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Review
. 2024 Nov 2:8:27550834241293022.
doi: 10.1177/27550834241293022. eCollection 2024 Jan-Dec.

Aligning our actions with our words: A systematic review of gender and racial diversity in surgical subspecialties

Joshua E Lewis  1 , Lornee C Pride  1 , Hannah G Luk  1 , Kafayat Oyejide  1 , Isha M Wilson  2 , Winston E Tawiah  1 , Cale M Watkins  1 , Wei-Chen Lee  3
Affiliations
Review

Aligning our actions with our words: A systematic review of gender and racial diversity in surgical subspecialties

Joshua E Lewis et al. J Med Access. .

Abstract

Introduction: Persistent racial and gender disparities are prevalent within the higher education and medical training system, notably seen in the underrepresentation of Hispanic or Latinos, Black Americans, and female surgeons compared to their respective population proportions. This study aims to quantify publications addressing ethnic or gender diversity across various surgical specialties, analyze publication trends, and explore specific topics within medical literature.

Database: The Database includes PubMed, Google Scholar, and Scopus.

Methods: Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a systematic literature review utilizing the PubMed, Google Scholar, and Scopus databases. A broad inclusion criterion for both ethnic and gender diversity of plastic surgery, neurosurgery, otolaryngology, dermatology, orthopedic surgery, and gender surgery was utilized. The literature was selected between 2014 and 2024. In the content of our study, diversity in articles was defined as any article that focused on addressing gender or racial/ethnicity in the subspecialty.

Results: Of 1529 initially screened articles, 346 were included. Orthopedic surgery had the most diversity publications (n = 86), followed by general surgery (n = 67) and plastic surgery (n = 51). Significant increases in diversity publications were observed across all specialties. Orthopedic surgery showed the highest growth (+0.17 publications/year, p < 0.001), followed by plastic surgery (+0.12, p = 0.002) and general surgery (+0.11, p = 0.003). Race/ethnicity was the primary focus (51.4%), with fewer articles on gender (19.7%) or both (28.9%). Diversity topics included demographics, pipeline/recruitment, application process, training experience, leadership, and workplace treatment.

Conclusion: These insights underscore the importance of continued efforts to promote diversity within surgical specialties to enhance patient care and outcomes. Further research and initiatives are needed to ensure equitable representation in surgical fields. Addressing diversity issues in surgical specialties is essential for improving healthcare outcomes and reducing disparities.

Keywords: Gender diversity; healthcare disparities; racial diversity; subspecialty; surgery.

Plain language summary

Investigating Diversity in Medical Specialties for Race, Ethnicity, and Gender Diversity in the medical community, particularly among physicians, plays a crucial role in improving patient outcomes and access to care for minority communities. However, there is a significant lack of diversity in surgical subspecialties like general surgery, neurosurgery, plastic surgery, orthopedic surgery, otolaryngology, and dermatology. This gap is evident when comparing the general US population demographics to the makeup of surgeons. For example, while 13.6% of the US population are Black and 19.1% are Hispanic, only 2.25% of surgeons are Black and 5.3% are Hispanic. A review of published journal articles from 2014 to 2024 aimed to understand the focus of diversity within these subspecialties. It found that orthopedic surgery had the highest number of publications on diversity (86 articles), followed by general surgery (67 articles) and plastic surgery (51 articles). There was a significant increase in diversity-related publications over time. The study categorized these articles into six main topics: demographics, pipeline/recruitment, application process, training experience, leadership, and workplace treatment. Most articles (51.4%) focused on race/ethnicity diversity, 19.7% on gender diversity, and 28.9% on both. Orthopedic surgery and general surgery had the most articles on race/ethnicity, while general surgery and orthopedics led to gender diversity publications. Plastic surgery had the highest number of articles addressing both race/ethnicity and gender. Despite these efforts, neurosurgery lagged in diversity publications, reflecting the low representation of women and minorities in this field. Initiatives like Nth Dimensions and the American Society of Plastic Surgery’s diversity efforts have shown promise in increasing diversity among applicants and practitioners. To address healthcare disparities, a diverse physician workforce is essential. Increased representation can improve patient trust, adherence to treatment, and overall health outcomes, particularly in underserved areas.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart detailing study selection process.
Figure 2.
Figure 2.
Number of articles discussing ethnic and/or gender diversity by subspecialties.
Figure 3.
Figure 3.
Number of articles regarding diversity in ethnic or gender by year.
Figure 4.
Figure 4.
Publications for each specialty by diversity topic.
Figure 5.
Figure 5.
Number of articles categorized by different topics discussing diversity in all surgical subspecialties.
Figure 6.
Figure 6.
Number of articles categorized by different topics discussing diversity in each surgical subspecialties.
See this image and copyright information in PMC

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