Report Shows Decline in Black Ob/Gyn Residents From 2014 to 2019

Jaleesa Baulkman

June 09, 2021

There has been a steady decline in the proportion of Black ob.gyn. residents from 2014 to 2019, according to new research published in JAMA Network Open.

Researchers found that Black residents made up 10.2% of ob.gyn. residents during the 2014-2015 academic year, compared with 7.9% in 2018-2019. Meanwhile, Native American or Alaskan Native and Native Hawaiian or Pacific Islander residents were the least represented in the field, making up just 0.2% of residents in 2014 and 0.1% in 2015.

"When we look at the trend [of Black residents] across several years, it's surprising that not only is the proportion of [ob.gyn.] Black residents [decreasing], but it was going down at a faster rate than other specialties," study author Claudia Lopez, MD, said in an interview.

The ob.gyn. specialty tends to have the highest proportion of underrepresented physicians, especially Black and Latino physicians, compared with other specialties, according to a 2016 study published in Obstetrics & Gynecology. This study also found that underrepresented minority ob.gyns. were more likely than White or Asian physicians to practice in underserved areas. However, researchers of the current study found that the decline in Black residents in this field is surprising.

"I do think that ob.gyn. is very unique in that it's surgical but also has a lot of primary care elements," Lopez said. "I think that's probably why initially our specialty historically has more underrepresented minorities, because it combines all those things and [physicians are] so intimate with their patient population."

Lopez, resident physician at the University of California, Davis, and colleagues analyzed deidentified data on the race and ethnicity of more than 520,000 residents in ob.gyn., surgical, and nonsurgical specialties from JAMA Medical Education reports from 2014 to 2019.

They found that ob.gyn., surgical, and nonsurgical residents most commonly identified as White, followed by Asian. In addition to the decline in Black ob.gyn. residents, researchers noticed that the proportion of Latino residents remained relatively unchanged. Furthermore, while the racial and ethnic composition of residents varied each year, higher proportions of ob.gyn. residents identified as Black or Latino, compared with those in surgical and nonsurgical specialties.

Researchers noted that, although their findings suggest ob.gyn. residencies have higher proportions of Black and Latino residents, compared with surgical and nonsurgical specialties, the diversity of the ob.gyn. programs lag behind the United States' changing demographics.

"Medicine in general has a lot to do to match the [U.S. demographic] population," Lopez said. "But at least the trend should hopefully be matching, showing some type of progression toward matching our population."

Gnankang Sarah Napoe, MD, who was not involved in the study, said in an interview that she was saddened by the new findings and believes that if the decline in Black residents continues it would exacerbate racial disparities in obstetric and gynecological care.

"I think recruitment should focus more on specifically recruiting [underrepresented] populations of students into our field, because we know that they are a crucial part of narrowing the health disparities," said Napoe, assistant professor in the department of obstetrics and gynecology and reproductive sciences at the University of Pittsburgh.

Significant health disparities exist within women's health and ob.gyn. care, with Black, American Indian, and Alaska Native women being two to three times more likely to have a pregnancy-related death than White women, according to the Centers for Disease Control and Prevention.

In an solicited commentary on the study, ob.gyns. from the University of Southern California, Los Angeles, referred to the declining population of Black ob.gyn. residents as "a failure of the medical education system to adapt to the changing demographic needs of its patients and cultivate diversity within the academic pipeline."

One approach to addressing these health disparities is by increasing the diversity among health care practitioners. A 2020 study published in JAMA Network Open found that a shared identity between the physician and patient is linked to increased patient satisfaction and higher levels of trust.

"We know that, within ob.gyn., there are higher proportions of minority physicians, but just because we know that doesn't mean that we're doing everything right," Lopez said. "When we look at the bigger picture, we're not actually seeing the change we want to see. We need to not be complacent and keep evaluating ourselves, because I think that's how you change."

The authors and editorialists disclosed no relevant financial relationships.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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