P0693 - Trends in Race/Ethnicity of Pediatric Residents and Fellows from 2007-2019

Background: The necessity for diversity in the medical workforce is well established. In academic medicine, several studies across various specialties have demonstrated modest improvements in underrepresented in medicine (UIM) trainee representation over time. To our knowledge, trends in racial/ethnic diversity of pediatric residents and subspecialty fellows has yet to be described.

Methods: We performed a cross-sectional study of race/ethnicity in pediatric residents and subspecialty fellows using publicly available Graduate Medical Education census reports from 2007 (when race/ethnicity data were first included) to 2019. We manually extracted race/ethnicity data for pediatric residents and fellows across 15 subspecialties. We defined UIM using the AAMC Medical Minority Applicant Registry definition (self-identification as African American/Black, Hispanic/Latinx, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander). We excluded combined residencies not restricted to pediatrics and trainees reporting race/ethnicity as multiracial or other/unknown. To determine whether there was a significant change in UIM proportions during the study period, rates were compared longitudinally using Cochran Armitage Test; results were considered statistically significant at a 2-tailed p-value <0.05. The Clopper-Pearson exact binomial method was used to calculate 95% confidence intervals. SAS (version 9.4, Cary, NC) was used for all analysis.

Results: A total of 109,344 pediatric residents and 44,420 fellows were included in our sample. Between 2007 and 2019, the annual number of pediatric residents and fellows increased (from 7,964 to 8,950 residents and 2,684 to 3,966 fellows) (Table). Over time, the percentage of UIM trainees was unchanged in pediatric residencies (16% [95% CI: 15.2%-16.9%] to 16.5% [95% CI: 15.8%-17.3%]; p=0.98) but decreased in all fellowships (14.2% [95% CI: 12.9%-15.6%] to 13.5% [95% CI: 12.4%-14.6%]; p=0.002). However, there were substantial differences by subspecialty. Significantly decreased trends in UIM representation occurred for neonatal-perinatal medicine (p<0.001), infectious diseases, (p<0.001) and critical care (p=0.006), with worsening trends in hematology/oncology (p=0.09). Significant improvements in UIM representation existed in endocrinology (p=0.002) and pulmonology (p=0.009) with improving trends in adolescent medicine (p=0.13). In 2019, pediatric residents and most subspecialties had considerably lower percentages of UIM trainees than the United States population (Figure).

Discussion: The percentage of UIM representation in pediatric residents remained stagnant between 2007-2019 and alarmingly declined for pediatric subspecialty fellows. In 2019, no specialties reflected the diversity of the US population. While further research is needed to delineate the etiology for this striking lack of UIM representation in pediatrics, several possibilities exist, including educational and economic disparities, implicit bias in the recruitment process, poor UIM representation among faculty members and leadership, and lack of effective and innovative programs aimed at expanding diversity in medicine, and specifically, pediatrics.

Conclusion: There is a critical need to recruit and retain pediatric UIM trainees to reflect the growing diversity of the US population.