Change is Happening: An Evaluation of Gender and Race Disparities in Academic Plastic Surgery
Brandon T. Smith, MS, Francesco M. Egro, MBChB, MSc, MRCS, Carolyn P. Murphy, BA, Alex G. Stavros, BA, Elizabeth M. Kenny, BS, Vu T. Nguyen, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
PURPOSE: Gender and race disparities in academic plastic surgery are known, but in recent years a change in culture has been promoted by professional societies. This study aims to evaluate the effects of these changes at faculty and leadership positions.
METHODS: A cross-sectional study was conducted in June 2018 to evaluate minority representation among academic plastic surgery faculty of programs accredited by the Accreditation Council for Graduate Medical Education. A search of the ACGME program listings identified current accredited plastic surgery training programs (n = 140). Institutions identified to have either an integrated residency or an independent plastic surgery fellowship or both were unified under a single listing with duplications removed (n = 100). Corresponding institution websites were located for all but one of the listed programs (n = 99). Faculty directories on these websites were utilized to identify the cohort of the study, which included clinical, adjunct, and tenure- and non-tenure-track plastic surgery faculty belonging to each institution. Faculty without plastic surgery training, emeritus professors, and research faculty without medical degrees were excluded from the analysis. Online faculty profiles, Doximity, LinkedIn, private-practice, and public records websites were used to obtain additional faculty data. 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 be an assistant professor [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)]. After adjustment for years of post-residency experience, only disparities at the full professor position remained [OR:0.34; (95%CI:0.16-0.47)], highlighting the importance of cohort experience.
Non-white plastic surgeons held 25.1% of all academic positions. Non-white plastic surgeons were significantly less likely to hold the full professor position [OR:0.60, (95%CI:0.14-0.88)], despite being more likely to have had 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).
CONCLUSION: As these faculty cohorts mature, a more equitable distribution of career outcomes may occur. However, the unequal appointment and advancement of faculty by program leadership indicates there are still issues which must be addressed.
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