Diversity Within the Most Competitive Internal Medicine Fellowships: Examining Trends from 2008 to 2018

Abstract

Background: Prior studies have demonstrated the importance of diversity among physicians. Identifying trends in diversity within the most competitive internal medicine (IM) fellowships can guide focused efforts to address barriers to equal representation.

Objective: To examine the racial and gender composition of resident applicants and accepted fellows to the top five most competitive IM specialties.

Design: Survey data from the AAMC, JAMA, and NRMP were obtained. Fisher's exact tests were conducted to compare differences in representation between fellows in the most competitive specialties, resident applicants into those specialties, and categorical IM residents. Linear regression was used to analyze trends within each group.

Participants: Categorical IM residents and fellows at ACGME-accredited M.D. programs in the USA.

Main measures: Proportion of each population by gender and race/ethnicity KEY RESULTS: Women saw an increase in representation among accepted fellows to the most competitive IM fellowships from 2008 to 2013 (+ 4.4%, p < 0.011), but the trend has since plateaued at a level (34%) significantly lower than their representation among IM residents (43%, p < 0.001). Black representation among accepted fellows (4.6%) has been increasing from 2008 to 2018 (+ 1.2%, p = 0.001), but is still significantly lower than their representation among IM residents (5.6%, p < 0.001). Hispanic resident applicant and fellow representation have seen minimal change.

Conclusion: Despite trends towards better representation among women and underrepresented minorities (URMs) among fellows in the most competitive IM specialties from 2008 to 2013, there has been a stagnation in both gender and racial diversity over the past 5 years. Further efforts must be undertaken to address barriers to entry and advocate for better representation of women and URMs in fellowship programs.

Keywords: diversity; fellowship; medical education; medical students; residents.

Fig. 1

Female, Black, and Hispanic representation at each stage of training from categorical internal medicine residents to resident applicants to fellows in the top 5 most competitive IM specialties in 2017. All groups continue to face decreasing representation when moving from IM residency to fellowship in the most competitive fields.

Fig. 2

Female (a), Black (b), and Hispanic (c) representation at each stage of training from internal medicine residents to fellows in the top 5 most competitive IM specialties from 2008 to 2018. The data show a plateau in resident applicants to fellowships and fellows among all three groups from 2014 to 2018 at levels of representation lower than at the categorical IM residency level.

Fig. 3

Female, Black, and Hispanic representation from categorical IM residents to accepted fellows in the top 5 most competitive IM specialties broken down by fellowship for 2017. Dotted line indicates representation at the IM resident level. *Significantly lower representation than at the IM resident level (p < 0.05).