.001), whereas the rate for white men decreased from 45% to 37.9% (P=0.002). Like Black men, the matriculation rate for Asian men remained unchanged over the 13-year period.

The overall percentage of women graduating from general surgery residency programs increased by 55.3%; specific increases were seen among white and Asian women, whose yearly graduation rates grew by 0.4% and 0.2%, respectively. Trend analyses for male graduates revealed notable declines in the percentages of Asian men (4.3% to 2.7%) and white men (48.4% to 41%). For Latino men, graduation rates only slightly increased (2.9% to 3.5%).

Overall attrition rates were disproportionately higher for Black trainees (4.1%) compared with their Asian (2.9%), Latino (2.7%), and white (2.6%) peers; however, all of these groups saw attrition rates grow throughout the 13-year period.

Berry and colleagues emphasized that the meager representation of Black and Latina women surgical trainees is not a consequence of their lack of interest in surgery as a career, as the number of applicants among both groups has increased since 2005.

They offered potential strategies to chip away at these disparities, such as developing visiting clerkships for medical students who self-identify as Black, initiating and supporting formal mentorships, and recruiting and promoting more Black surgeons to leadership roles.

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