Minority Underrepresentation in Academia: Factors Impacting Careers of Surgery Residents

Abstract

Background Underrepresentation of minorities within academic surgery is an ever present problem with a profound impact on healthcare. The factors influencing surgery residents to pursue an academic career have yet to be formally investigated. We sought to elucidate these factors, with a focus on minority status. Methods A web-based questionnaire was sent to all administered to all ACGME-accredited general surgery programs in the United States. The main outcome was the decision to pursue a fully academic versus non-academic career. Multivariable logistic regression was used to identify characteristics impacting career choice. Results Of the 3,726 residents who received the survey, a total of 1,217 residents completed it – a response rate of 33%. Forty-seven percent planned to pursue non-academic careers, 35% academic careers, and 18% were undecided. There was no association between underrepresented minority status and academic career choice (Odds Ratio = 1.0, 95% Confidence Interval 0.6 – 1.6). Among all residents, research during training (OR=4.0, 95% CI 2.7-5.9), mentorship (OR=2.1, 95% CI 1.6-2.9), and attending a residency program requiring research (OR=2.3, 95% CI 1.5-3.4) were factors associated with choosing an academic career. When the analysis was performed among only senior residents (i.e., 4th and 5th year residents), a debt burden >$150,000 was associated with choosing a non-academic career (OR=0.4, 95% CI 0.1-0.9). Conclusions Underrepresented minority status is not associated with career choice. Intentional recruitment of minorities into research-oriented training programs, increased mentorship and research support among current minority residents, and improved financial options for minorities may increase the number choosing an academic surgical career.

Influence of Student Loan Debt on General Surgery Resident Career and Lifestyle Decision-Making

“…Furthermore, educational debt over $150,000 among general surgeons has been associated with choosing a nonacademic career. 16 From the same 2009 study, Kibbe and coworkers 4 found that 29.3% of surgeon respondents had considered pursuing a nonacademic career because of their educational debt, and 29.5% felt that their educational debt burden affected their academic productivity.…”

Is Dedicated Research Time During Surgery Residency Associated With Surgeons’ Future Career Paths?

“…Our finding regarding a negative association between debt and academic-medicine career aligns with results of a national general surgery resident survey, which reported that high debt (>$150,000) among senior residents was associated with a lower likelihood of academic-medicine career plans. 23 Our findings underscore the importance of promoting awareness about NIH Loan Repayment Programs among highly indebted general surgery residents who might otherwise consider pursuing research-related careers. 41 Our study has several strengths.…”

“…Our findings extend previous single institutional findings of general surgery training-program graduates' career paths [2][3][4] and a national survey of general surgery residents' career intentions. 23 That graduation year was negatively associated with faculty appointment in our sample was not unexpected as faculty appointees continue to accrue among US medical school graduates for 15 years after graduation. 33 We have not yet followed the surgeons in our study beyond initial faculty appointment to determine if GME-research participation is associated with a greater likelihood of academic-medicine retention and promotion, which will be additional long-term indicators of success as academicians, beyond initial appointment.…”

“…Lack of racial/ethnic diversity among physician-scientists and academic surgeons are issues of national concern. 7,22,23 In our study, URM surgeons were as likely as white surgeons to have participated in ≥1 year of GME research, and to have received faculty appointments and K/RPG awards. Thus, efforts to increase entry and retention of URM medical-school graduates in general surgery training programs should ultimately serve to increase diversity of the academic surgery 23 and the federally funded surgeon-scientist workforces.…”

Potential long-term impacts of surgical placement cancellations

“…Diversity in medicine and surgery is important as it leads to more inclusive and patient-centred care, increased patient compliance, satisfaction and participation in clinical trials, and greater access to care for disenfranchised communities [ 4 ]. There remains a lack of representation of minority groups in positions of leadership in surgery [ 5 ], and mentorship is a crucial factor in promoting a career in surgery [ 6 – 10 ]. Roberts SE et al found that the perceived barriers preventing African Americans from pursuing a career in surgery included ‘lack of mentorship’, ‘difficulty finding minority role models’, and ‘fighting stereotypes’ [ 11 ].…”