Diversity of Pain Medicine Trainees and Faculty in the United States: A Cross-Sectional Analysis of Fellowship Training from 2009-2019

Abstract

Objective: Diversity and equity in medicine remain pivotal to care delivery. Data analysis on sex and racial diversity of pain medicine fellowship trainees and faculty in the United States are scant. We sought to characterize demographic and retention patterns among pain medicine fellows and faculty, who represent the emerging chronic pain management workforce.

Design: cross-sectional retrospective analysis.

Method: We conducted an analysis of data from the American Association of Medical Colleges (AAMC) and the United States Accreditation Council on Graduate Medical Education (ACGME)-approved residency and fellowship training-programs for each year from 2009 through 2019, inclusively. We compared changes in sex, racial/ethnicity composition and retention rates of fellows and faculty in the United States by practice setting.

Results: From 2009 to 2019, there was a 14% increase in the number of ACGME pain fellowship programs. From 2009 to 2019, the ratio of men to women pain fellows ranged from 5:1 to 3.7:1. Compared with their self-identified White peers, Asian (OR 0.44; 95% CI: 0.34-0.58), Black (OR 0.46; 95% CI: 0.30-0.72), and Native American/Alaskan Native (OR 0.26; 95% CI: 0.08-0.80) identifying individuals had significantly lower odds of being a pain fellow, P < 0.05. There was no significant difference in female (OR = 0.4, 95% CI: 0.148-1.09) and Black (OR 0.36; 95% CI: 0.11-1.12) program-directors. Pain-fellow in-state retention was 53%.

Conclusions: The demographics of pain medicine training programs reflect a persistent male vs. female gap with underrepresentation of racial minorities. Further research is needed to elucidate reasons underlying these disparities.

Keywords: Diversity; Faculty; Fellows; Pain Medicine; Race; Sex.

Figure 1

Characteristics of Training Program and Changes in ACGME Pain Medicine Fellowships from 2009–2019. A) Figure shows trends in the number of pain fellows and fellowship programs from 2009 through 2019. B) Figures shows number of ACGME programs by program setting in 2018–2019 academic yea. Sources: https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2019/executive-summary

Figure 2

Distribution of trainees and fellowship program directors in pain medicine in 2018 by race and ethnicity. Sources: https://www.census.gov/acs/www/data/data-tables-and-tools/data-profiles/ https://www.aamc.org/data-reports/students-residents/interactive-data/2019-facts-applicants-and-matriculants-data https://www.aamc.org/system/files/d/1/92-applicant_and_matriculant_data_tables.pdf https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2019/executive-summary https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/02/Program-Results-SMS-2016-2020.pdf

Figure 3

Distribution of pain fellows from 2009-2019 and pain fellowship program directors in 2018–2019 by sex. A) Shows the percent distribution of fellows by sex from 2009 through 2019. B) Shows sex of AGME pain fellowship program director in the 2018-2019 academic year. Source: https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book

Figure 4

Career outcomes of those who have completed pain fellowship. A) Shows the practice location of practicing physicians who completed fellowship training from 2009 through 2018. B) Shows distribution of physicians who completed fellowship training from 2009 through 2018 and currently practicing in vs. out of the state where they trained. C) In vs. Out of State retention by Sex. D) Faculty appointment status of physicians who completed fellowship training from 2009 through 2018. E) Academic rank of physicians who completed fellowship training from 2009 through 2018. Sources: https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2019/table-c2-number-individuals-who-completed-residency-and-are-practicing https://www.ama-assn.org/practice-management/masterfile/ama-physician-masterfile https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2019/table-c4-physician-retention-state-residency-training-last-completed-gme https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2019/table-c7-full-time-faculty-appointment-status-us-medical-schools-residents