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The Evolution of Racial and Ethnic Diversity in U.S. Urology Residency Programs
Manuel Ozambela, MD1, Michael Zavaski, MD2, Nawar Hanna, MD2, Valary T. Raup, MD2, Alejandro Sanchez, MD3, Douglas S. Smink, MD, MPH2, Steven L. Chang, MD,MS2.
1Harvard Medical School, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA, 3Massachusetts General Hospital, Boston, MA, USA.

BACKGROUND: The U.S is becoming increasingly diverse. Underrepresented minorities (URMs), defined as African-American, Hispanic, and other (Native American and multi-racial) currently constitute 32.7% of the population and are predicted to exceed 50% by 2060. Increased racial/ethnic diversity in medicine has been associated with positive health outcomes attributed to increased access to healthcare for underserved communities, improved anticipation of patients needs, and acceleration of research. Our aim was to examine trends in racial/ethnic diversity among urology training programs in the U.S.
METHODS: We obtained data from the US graduate medical education reports published in the Journal of the American Medical Association annually from 1995 to 2013. In addition, we queried the 2014 AUA Census Public Microdata file to evaluate the racial and ethnic makeup of the current urologic work force following residency training. We used descriptive statistics to evaluate trends in racial/ethnic diversity by calculating the change in the proportion of trainees from underrepresented groups over time, and we used these data to compare urology to other surgical and medical residencies. A logistic regression model was developed to evaluate the relationship between URM and practice in an academic setting.
RESULTS: We found less racial/ethnic diversity among urology trainees over the past 20 years compared to other specialties. Although the proportion of URMs in urology increased from 7.03% in 1995 to 12.1% in 2013 (Figure 1), urology consistently trailed behind other surgical and medical specialties. The gap in URM representation did narrow, however, by the end of the study. Our adjusted model showed that URM graduates of urology training programs were far less likely to work in an academic practice (adjusted OR: 0.18, 95% CI: 0.08 to 0.42, p<0.0001).
CONCLUSIONS: While some gains have been made since 1990 concerning racial/ethnic diversity in Urology, there continues to be fewer URMs in urology residency programs compared to other disciplines. This disparity may be aggravated by the absence of mentorship due to the limited number of URM urologists in academics. With the anticipated changes in the demographics of the U.S, further investigation is needed to understand the barriers for URMs to enter the field of Urology.


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