Perceptual Barriers to Becoming a Plastic Surgeon among Underrepresented Medical Students

Increasing African American representation in plastic surgery

Plastic surgery is a specialty crucial for addressing the needs of diverse patient, yet it faces significant underrepresentation of African Americans, especially in academic leadership. This imbalance persists throughout medical education, training, and professional advancement. Dr. Arthur L. Garnes, the first board-certified African American plastic surgeon, overcame profound challenges, inspiring subsequent generations. Notable figures like Dr. Camille Cash and Dr. Steven Williams further exemplify resilience in the face of barriers. Mentorship emerges as pivotal, fostering diversity and inclusion within plastic surgery. Initiatives promoting mentorship, financial support, and recruitment are essential to rectifying disparities, ensuring equitable representation, and improving access to care for minority patients.

Racial and Ethnic Diversity in American Plastic Surgery Residency

INTRODUCTION

Significant efforts during the past decades have led to growing racial diversity in the field, resulting in more underrepresented minorities (URM) in training. To highlight areas for improving URM inclusion and training, we sought to pinpoint educational and achievement gaps among URMs in contrast to White and Asian trainees.

METHODS

In this cross-sectional study, publicly accessible records were assessed for data on trainees' education, research, location, and race, comparing URMs (Black, Hispanic, Hawaiian, Native American) to White and Asian trainees.

RESULTS

Among 1092 trainees across 95 programs (950 integrated and 142 independent), Whites and Asians comprised 94.2%, while URMs (Blacks, Hispanics, and Others) made up 5.8%. Compared to U.S. medical students, there was a 21.4% increase in Whites and 1.2% in Asians, with a 3.9% and 4.3% decrease in Blacks and Hispanics, respectively. Comparable proportions graduated from medical schools with affiliated residency programs, matched at their schools, or pursued alternative pathways. URMs were all allopathic graduates, had more advanced degrees, with significantly more MBAs (p=0.024). A higher proportion of URMs trained in independent programs (p=0.003) and were distributed towards Southern and Midwestern programs (p=0.021). URMs had fewer citations (p=0.047), though publications and Hirsch index were comparable.

CONCLUSIONS

Our analysis identifies a remediable issue, offering avenues for improved racial representation. Early pre-match mentorship remains the key intervention to diversify the field by effectively guiding match strategies for URMs. This is evidenced by fewer citations among URM trainees albeit comparable research backgrounds higher prevenance of advanced degrees, particularly MBAs.

Underrepresented in Medicine Applicants are Less Likely to Successfully Match into Plastic Surgery

IMPORTANCE

The lack of underrepresented in medicine physicians in academic plastic surgery has been a topic of interest for many years, and accordingly outreach has been undertaken to address the pipeline from medical school to residency and beyond.

OBJECTIVE

This study aims to assess and identify the characteristics associated with plastic surgery match success for underrepresented in medicine applicants.

DESIGN

Residency application data for first time, US allopathic medical school seniors from the 2017-2018 to 2021-2022 applicant cycles were abstracted from Electronic Residency Application Service applications, and match results were determined using the National Residency Matching Program database and online public sources. Data included self-reported race, and multiple application characteristics. Multivariable logistic regression of application characteristics were used to assess the relationship between underrepresented in medicine status and successfully matching. Binary logistic regression was used in subgroup analyses of each application characteristic, and interactions regression was used to evaluate the relative weight of each characteristic on successfully matching.

RESULTS

Underrepresented in medicine applicants were 57% less likely to match than non-underrepresented in medicine applicants (OR 0.43, p = 0.001), though they were 60% less likely to match (ORadj 0.4, p = 0.216) when adjusted. Subgroup analysis revealed that odds of matching as an underrepresented in medicine applicant were significantly increased if the applicant had a home program, took a research year, and had an increased number of published research and presentations (ORs 0.43-0.48, all p < 0.05). Odds of matching as an underrepresented in medicine applicant were significantly decreased if the applicant went to a medical school ranked in the highest or lowest third (ORs 0.41-0.42, all p < 0.01); however, on interaction regression the odds of matching from a highly ranked medical school was increased (OR 3.5, 95% CI 0.98-12.55, p = 0.05).

CONCLUSIONS

The likelihood of matching as an underrepresented in medicine applicant is lower than the rest of the applicant population, and there are no individual applicant characteristics that can increase these odds to equal that of the general applicant population.

Diversity, Equity, and Inclusion in Plastic Surgery: A Systematic Review

BACKGROUND

The number of publications on the subject of diversity, equity, and inclusion has surged in the last 5 years. However, a systematic review of this topic has not been published.

METHOD

Six top plastic surgery journals were queried from 2018 to 2023 using the search term "diversity." Methods, conclusions, and recommendations were tabulated.

RESULTS

A total of 138 publications were identified; 68 studies presented data suitable for analysis. All studies were retrospective. Currently, over 40% of plastic surgery residency applicants are women. The proportion of women in integrated plastic surgery residents is now 43%. In 2021 and 2022, the percentage of female first-year residents exceeded men. The percentage of female presenters at meetings (34%) is double the number in the workforce (17%). Twenty-five percent of academic faculty positions and 22% of program director positions are now held by women. Underrepresented minorities account for fewer than 10% of applicants to integrated plastic surgery residencies.

DISCUSSION

The proportion of Black and Hispanic applicants to integrated plastic surgery residencies (6% and 8%, respectively) mirrors the proportion of Black and Hispanic medical students (7% and 6%, respectively). Numerous recommendations have been made to increase the proportion of underrepresented minorities in plastic surgery programs.

CONCLUSIONS

The representation of women in plastic surgery has increased dramatically. A lack of Hispanics and Blacks reflects a small pool of applicants, as opposed to a "leaky pipeline."