Abstract
This study compares postgraduate trainee racial, ethnic, and gender representation and faculty compensation for 21 clinical specialties using 2015-2022 data.
Clinical specialties differ in workforce diversity and compensation.1 A study of trainees in 12 specialties from 2011 to 2018 found racial and gender diversity was inversely associated with compensation.2 Concern for health care workforce inequities, including racial and gender differences in trainee attrition,3 justify study of newer and more comprehensive data. We compared clinical specialty postgraduate trainee representation and faculty compensation using 2015-2022 data.
Methods
We conducted a cross-sectional analysis of trainee racial, ethnic, and gender representation and faculty compensation for 21 clinical specialties (Table 1; eMethods 1 and 2 and eTable in Supplement 1). Trainees self-reported their race and ethnicity as Asian; underrepresented in medicine (URiM; defined as African American, Alaska Native, American Indian, Hispanic, Latino, and Native Hawaiian or Other Pacific Islander); White; other; or unknown. Those who did not report their race and ethnicity were categorized as unknown. Trainees self-reported gender as woman, man, or nonbinary or did not report their gender.
Table 1. Racial, Ethnic, and Gender Trainee Representation for 21 Clinical Specialties, 2015-2022a.
| Specialty | Race and ethnicity representationb | Gender representationc | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Asian | Underrepresented in medicined | White | Men | Women | ||||||
| Trainees | Median, % (IQR) | Trainees | Median, % (IQR) | Trainees | Median, % (IQR) | Trainees | Median, % (IQR) | Trainees | Median, % (IQR) | |
| Overall | 152 311 | 18.8 (14.6-22.4) | 90 660 | 9.7 (7.8-13.6) | 350 621 | 50.9 (46.6-55.7) | 407 487 | 59.3 (48.8-66.2) | 347 076 | 39.9 (32.8-49.6) |
| Surgical specialtiese | 25 865 | 15.0f (12.3-20.3) | 19 665 | 8.5f (6.3-11.7) | 97 449 | 55.0f (50.8-58.0) | 98 688 | 61.3f (58.2-76.7) | 77 517 | 36.9f (23.1-40.8) |
| General surgery | 8712 | 12.2 (12.0-18.4) | 7057 | 9.7 (9.5-15.1) | 30 638 | 47.4 (46.6-55.6) | 34 793 | 57.7 (55.5-59.6) | 24 345 | 38.9 (36.5-43.9) |
| Neurosurgery | 1804 | 15.5 (14.4-22.6) | 1023 | 8.5 (8.4-12.4) | 5371 | 50.8 (49.9-55.6) | 8237 | 81.4 (79.2-81.8) | 1920 | 17.6 (17.3-20.4) |
| Obstetrics and gynecology | 4570 | 10.4 (9.6-15.2) | 6064 | 14.7 (13.7-18.3) | 20 817 | 52.9 (48.9-58.0) | 6148 | 16.1 (14.8-16.7) | 32 318 | 81.9 (81.6-84.6) |
| Ophthalmology | 2680 | 22.5 (21.9-30.9) | 761 | 6.3 (5.8-9.5) | 5399 | 50.8 (50.3-52.6) | 6223 | 59.3 (58.1-59.6) | 4306 | 40.6 (40.2-41.8) |
| Orthopedic surgery | 2940 | 9.3 (8.8-12.4) | 2319 | 6.4 (6.2-10.8) | 18 246 | 61.5 (57.8-69.6) | 23 743 | 82.8 (82.2-83.0) | 4481 | 14.7 (14.0-16.7) |
| Otolaryngology | 1976 | 15.2 (14.5-22.1) | 816 | 6.1 (5.3-9.0) | 6498 | 55.4 (54.5-59.2) | 7153 | 62.4 (62.0-63.1) | 4200 | 35.7 (35.4-37.4) |
| Plastic surgery | 1265 | 14.3 (12.9-20.1) | 702 | 7.9 (7.4-10.5) | 4410 | 53.5 (53.4-59.0) | 4767 | 59.8 (59.0-60.6) | 3142 | 38.6 (37.3-40.6) |
| Urology | 1918 | 16.8 (15.4-22.2) | 923 | 7.6 (6.2-11.1) | 6070 | 58.1 (56.8-59.0) | 7624 | 73.9 (71.3-75.0) | 2805 | 25.5 (24.6-28.5) |
| Nonsurgical specialtiese | 126 446 | 20.4f (17.5-23.9) | 70 995 | 10.4f (8.6-14.1) | 253 172 | 49.3f (42.2-52.2) | 308 799 | 53.6f (46.7-64.0) | 269 559 | 43.8f (34.8-51.5) |
| Anesthesiology | 9178 | 17.9 (17.4-25.1) | 4740 | 9.1 (8.1-13.0) | 21 882 | 46.2 (44.3-51.7) | 29 826 | 64.6 (64.0-66.2) | 15 413 | 33.4 (32.8-34.6) |
| Dermatology | 1837 | 16.0 (13.7-21.7) | 891 | 6.8 (6.3-11.5) | 6087 | 57.7 (56.0-58.1) | 4106 | 39.2 (36.1-40.8) | 6499 | 60.7 (58.9-63.5) |
| Diagnostic radiology | 7307 | 21.0 (20.3-26.7) | 2761 | 8.0 (6.9-11.2) | 17 070 | 52.9 (51.2-53.1) | 23 850 | 73.1 (72.9-73.5) | 8643 | 26.5 (26.0-26.7) |
| Emergency medicine | 6597 | 11.1 (10.1-14.8) | 6004 | 9.8 (9.1-13.8) | 32 689 | 58.0 (57.1-62.8) | 34 122 | 63.2 (62.0-63.3) | 19 679 | 35.6 (34.8-36.9) |
| Family medicine | 17 964 | 18.5 (17.8-22.5) | 14 008 | 14.4 (13.7-17.4) | 44 656 | 49.3 (48.9-49.8) | 40 840 | 45.5 (44.6-45.9) | 48 299 | 53.5 (53.1-54.2) |
| General internal medicine | 51 254 | 21.4 (20.9-33.5) | 22 455 | 9.7 (8.9-14.1) | 61 259 | 28.3 (27.2-36.3) | 108 175 | 54.5 (53.8-55.6) | 81 636 | 40.7 (39.9-42.4) |
| General pediatrics | 10 119 | 12.7 (12.2-21.3) | 8220 | 10.3 (9.7-16.7) | 25 760 | 35.3 (32.8-50.7) | 16 735 | 25.4 (24.9-27.0) | 44 036 | 66.7 (65.1-71.1) |
| Neurology | 4924 | 20.8 (20.7-30.7) | 2172 | 9.0 (8.0-13.7) | 8059 | 38.3 (37.5-42.3) | 10 651 | 52.3 (52.1-53.4) | 8967 | 43.1 (41.7-46.5) |
| Pathology | 3780 | 21.3 (20.9-27.0) | 1641 | 9.4% (7.5-12.6) | 7120 | 43.9 (40.3-45.7) | 7942 | 48.5 (48.2-49.2) | 8207 | 50.2 (49.3-51.5) |
| Physical medicine and rehabilitation | 2203 | 20.2 (20.1-26.0) | 1088 | 10.8 (9.6-12.1) | 5048 | 50.5 (49.8-52.1) | 6212 | 62.2 (60.2-65.0) | 3658 | 37.3 (34.8-39.4) |
| Preventive medicine | 461 | 17.5 (17.3-20.0) | 497 | 19.0 (17.8-22.6) | 1200 | 49.1 (46.8-50.1) | 1302 | 53.5 (51.9-54.4) | 1140 | 45.6 (44.4-47.8) |
| Psychiatry | 9383 | 19.7 (18.5-25.3) | 6129 | 12.4 (12.0-15.9) | 19 603 | 41.6 (41.3-48.0) | 21 346 | 48.4 (46.7-49.8) | 21 779 | 49.1 (48.9-50.2) |
| Radiation oncology | 1439 | 26.1 (25.3-30.5) | 389 | 6.6 (6.5-7.8) | 2739 | 51.0 (50.6-53.0) | 3692 | 69.6 (68.7-69.9) | 1603 | 30.0 (28.9-30.5) |
Figures represent totals and medians of data reported from 2015-2022 by the Accreditation Council for Graduate Medical Education Data Resource Books.
Individuals self-reported race and ethnicity from fixed categories. Those who responded other and unknown were not included in the race and ethnicity groups above.
Trainees who self-reported their gender as nonbinary and not reported were not included because sample sizes were too small. The nonbinary category was first reported in 2019-2020.
According to the Association of American Medical Colleges, underrepresented in medicine includes those who self-identified into the following racial groups: African American or Black, American Indian or Alaska Native, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander.
Specialties were categorized as surgical or nonsurgical based on American College of Surgeons recommendations.
P < .001.
Trainee racial, ethnic, and gender representation in each specialty for each year were obtained from the Accreditation Council for Graduate Medical Education. Although most trainees do not enter academic medicine, their most proximal role models are usually academic physicians. Therefore, faculty compensation data were obtained from the Association of American Medical Colleges Faculty Salary Reports and inflation-adjusted to 2022 dollars using the Consumer Price Index.
For each specialty, we report the median and IQR of trainee representation for each race, ethnicity, and gender category reported annually from 2015 to 2022, and the median and IQR of compensation for the 3 commonest professorial ranks (assistant, associate, and full) reported annually from 2015 to 2022. We used the Wilcoxon rank-sum test to compare surgical and nonsurgical specialties, and Spearman rank correlation to examine specialty-level associations between trainee representation and faculty compensation by rank. The α level was .05 (2-sided), and calculated using Stata version 17.1 (StataCorp). In accordance with 45 CFR §46, this study of publicly available information involving no patient records did not require institutional review board approval.
Results
There were 772 910 trainees in 21 clinical specialties from 2015 to 2022. Overall, 19.7% self-reported as Asian, 45.4% White, 4.4% other, 11.7% URiM, and 17.5% did not know or report their race and ethnicity. Further, 44.9% self-reported as women, 52.7% men, less than 0.1% nonbinary, and 2.4% did not report their gender. The median URiM representation was 9.7% (IQR, 7.8%-13.6%), ranging from 6.1% (IQR, 5.3%-9.0%) in otolaryngology to 19.0% (IQR, 17.8%-22.6%) in preventive medicine (Table 1). The median Asian and White representation was 18.8% (IQR, 14.6%-22.4%) and 50.9% (IQR, 46.6%-55.7%), respectively. The median women representation was 39.9% (IQR, 32.8%-49.6%), ranging from 14.7% (IQR, 14.0%-16.7%) in orthopedic surgery to 81.9% (IQR, 81.6%-84.6%) in obstetrics and gynecology. Surgical and nonsurgical specialties differed in median representation of URiM (8.5% vs 10.4%, P < .001) and women (36.9% vs 43.8%, P < .001) trainees.
The median faculty compensation in 2022 dollars was lowest for general pediatrics and highest for neurosurgery among assistant ($200 860 vs $641 300) and full ($278 300 vs $831 900) professors (Table 2). Surgical and nonsurgical specialty compensation differed among assistant ($403 895 vs $255 300, P < .001), associate ($486 465 vs $285 360, P < .001), and full ($552 445 vs $332 760, P < .001) professors.
Table 2. Full, Associate, and Assistant Professor Compensation for 21 Clinical Specialtiesa.
| Rank | Median compensation, $ (IQR) | ||
|---|---|---|---|
| Full professor | Associate professor | Assistant professor | |
| Specialty | |||
| Overall | 425 580 (315 100-551 040) | 375 100 (274 290-484000) | 331 752 (250 470-425 580) |
| Surgical specialtiesb | 552 455 (464 987-680 880)c | 486 465 (413 134-607 900)c | 403 895 (333 240-472 539)c |
| General surgery | 534 760 (516 660-543 660) | 475 600 (453 804-485 850) | 390 580 (388 680-403 650) |
| Neurosurgery | 831 900 (810 570-855 461) | 792 960 (768 750-805 860) | 641 300 (627 300-660 040) |
| Obstetrics and gynecology | 384 680 (368 047-399 750) | 344 520 (341 628-350 750) | 304 440 (301 351-307 050) |
| Ophthalmology | 428 040 (413 159-435 850) | 375 100 (363 873-385 120) | 302 974 (290 280-311 520) |
| Orthopedic surgery | 704 460 (668 150-716 320) | 675 050 (665 542-693 330) | 538 240 (514 484-544 890) |
| Otolaryngology | 537 510 (518 731-553 150) | 488 750 (463 810-499 960) | 388 410 (373 106-389 400) |
| Plastic surgery | 673 069 (648 706-682 080) | 577 882 (548 130-594 720) | 437 780 (428 846-442 750) |
| Urology | 560 500 (551 040-568 100) | 482 620 (479 080-487 080) | 405 900 (404 740-419 750) |
| Nonsurgical specialtiesb | 332 760 (301 350-443 900)c | 285 360 (258 667-411 700)c | 255 300 (240 790-346 840)c |
| Anesthesiology | 488 840 (480 095-494 500) | 468 270 (463 710-475 600) | 431 880 (429 550-434 700) |
| Dermatology | 440 340 (428 271-443 900) | 398 840 (391 212-411 700) | 343 380 (332 519-346 840) |
| Diagnostic radiology | 500 320 (492 000-512 720) | 466 100 (462 480-472 120) | 425 980 (423 527-437 320) |
| Emergency medicine | 394 400 (383 864-398 090) | 367 720 (354 213-368 160) | 335 170 (325 090-336 400) |
| Family medicine | 271 400 (268 140-273 386) | 252 520 (248 460-257 520) | 237 180 (232 470-240 790) |
| General internal medicine | 312 040 (306 301-313 390) | 272 250 (265 680-277 240) | 248 980 (247 434-252 880) |
| General pediatrics | 278 300 (271 440-279 210) | 227 740 (219 747-231 240) | 200 860 (196 350-201 840) |
| Neurology | 320 650 (311 627-327 120) | 273 460 (272 580-276 080) | 246 039 (237 390-251 720) |
| Pathology | 367 840 (360 037-371 200) | 308 550 (301 985-311 520) | 254 100 (249 690-257 520) |
| Physical medicine and rehabilitation | 332 760 (308 401-335 790) | 285 360 (275 694-292 100) | 261 050 (254 299-265 680) |
| Preventive medicine | 290 280 (276 327-294 640) | 227 360 (219 650-238 360) | 222 720 (199 810-232 320) |
| Psychiatry | 312 415 (301 350-315 100) | 265 500 (258 667-269 120) | 250 470 (240 998-254 219) |
| Radiation oncology | 605 160 (571 727-612 420) | 523 160 (504 787-526 440) | 439 640 (429 170-444 070) |
Compensation figures represent medians reported annually from 2015-2022 by the Association of American Medical Colleges Faculty Salary Reports, inflation adjusted to 2022 dollars using the Consumer Price Index. Correlations with an absolute value between 0-0.19 are considered very weak; 0.20-0.39, weak; 0.40-0.59, moderate; 0.60-0.79, strong; and 0.80-1.0, very strong.
Specialties were categorized as surgical or nonsurgical based on American College of Surgeons recommendations.
P ≤ .001.
There were strong, negative correlations between specialty URiM and women trainee representation and faculty compensation at all 3 academic ranks (URiM: ρ = −0.64 to −0.76, P values ≤ .002; women: ρ = −0.76 to −0.78, P values < .001) and strong, positive correlations between White and men trainee representation and faculty compensation at all 3 academic ranks (White: ρ = 0.62 to 0.65, P values ≤ .003; men: ρ = 0.74 to 0.77, P values < .001).
Discussion
From 2015 to 2022, among 21 clinical specialties, lower URiM and women trainee representation correlated strongly with higher faculty compensation. For example, surgical specialties had less diverse representation and were higher compensated than nonsurgical specialties. Limitations of this study include being unable to count Pacific Islander trainees as URiM until 2019-2020; to report compensation by race, ethnicity, and gender; and to analyze race, ethnicity, and gender simultaneously.
These results suggest that higher compensated specialties—including many surgical specialties—were less successful at recruiting URiM and women trainees. Why certain groups are underrepresented in higher-compensated specialties, such as discrimination,4,5 attrition,3 and specialty culture,6 needs further investigation.
Section Editors: Jody W. Zylke, MD, Deputy Editor; Karen Lasser, MD, and Kristin Walter, MD, Senior Editors.
eMethods 1. Specialty Selection
eTable. Clinical Specialties Represented in ACGME Data Resource Books, AAMC Faculty Salary Database, and Denoted Surgical by the American College of Surgeons
eMethods 2. Racial, Ethnic, and Gender Categories
Data Sharing Statement
References
- 1.Deville C, Hwang W-T, Burgos R, Chapman CH, Both S, Thomas CR Jr. Diversity in graduate medical education in the United States by race, ethnicity, and sex, 2012. JAMA Intern Med. 2015;175(10):1706-1708. [DOI] [PubMed] [Google Scholar]
- 2.Mensah MO, Ghanney Simons EC, Mangurian C, Ross JS. US post-graduate residency competitiveness, trainee diversity, and future salary among 12 clinical specialties. J Gen Intern Med. 2023;38(6):1567-1569. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in resident attrition among surgical subspecialties. JAMA Surg. 2023;158(4):368-376. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Yuce TK, Turner PL, Glass C, et al. National evaluation of racial/ethnic discrimination in US surgical residency programs. JAMA Surg. 2020;155(6):526-528. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hu Y-Y, Ellis RJ, Hewitt DB, et al. Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med. 2019;381(18):1741-1752. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Khoushhal Z, Hussain MA, Greco E, et al. Prevalence and causes of attrition among surgical residents. JAMA Surg. 2017;152(3):265-272. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eMethods 1. Specialty Selection
eTable. Clinical Specialties Represented in ACGME Data Resource Books, AAMC Faculty Salary Database, and Denoted Surgical by the American College of Surgeons
eMethods 2. Racial, Ethnic, and Gender Categories
Data Sharing Statement