A. Saif1, A. L. Sarvestani1, A. R. Copeland1, S. Gupta1, M. L. Shindorf1, S. M. Steinberg1, A. M. Blakely1, J. M. Hernandez1 1National Cancer Institute, Surgical Oncology, Bethesda, MD, USA
Introduction:
The changing landscape of the surgical workforce and the dynamics of gender inequality have been heavily publicized in the surgical community. Gender parity may exist for medical schools in the U.S., but proportionally fewer women enter surgical specialties. Data regarding sex-based trends in surgical fellowship matriculation remain poorly defined with the latest study on demographics of General Surgery (GS) residents pursuing surgical fellowship having been published in 2008.
Methods:
Data were provided by the Association of American Medical Colleges (AAMC) from the Electronic Residency Application Service (ERAS). Applicants and matriculants to categorical GS residency positions and fellowship programs (Complex General Surgical Oncology, Pediatric, Cardiothoracic, Vascular, and Colorectal Surgery) were reported. Only graduates of U.S. medical schools are reported. The data were stratified by applicant-reported sex. Statistical analyses were performed using SAS®9.4 (SAS Institute, Cary, NC). A Cochran-Armitage test for trend was used to evaluate change in the distribution of male and female matriculants over time. Match rates by sex were calculated as a ratio of matriculants to all applicants for each program and compared across years using a two-tailed Fisher’s exact test and z-test of proportions.
Results:
From 2008-2019, 23,225 U.S. medical students applied to GS, including 8,898 females (38%) and 14,314 (62%) males. Categorical GS positions were secured by 48% of applicants. Match rates were higher for female applicants (54% versus 44%; p<0.05). Sex parity among matriculants significantly improved over time (p=0.003), with females comprising 43% of matriculants overall (annual range 41.5-48.5%; Figure 1a).
From 2008-2018, 3,320 GS graduates applied to U.S. fellowship positions, including 1,167 (35%) females and 2,152 (65%) males. Fellowship positions were secured by 81% of applicants. A significantly lower proportion of females applied to fellowship compared to residency (p<0.05). Match rates were lower for females than males (76% versus 84%; p<0.05). Sex parity among fellowship matriculants significantly improved over time (p=0.002), with females comprising 33% of matriculants overall (annual range 25-38%). The subspecialty fellowships that demonstrated the greatest degree of sex parity were Complex General Surgical Oncology, Colorectal, and Pediatric Surgery (Figure 1b-f).
Conclusion:
Over time, the sex gap has narrowed, with increasing numbers and proportions of female applicants matriculating into GS residencies. Additionally, there was a narrowing of the sex gap at the surgery fellowship level, best exemplified by Pediatric and Colorectal Surgery.
