Meghan B Lane-Fall1, Todd A Miano, Jaya Aysola, John G T Augoustides. 1. 1Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 2Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 3Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. 5Robert Wood Johnson Foundation, Harold Amos Medical Faculty Development Program, Indianapolis, IN. 6NIH-NHLBI PRIDE Research in Implementation Science for Equity, San Francisco, CA. 7Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 8Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, Philadelphia, PA. 9Office of Diversity and Inclusion, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Abstract
OBJECTIVES: Diversity in the physician workforce is essential to providing culturally effective care. In critical care, despite the high stakes and frequency with which cultural concerns arise, it is unknown whether physician diversity reflects that of critically ill patients. We sought to characterize demographic trends in critical care fellows, who represent the emerging intensivist workforce. DESIGN: We used published data to create logistic regression models comparing annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. SETTING: United States Accreditation Council on Graduate Medical Education-approved residency and fellowship training programs. SUBJECTS: Residents and fellows employed by Accreditation Council on Graduate Medical Education-accredited training programs from 2004 to 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2004 to 2014, the number of critical care fellows increased annually, up 54.1% from 1,606 in 2004-2005 to 2,475 in 2013-2014. The proportion of female critical care fellows increased from 29.5% (2004-2005) to 38.3% (2013-2014) (p < 0.001). The absolute number of black fellows increased each year but the percentage change was not statistically significantly different (5.1% in 2004-2005 vs 3.9% in 2013-2014; p = 0.92). Hispanic fellows increased in number from 124 (7.7%) in 2004-2005 to 216 (8.4%) in 2013-2014 (p = 0.015). The number of American Indian/Alaskan Native/Native Hawaiian/Pacific Islander fellows decreased from 15 (1.0%) to seven (0.3%) (p < 0.001). When compared with population estimates, female critical care fellows and those from racial/ethnic minorities were underrepresented in all years. CONCLUSIONS: The demographics of the emerging critical care physician workforce reflect underrepresentation of women and racial/ethnic minorities. Trends highlight increases in women and Hispanics and stable or decreasing representation of non-Hispanic underrepresented minority critical care fellows. Further research is needed to elucidate the reasons underlying persistent underrepresentation of racial and ethnic minorities in critical care fellowship programs.
OBJECTIVES: Diversity in the physician workforce is essential to providing culturally effective care. In critical care, despite the high stakes and frequency with which cultural concerns arise, it is unknown whether physician diversity reflects that of critically illpatients. We sought to characterize demographic trends in critical care fellows, who represent the emerging intensivist workforce. DESIGN: We used published data to create logistic regression models comparing annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. SETTING: United States Accreditation Council on Graduate Medical Education-approved residency and fellowship training programs. SUBJECTS: Residents and fellows employed by Accreditation Council on Graduate Medical Education-accredited training programs from 2004 to 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2004 to 2014, the number of critical care fellows increased annually, up 54.1% from 1,606 in 2004-2005 to 2,475 in 2013-2014. The proportion of female critical care fellows increased from 29.5% (2004-2005) to 38.3% (2013-2014) (p < 0.001). The absolute number of black fellows increased each year but the percentage change was not statistically significantly different (5.1% in 2004-2005 vs 3.9% in 2013-2014; p = 0.92). Hispanic fellows increased in number from 124 (7.7%) in 2004-2005 to 216 (8.4%) in 2013-2014 (p = 0.015). The number of American Indian/Alaskan Native/Native Hawaiian/Pacific Islander fellows decreased from 15 (1.0%) to seven (0.3%) (p < 0.001). When compared with population estimates, female critical care fellows and those from racial/ethnic minorities were underrepresented in all years. CONCLUSIONS: The demographics of the emerging critical care physician workforce reflect underrepresentation of women and racial/ethnic minorities. Trends highlight increases in women and Hispanics and stable or decreasing representation of non-Hispanic underrepresented minority critical care fellows. Further research is needed to elucidate the reasons underlying persistent underrepresentation of racial and ethnic minorities in critical care fellowship programs.
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