Minority Women Less Likely Than Minority Men to Be Leaders in Academic Surgery

By Marilynn Larkin

May 17, 2021

NEW YORK (Reuters Health) - Women from racial/ethnic minorities are less likely than their male peers to achieve leadership positions in academic surgery, highlighting an urgent need for diversification, researchers say.

"The findings of underrepresentation did not surprise us. What did surprise us was the downward trend from young minority and female faculty members in surgery to leadership positions," Drs. Andrea Riner and Jose Trevino of the University of Florida College of Medicine in Gainesville told Reuters Health by email. "These results suggest we are losing our diversity along the road to academic and professional influence and power in surgery. Additionally, we were surprised by female minority surgeons having more favorable trends than male minority surgeons early on in the pipeline."

"Our findings suggest that while female minority surgeons are modestly climbing in numbers at early-career faculty positions, the 'glass ceiling' persists and leaves these women even more disadvantaged than male minority surgeons in reaching leadership positions," they said. "In other words, if you are a male from a racial/ethnic diverse background, your chances of achieving leadership positions in surgery are higher than if you are a female of the same background."

As reported in JAMA Surgery, the team conducted a cross-sectional and longitudinal analysis of US surgical faculty census data from the Association of American Medical Colleges faculty database from 2013-2019.

More than 15,000 surgical faculty - of whom 3,876 (24.8%) were women - were included in the 2019 data set.

Female faculty from racial/ethnic minority groups experienced an increase in representation at instructor and assistant and associate professorship appointments during the study period, with a more favorable trajectory than male faculty from racial/ethnic minority groups across nearly all ranks.

However, White faculty held most leadership positions as full professors (77.7%) and chairs (77.4%).

The greatest magnitude of underrepresentation in the surgical leadership pipeline was among Black (2.7%) and Hispanic/Latinx (4.4%) full professors; although Black and Hispanic/Latinx male representation increased modestly (annual change, 0.07% and 0.10%, respectively), representation among Black females remained constant (annual change, 0.00004%) and Hispanic/Latinx female representation decreased (annual change, −0.16%).

Overall, chair representation among Hispanic/Latinx (5.3%) and Blacks (3.4%) did not change; only one Black and one Hispanic/Latinx woman ascended to chair from 2013 to 2019.

The authors conclude in the paper, "These findings highlight the urgency to diversify surgical leadership."

Drs. Riner and Trevino said, "Improving the diversity and inclusion of racial/ethnic minority men and women in surgery certainly begins well before medical school by exposing children from these diverse groups to the profession."

"Then," they said, "it becomes a matter of supporting them along every step of the journey, through focused mentorship, sponsorship, and recognition for the tremendous work they are fully capable of performing, equal to their counterparts."

Dr. Tania Arora of Augusta University at the Medical College of Georgia, coauthor of a related editorial, commented in an email to Reuters Health, "The study adds to a growing body of literature that has addressed the stagnant pace of diversification in surgery over the last several years."

"While many institutions have started implementation of diversity champions and statements, these steps remain mostly symbolic, without fortifying systems and protocols that drive culture change," they said. "Organizations should start with introspection to identify trends in leadership and patterns of promotion and consider benchmarks and long-term goals to strive for. Creating a critical mass that creates sustainable mentorship and inclusivity is not a 'one size fits all' enterprise."

"Similarly," she said, "departments should seek out leaders that are willing to have uncomfortable conversations and shepherd with vulnerability. They must employ recruitment systems that market opportunities to a broader audience, standardize interviews and empower staff at all levels to recognize and mitigate bias."

"Our leaders must pave the way, reaching back to 'pull up' those who aspire to lead," they said. "Hopefully, this will benefit not only the individual surgeon, but also the entire surgical pipeline as trainees may be more drawn to a profession that is diverse and inclusive from the top down."

SOURCE: https://bit.ly/2SGitGP and https://bit.ly/3y8HE5c JAMA Surgery, online May 5, 2021.

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