Change is Happening: Evaluation of Gender and Race Disparities in Academic Plastic Surgery
Brandon T. Smith, MS, Francesco M. Egro, MBChB, MSc, MRCS, Alex Stavros, BA, Carolyn Murphy, BA, Vu T. Nguyen, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
BACKGROUND: Historic gender and ethnic disparities in the field of academic plastic surgery are well documented. National governing bodies in plastic surgery have made a concerted effort to highlight and reverse these disparities. However, the impact of their efforts is unknown. Therefore, the aim of this study was to measure current race and gender representation in academic plastic surgery, quantify group differences in the pre-career pathways to these positions, and understand the short and long-term effects of recent policy changes. We hypothesized that female and non-white plastic surgeons would have less representation at the full professor and program chair positions.
METHODS: A comprehensive database characterizing all current academic plastic surgeons participating in certified residency programs was created by cross-referencing 2018 ACGME program reports with online faculty website listings. Nine-hundred and thirty-one faculty met inclusion criteria and were included in the study. Group comparisons were made using student’s t-test and Chi-squared test, where appropriate.
RESULTS: Overall, women represented 19.8% of all academic plastic surgeons. Female academic plastic surgeons were significantly more likely to hold an assistant professor position [OR: 2.19, (95% CI: 1.58-3.05)], and significantly less likely to be a full professor [OR: 0.20, (95% CI: 0.11-0.35)] or program chair [OR: 0.32, (95% CI: 0.16-0.65). When assessed as an overall cohort 58.2 percent of current female academic plastic surgeons have 10 or fewer years of post-residency experience, compared to 37.9 percent of all male academic plastic surgeons. When measured against male averages, just 8.2 percent of women have post-residency experience equal-to or exceeding the chair position (24 years) compared to 27.1 percent of men.
Non-white plastic surgeons held 25.1% of all academic positions. Non-white plastic surgeons were significantly less likely than whites to hold a full professor position [OR: 0.60, (95% CI: 0.14-0.88)], despite being significantly more likely to have prior fellowship training [OR: 1.62, (95% CI: 1.16-2.26)] and microsurgery fellowship training [OR: 1.78, (95% CI: 1.24-2.54)]. Programs with a non-white chair had a significantly greater proportion of non-white faculty (40.5% versus 20.5%; p < 0.0001) and more equitable career outcomes for non-white faculty (Non-white chair = 22.7% increase in non-white full-professors; p < 0.0001).
CONCLUSIONS: As these faculty cohorts mature, a more equitable distribution of career outcomes is expected. However, the unequal appointment and advancement of faculty based on the ethnicity of program leadership indicates there are still diversity issues in the field which must be addressed.
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