Black, Native American and Alaskan Native women are three to four times more likely to have a pregnancy-related death when compared with white women, according to the Centers for Disease Control and Prevention (CDC), which tracks pregnancy-related deaths in the United States.
One approach to addressing these health care disparities among minority women in obstetrics and gynecology is to increase diversity among health care providers to better reflect the patient population they serve.
Through this lens, UC Davis Health researchers studied the current demographics among medical residents in the United States. The study gauged how the diversity within obstetrics and gynecology compares to other medical specialties and how the workforce reflects the patient population. The findings were published this month by the JAMA Network.
Led by Claudia López, a UC Davis obstetrics and gynecology resident, the researchers used JAMA Medical Education reports from 2014 to 2019 to examine the race and ethnicity among OB/GYN, surgical and nonsurgical residents.
Surgical residents were from specialty areas including colon and rectal surgery, neurological surgery, ophthalmology, orthopedic surgery, otolaryngology and plastic surgery. Nonsurgical residents worked in specialties including allergy and immunology, anesthesiology, dermatology, emergency medicine, family medicine and internal medicine.
A total of 520,116 medical residents were included in this study. The findings were as follows:
- For each year, OB/GYN, surgical and nonsurgical residents most commonly identified as white (for example, in 2014-2015, 59.3%), followed by Asian (for example, in 2014-2015, 26.6%). Native American or Alaskan Native and Native Hawaiian or Pacific Islander residents were the least represented in all residency categories (for example, in 2014-2015, 0.3%).
- The racial and ethnic composition of residents varied among OB/GYN, surgical and nonsurgical specialties each year. A higher proportion of OB/GYN residents identified as Black (e.g. in 2014-2015, 10.2%) or Hispanic (e.g. in 2014-2015, 9.6%), compared with surgical (in 2014-2015, Black residents were at 4.7% and Hispanic residents were at 7%) and nonsurgical specialties (in 2014-2015, Black residents were at 5.8% while Hispanic residents were at 7.6%).
- Across the five-year period, among OB/GYN residents, there was a decrease in white and Black residents and an increase in those categorized as other or unknown race/ethnicity. In surgical specialties, there were decreases in white and Black residents and increases in multiracial and other or unknown residents. Among nonsurgical residents, there was a decrease in white and Asian residents, while there was an increase in multiracial, other or unknown, and Hispanic residents.
“Despite the overall larger proportions of Black and Hispanic residents in OB/GYN, the larger trends of stagnant or decreasing rates of underrepresented minority residents are concerning, indicating that more work is needed to recruit and retain these residents,” López said.
López suggested that to reverse these trends, assessing the pathway for minorities in OB/GYN and the minority experience during training should take place at multiple milestones: grade school, undergraduate school, medical school and residency training.
“It is important not to become complacent. We must assess why this decrease in underrepresented minority physicians is occurring and find ways to address it,” López added.
Co-authors included Machelle Wilson from the UC Davis Division of Biostatistics; Melissa Chen, associate director of the fellowship in complex family planning at UC Davis Health; and Melody Hou, director of medical student education in obstetrics and gynecology at UC Davis Health.