R. Udyavar1, D. Smink1, J. Mullen3, T. Kent2, W. A. Davis1, A. Green3, N. Changoor1,2,4, A. Haider1 1Brigham And Women’s Hospital,Boston, MA, USA 2Beth Israel Deaconess Medical Center,Boston, MA, USA 3Massachusetts General Hospital,Boston, MA, USA 4Howard University College Of Medicine,Washington, DC, USA
Introduction:
Racial discordance between patients and providers is associated with poor patient satisfaction, decreased compliance, and overall worse health care outcomes in minority patients. General surgery and surgical subspecialties appear consistently less diverse than other medical disciplines, but the degree of racial discordance observed among surgeons has not been quantified. We sought to establish the degree of racial dissimilarity between surgical patients and surgeons in training, to determine if potential differences would be decreasing as the surgical workforce diversifies.
Methods:
Racial demographic information for patients who underwent one or more representative inpatient surgical procedures, which were categorized according to the clinical classifications software (CCS), was obtained from the Nationwide Inpatient Sample (NIS) (2005-2011). These data were compared to the racial demographic information for residents on duty in General Surgery, Neurologic Surgery, Otolaryngology, Orthopedic Surgery, and Urology, as well as Integrated Cardiothoracic, Vascular, and Plastic and Reconstructive Surgery programs as reported by the corresponding annual Graduate Medical Education (GME) surveys.
Results:
Across all surgical disciplines, Black and Hispanic residents were consistently underrepresented relative to the patient population. Black patients represented 11.46% of all patients who underwent one or more of the selected procedures, but Black residents constituted only 3.38% of surgical residents on duty (p<0.001). Hispanic patients comprised 9.79% of surgical patients, while only 1.25% of surgical residents were Hispanic (p=0.001). Asian/Pacific Islander patients comprised only 2.29% of surgical patients, while 18.16% of surgical residents were Asian/Pacific Islander (p<0.0001). There was no observed difference between White surgery residents and White patients (65.88% and 72.63%, p=0.08). Among all the surgical subspecialties, the Orthopedic Surgery work force was the most racially discordant, with Blacks (p<0.0001), Hispanics (p<0.0001), and Native Americans (p=0.0127) disproportionately underrepresented. Over the 7-year study period, no upward trend was seen in the percentages of Black, Hispanic, or Native American general surgical residents, while the percentages of White and Asian/Pacific Islander residents continued to increase.
Conclusion:
Despite efforts to encourage racial diversity among health care professionals, including with resident recruitment, general surgery and surgical subspecialties remain more racially homogenous than the surgical patient population. We found no evidence to suggest that diversity is increasing over time. Quantifying racial discordance in surgery reinforces the importance of augmenting recruitment efforts to achieve a more racially balanced cohort of surgical residents, as well as incorporating cultural competency training, in order to mitigate racial disparities in surgical care.