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Cook, Thomas P. MD
Health care institutions are creating or expanding diversity programs to address deficiencies relative to gender, ethnicity, and sexual orientation. Graduate medical education is particularly interested in recruiting underrepresented minorities (URMs). This effort is more complex than what I can cover in this space. Centuries of racial oppression are difficult to unwind quickly in a profession that takes more years of education than any other in society.
My goal was to find effective methods to improve my program’s diversity. I asked to join the diversity subcommittee for GME at my institution; our aim is to develop strategies to increase the number of URM graduates from our programs. South Carolina has a relatively large number of Black citizens (27% of the population, according to the U.S. Census Bureau; https://bit.ly/3n55gnx), but we struggle to matriculate Black doctors into our residencies.
My assignment on the committee was to investigate the number of URMs currently in residency training, regionally and nationally. My analysis indicates that we have a long way to go and that it will be challenging to get more URMs into EM residency training in the near future.
The Association of American Medical Colleges provides an annual Report on Residents. (2021; https://bit.ly/3G5Hu1T.) One section entitled “Number of Active Residents by Race/Ethnicity (Alone or In Combination) and GME Specialty” shows the number of residents from different ethnic groups in every residency and fellowship by specialty.
A summary of the ethnic makeup of all allopathic and osteopathic residents compared with the United States population is seen in Table 1. Based on this information, Hispanic and Blacks are the most underrepresented minorities relative to all graduate medical education in the United States. The deficiency in URMs in emergency medicine is similar to most other residency and fellowship programs. (Table 2.)
The total numbers of Hispanic and Black residents in emergency medicine programs in the 2020-2021 academic year were 679 and 456, respectively. If these URM residents were divided equally among the approximately 270 programs in operation at that time, that would mean 2.5 Hispanic and 1.7 Black residents per program (not just a single class). If the percentage of these URMs matched the United States population, more than double the number of residents would be in each program for each racial group.
I suspect all emergency medicine residency programs actively recruit URM applicants. Many of them offer monetary stipends as incentives for URM applicants to rotate with their program in the months leading up to the interview season. Applicants usually develop relationships with residents and attendings during these rotations, and it is not unusual that many applicants who match into a given residency class rotated at the program before the match.
With a limited number of URM applicants in the match pool, however, most programs only maintain or slightly improve their number of URM residents. The pinch point for increasing the number of Hispanic and Black residents appears to be the number of URMs in medical school.
A review of the AAMC data on the race and ethnicity of U.S. medical students demonstrated an increasing number of Hispanic and Black men and women entering allopathic medical schools. (Table 3.) It is a slow process. The percentage of Black allopathic students increased from seven to eight percent over the past five years. The increase was from six to seven percent for Hispanic allopathic students.
Given that the process to complete medical school is at least eight years, the slow rate of change is understandable, but the urgency we feel now in light of recent events could dissipate if we are not vigilant to guard against becoming distracted by other issues. We must also not let slow progress at recruiting URMs challenge our ability to stay focused on this issue.
The percentage of URMs pursuing emergency medicine training is comparable with other specialties, but we must find strategies to attract more of them into our field. The current oversupply of EM residency positions and concerns about the future job market work against our efforts to increase diversity.
None of these obstacles is an excuse to give up trying. We need to understand that the bottleneck to more URM applicants is their entrance into medical schools and maintain our vigilance at correcting the problem. Anything we can do to encourage higher URM enrollment will help us in the future.
Dr. Cookis the program director of the emergency medicine residency at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter@3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.
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