‘Systemic Disparities’ Present in Residency Selection: Study

Aftershock, a recent movie that highlights the plights of two Black women who died as a result of childbirth-related complications, may help continue a national conversation about the Black maternity mortality rate in the United States. According to the Centers for Disease Control and Prevention, the maternal mortality rate for non-Hispanic Black women is 2.9 times the rate for non-Hispanic White women.

Increasing the ranks of Black women in obstetrics/gynecology may help. But first, Black medical school students need access to residency programs.

A recent study that was published in JAMA focuses on racial and ethnic differences in the selection of residents across eleven specialties. Defined as underrepresented groups in the study are Black, American Indian, Alaska Native, Hispanic, Latino, Native Hawaiian, and Pacific Islander people.

The JAMA study yielded two findings: White matched residents were overrepresented, and racial and ethnic minority groups other than Asian were underrepresented in the 11 competitive specialties included in the study.

Additional research is needed to determine the reasons for these differences, according to the researchers. This includes evaluation across the screening, reviewing, interviewing, and ranking stages of the selection process.

For example, in ob/gyn, although White individuals constituted 53% of the applicant pool, they were present in a higher proportion among matched residents, 60%, per the study. By comparison, 19% of applicants to ob/gyn identified as underrepresented individuals, but only 11% of residents that matched into ob/gyn were underrepresented.

There were also lower percentages of matched residents among underrepresented applicants in the other 10 specialties studied, including general surgery (15% applicant pool; 9% matched), emergency medicine (12% applicant pool; 7% matched), and neurologic surgery (13% applicant pool, 8% matched).

Sarah Bowe, MD, a pediatric otolaryngologist with the US Air Force and a study co-author, told Medscape Medical News, “Within our study, we found evidence of disproportionate selection, which suggests systemic disparities in the residency selection process. Efforts to diversify the physician workforce will remain stagnant if recruitment efforts don’t translate into more proportionate rates of selection.”

Critically important to addressing this challenge, said Bowe, are physicians and physician leaders who make “intentional efforts to develop underrepresented in medicine applicants.”

For example, physicians can participate in mentorship organizations that support students who are underrepresented in medicine, such as the Student National Medical Association (which supports current and future underrepresented minority medical students) and the Latino Medical Student Association.

Increasing Diversity Improves Patient Experience

For Black patients, being seen by a Black doctor can create a sense of comfort and can reduce anxiety and pain, according to a 2020 study published in Pain Medicine. That’s important in light of a 2016 study, which was published in Proceedings of the National Academies of Science, that found that half of medical students and residents believed that Black patients felt less pain than White patients.

Still, the number of Black physicians remains stubbornly low. A 2019 study found that Black male students constituted 2.9% of the national medical school student body; in 1978, 3.1% of the national medical school body was composed of Black male students. Of the numbers of Black men in medical school, 15% are enrolled in historically Black medical schools, such as Howard University College of Medicine, in Washington, DC, and Meharry Medical College, in Nashville.

According to the American Association of Medical Colleges (AAMC), 6.2% of medical school students in 2019 were Black. In January 2022, the AAMC announced that the incoming class of medical students in fall 2021 was more diverse than at any time in history. Of the more than 22,000 students who started medical school in 2021, the number of Black individuals increased by 21% from the previous year. In addition, there were 8.3% more Asian students in medical school and more than 7.1% students of Hispanic or Latino origin than the previous academic year, per the AAMC.

Approximately 2.6% of all active physicians in the United States are Black women.

David Satcher, MD, PhD, who served as surgeon general of the United States from 1988 to 2002, wrote a viewpoint article that was published in JAMA in 2021 concerning the urgent need to reinvent the patient-physician relationship, owing to racial disparities related to the COVID-19 pandemic.

Satcher, who also served as president of Meharry Medical College, noted that life expectancy dropped an estimated 2.7 years for Blacks and an estimated 2 years for Latino persons in the first 6 months of 2020. By comparison, it is estimated that White individuals lost less than 1 year.

JAMA. Published online June 28, 2022. Abstract

Bowe’s comments are her own and don’t reflect the official policy of the US Air Force.

Aine Cryts is a veteran health IT and healthcare writer.

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