Gender, Race, and Ethnicity of US Academic Ophthalmology Faculty and Department Chairs From 1966 to 2021

This cohort study investigates the longitudinal changes in workforce diversity of US full-time academic ophthalmology faculty and department chairs from 1966 to 2021.

Key Points

Question

What are the longitudinal changes in workforce diversity of US full-time academic ophthalmology faculty and department chairs over the last 50 years?

Findings

In this cohort study including 221 academic physicians in 1966 and 3158 academic faculty by 2021, in both groups, non-Hispanic White men predominated representation whereas women, multiracial individuals, and groups underrepresented in medicine (ie, American Indian or Alaska Native, Black or African American, Hispanic, and Native Hawaiian or Other Pacific Islander) grew the least among marginalized groups.

Meaning

Results revealed that since 1966, associated with the slow progression of workforce diversity, representational disparity persists among ophthalmology faculty and departmental leadership.

Abstract

Importance

Workforce diversity is integral to optimal function within health care teams.

Objective

To analyze gender, race, and ethnicity trends in rank and leadership among US full-time academic ophthalmology faculty and department chairs between 1966 and 2021.

Design, Setting, and Participants

This cohort study included full-time US academic ophthalmology faculty and department chairs registered in the Association of American Medical Colleges. Study data were analyzed in September 2023.

Exposure

Identifying with an underrepresented in medicine (URiM) group.

Main Outcomes and Measures

The main outcome measures were demographic (ie, gender, race, and ethnicity) changes among academic faculty and department chairs, assessed in 5-year intervals. The term minoritized race refers to any racial group other than White race.

Results

There were 221 academic physicians in 1966 (27 women [12.2%]; 38 minoritized race [17.2%]; 8 Hispanic, Latino, or Spanish [3.6%]) and 3158 academic faculty by 2021 (1320 women [41.8%]; 1298 minoritized race [41.1%]; 147 Hispanic, Latino, or Spanish ethnicity [4.7%]). The annual proportional change for women, minoritized race, and Hispanic, Latino, or Spanish ethnicity was +0.63% per year (95% CI, 0.53%-0.72%), +0.54% per year (95% CI, 0.72%-0.36%), and −0.01% (95% CI, −0.03% to 0%), respectively. Women were underrepresented across academic ranks and increasingly so at higher echelons, ranging from nonprofessor/instructor roles (period-averaged mean difference [PA-MD], 19.88%; 95% CI, 16.82%-22.94%) to professor (PA-MD, 81.33%; 95% CI, 78.80%-83.86%). The corpus of department chairs grew from 77 in 1977 (0 women; 7 minoritized race [9.09%]; 2 Hispanic, Latino, or Spanish ethnicity [2.60%]) to 104 by 2021 (17 women [16.35%]; 22 minoritized race [21.15%]; 4 Hispanic, Latino, or Spanish ethnicity [3.85%]). For department chairs, the annual rate of change in the proportion of women, minoritized race, and Hispanic, Latino, or Spanish ethnicity was +0.32% per year (95% CI, 0.20%-0.44%), +0.34% per year (95% CI, 0.19%-0.49%), and +0.05% per year (95% CI, 0.02%-0.08%), respectively. In both faculty and department chairs, the proportion of URiM groups (American Indian or Alaska Native, Black or African American, Hispanic, and Native Hawaiian or Other Pacific Islander) grew the least. Intersectionality analysis suggested that men and non-URiM status were associated with greater representation across ophthalmology faculty and department chairs. However, among ophthalmology faculty, URiM women and men did not significantly differ across strata of academic ranks, whereas for department chairs, no difference was observed in representation between URiM men and non-URiM women.

Conclusion & Relevance

Results of this cohort study revealed that since 1966, workforce diversity progressed slowly and was limited to lower academic ranks and leadership positions. Intersectionality of URiM status and gender persisted in representation trends. These findings suggest further advocacy and intervention are needed to increase workforce diversity.

Introduction

Practitioner diversity is important to foster patient communication, trust, and engagement.^1,2 Unfortunately, there remains a critical diversity gap in health care and academic institutions, coined the “sticky floor, broken ladder, and glass ceiling” phenomenon.^3,4,5,6 Lett et al⁷ report a widening diversity gap in nearly all specialties and faculty rankings when comparing the current composition with that of the 1990s. Further, between 2002 and 2017, American Indian or Alaska Native, Black or African American, and Hispanic students remained underrepresented (relative to their population proportion) among US allopathic medical school matriculants.⁸

Workforce demographics (gender, race, and ethnicity) in academic ophthalmology have not been comprehensively analyzed. The longest spanning work is by Ali et al,⁹ who analyzed ophthalmology faculty diversity trends over the past 20 years. Although the prevalence of women increased, the underrepresentation of racial and ethnic groups did not change.¹⁰ Demographic trends before 2000 were not captured. The current study sought to analyze the demographics of US ophthalmology faculty and department chairs between 1966, the earliest year in which data from the Association of American Medical Colleges (AAMC) faculty roster are available, to 2021. The main objective was to determine the raw proportion and annual change of women, racialized, and ethnic US academic ophthalmology faculty across the 55-year study period.

Methods

Data Source

As data were publicly requestable and deidentified, ethics board review and participant consent were waived. Data on US academic full-time ophthalmology faculty and department chairs between 1966 and 2021 were acquired through a formal request from the AAMC.¹¹ Demographic data are reported in accordance with recommendations endorsed by the US Census Bureau.^12,13 Gender is reported as a binary variable of either “man” or “woman”; ethnicity is encoded as “Hispanic, Latino, or of Spanish Origin” or “Not Hispanic, Latino, or of Spanish Origin”; and race is stratified as “American Indian or Alaskan Native,” “Asian,” “Black or African American,” “multiracial,” “Native Hawaiian or Other Pacific Islander,” “White,” “other” (unspecified), or “unknown.”^12,13 The group underrepresented in medicine (URiM) included American Indian or Alaska Native, Black or African American, Hispanic, and Native Hawaiian or Other Pacific Islander. Academic rank was coded across 5 levels: professor, associate professor, assistant professor, instructor, and other (contents unspecified in this dataset). This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

Statistical Analysis

We calculated the annual prevalence of each gender, race, and ethnicity among all academic ophthalmology faculty, within each academic rank, and among all ophthalmology department chairs. A linear regression analysis was used to evaluate if the rate of change in prevalence over time for each demographic group was significantly different from nonzero. Significance testing for 2-group comparisons was conducted via the Welch 2-sample t test. For comparisons among 3 or more groups, analysis of variation and subsequent Tukey honestly differences for multiple comparisons were conducted. Because data were collected systematically by the AAMC and missing identities were coded as unknown, there were no true instances of missing and unassigned data points. We summarized data using absolute number, percentage, period-averaged mean difference (PA-MD) spanning the entire study period, and mean percentage prevalence change per year with 95% CI. All P values were 2-sided but not adjusted for multiple analyses, and a P value <.05 was considered significant. Analysis and figures synthesis were performed in R, version 4.3.0 (R Foundation for Statistical Computing). Study data were analyzed in September 2023.

Results

We identified 221 US academic ophthalmology faculty in 1966 (27 women [12.2%], 38 minoritized race [17.2%], and 8 Hispanic, Latino, or Spanish [3.2%] ethnicity), which rose to 3158 faculty by 2021 (1320 women [41.8%], 1298 minoritized race [41.1%], and 147 Hispanic, Latino, or Spanish ethnicity [4.7%]). The prevalence of unknown gender reporting was 0%, and the prevalence of unknown race and ethnicity reporting was less than 20% across all years.

Overall, the prevalence of women ophthalmology faculty grew by a mean of +0.63% (95% CI, 0.53%-0.72%) per year (Table 1 and eFigure 1 in Supplement 1). However, men outnumbered their women counterparts (PA-MD, 56.18%; 95% CI, 52.34%-60.03%) across 1966 to 2021, which is inconsistent with census data on the entire US population across the same time period (eTable 1 in Supplement 1). This disparity was greatest at the highest rank of professor (PA-MD, 81.33%; 95% CI, 78.80%-83.86%) and narrowed with descending rank, from associate professor (PA-MD, 60.59%; 95% CI, 56.85%-64.34%), assistant professor (PA-MD, 45.30%; 95% CI, 40.61%-49.99%), and instructor (PA-MD, 28.03%; 95% CI, 23.64%-32.42%) to other roles (PA-MD, 19.88%; 95% CI, 16.82%-22.94%).

Table 1. Representation by Gender^a.

Rank	Group	1966-1970	1971-1975	1976-1980	1981-1985	1986-1990	1991-1995	1996-2000	2001-2005	2006-2010	2011-2015	2016-2021	Overall (mean over all years)
All academic faculty	Mean No. of academic faculty	309.80	508.20	749.00	949.80	1210.40	1505.00	1756.20	2104.00	2480.80	2899.80	3154.33	1602.48
	Men, %	88.43	89.44	89.85	87.59	84.14	78.97	76.22	72.96	69.00	65.57	60.38	78.41
	Women, %	11.57	10.56	10.15	12.41	15.86	21.03	23.78	27.04	31.00	34.43	39.62	21.59
Professor	Mean of total, No.	103.20	144.60	215.60	298.20	362.40	417.80	486.40	555.80	661.80	769.40	852.17	442.49
	Men, %	99.00	97.55	95.91	95.09	93.98	93.40	91.16	88.30	85.52	82.72	77.35	90.91
	Women, %	1.00	2.45	4.09	4.91	6.02	6.60	8.84	11.70	14.48	17.28	22.65	9.09
Associate professor	Mean of total, No.	80.20	129.40	180.00	230.20	294.20	367.60	398.20	456.00	513.20	574.40	636.00	350.85
	Men, %	92.88	90.39	89.65	88.67	85.42	82.31	79.20	76.18	72.40	67.39	62.36	80.62
	Women, %	7.12	9.61	10.35	11.33	14.58	17.69	20.80	23.82	27.60	32.61	37.64	19.38
Assistant professor	Mean of total, No.	61.00	142.40	265.00	324.20	408.40	508.80	612.80	760.60	911.00	1117.80	1247.83	578.17
	Men, %	83.58	86.78	88.47	85.22	80.10	71.91	70.02	66.75	60.99	57.05	52.34	73.02
	Women, %	16.42	13.22	11.53	14.78	19.90	28.09	29.98	33.25	39.01	42.95	47.66	26.98
Instructor	Mean of total, No.	50.80	74.00	71.80	80.80	120.00	158.80	188.00	246.60	292.40	338.00	305.17	175.12
	Men, %	70.30	81.46	81.75	71.43	70.90	61.49	57.26	55.85	54.73	55.93	46.58	64.33
	Women, %	29.70	18.54	18.25	28.57	29.10	38.51	42.74	44.15	45.27	44.07	53.42	35.67
Otherb	Mean of total, No.	14.60	17.80	16.60	16.40	25.40	52.00	70.80	85.00	102.40	100.20	113.17	55.85
	Men, %	66.57	72.28	69.60	62.27	52.73	62.09	61.06	59.80	56.80	51.25	47.41	60.17
	Women, %	33.43	27.72	30.40	37.73	47.27	37.91	38.94	40.20	43.20	48.75	52.59	39.83

^a Data are stratified by all academic ophthalmology faculty and by academic rank (full professor, associate professor, assistant professor, instructor, and other). The mean total number for each rank is depicted, and for each group, their proportions (%) are averaged in 5-year intervals.

^b Other is unspecified in the dataset.

Overall, the prevalence of academic faculty with minoritized race (referring to any racial group other than White race) grew by a mean of +0.54% (95% CI, 0.36%-0.72%) per year. The prevalence changes per year among American Indian or Alaska Native, Black or African American, and Native Hawaiian or Other Pacific Islander were −0.003% (95% CI, −0.005% to −0.002%), +0.03% (95% CI, 0.02%-0.05%), and +0.001% (95% CI, 0%-0.002%), respectively. Notably, the Hispanic group did not change over the period; the annual proportional change for Hispanic, Latino, or Spanish ethnicity was −0.01% (95% CI, −0.03% to 0%). In further detail, eTable 2 in Supplement 1 summarizes academic rank representation by race and ethnicity between 1966 and 2021, averaged by 5-year intervals (eFigures 2, 3, and 4A-E in Supplement 1). Subsequent pairwise testing is summarized by eTable 3 in the Supplement, showing that participants with minoritized race were less likely to hold a given academic rank than White individuals. Compared with census data on race and ethnicity of the US population between 1960 and 2020 (eTable 1 in the Supplement), Asian individuals were overrepresented in ophthalmology faculty, whereas all other individuals with minoritized race as well as Hispanic, Latino, or Spanish ethnicity were underrepresented.

We identified a total of 77 ophthalmology department chairs in 1977 (0 women; 7 minoritized race [9.09%]; and 2 Hispanic, Latino, or Spanish ethnicity [2.60%]), which rose to 104 by 2021 (17 women [16.35%]; 22 minoritized race [21.15%]; and 4 Hispanic, Latino, or Spanish ethnicity [3.85%]) (eFigures 5 and 6 in Supplement 1). Table 2 and Table 3 (corresponding to eFigures 7 and 8 in Supplement 1) summarize trends in gender and race or ethnicity between 1977 and 2021, averaged in 5-year intervals, respectively. Over this period, the prevalence of women chairs grew by a mean of +0.32% (95% CI, 0.20%-0.44%) per year, and that of chairs with minoritized race grew by a mean of +0.34% (95% CI, 0.19%-0.49%) per year. Among URiM groups, the prevalence changes per year among American Indian or Alaska Native, Black or African American, and Hispanic groups were −0.03% (95% CI, −0.05% to −0.02%), +0.10% (95% CI, 0.06%-0.14%), and +0.05% (95% CI, 0.02%-0.08%), respectively. Notably, there has never been a chair from the Native Hawaiian and Other Pacific Islander group. Averaged over this period, men outnumbered their women counterparts as chairs (PA-MD, 91.52%; 95% CI, 89.47%-93.57%). eTable 4 in Supplement 1 shows that individuals with minoritized race were less likely to hold a chair position than White individuals.

Table 2. Department Chair Representation by Gender^a.

Group	1977-1981	1982-1986	1987-1991	1992-1996	1997-2001	2002-2006	2007-2011	2012-2016	2017-2021	Overall (mean over all years)
Mean number of department chairs, No.	84.4	80.6	87	92.8	96.2	94.6	98.8	102.4	104.6	93.49
Men, %	99.54	98.02	98.16	98.94	97.9	97.48	96.56	91.08	84.16	95.76
Women, %	0.46	1.98	1.84	1.06	2.1	2.52	3.44	8.92	15.84	4.24

^a The mean number of chairs is depicted, and for each group, their proportions (%) are averaged in 5-year intervals.

Table 3. Department Chair Representation by Race and Ethnicity^a.

Group	1977-1981	1982-1986	1987-1991	1992-1996	1997-2001	2002-2006	2007-2011	2012-2016	2017-2021	Overall (mean over all years)
Mean number of department chairs, No.	84.4	80.6	87	92.8	96.2	94.6	98.8	102.4	104.6	93.49
American Indian or Alaska Native, %	0.92	1.22	1.14	0.66	0	0	0	0	0	0.44
Asian, %	2.38	1.98	3.02	2.16	4.74	6.14	8.9	11.88	11.68	5.88
Black or African American, %	0.92	0.96	0.7	0.84	2.5	3.82	4.06	3.92	3.82	2.39
Hispanic, %	2.38	2.22	2.06	2.16	3.1	4.24	3.66	3.92	3.82	3.06
Multiracial, Hispanic, %	0	0	0	0	0	0	0	0	0	0
Multiracial, non-Hispanic, %	0	0	0	0	0	0.44	0.22	0	0	0.07
Native Hawaiian or Other Pacific Islander, %	0	0	0	0	0	0	0	0	0	0
White, %	89.84	90.84	91.44	91.58	88.06	82.64	81.16	79.5	80.3	86.15
Other, %b	0	0	0	0	0	0.22	0.84	0	0	0.12
Unknown, %	3.56	2.72	1.6	2.6	1.66	2.54	1.24	0.78	0.4	1.90
URiMc	4.22	4.40	3.90	3.66	5.60	8.06	7.72	7.84	7.64	5.89

Abbreviation: URiM, underrepresented in medicine.

^a The mean number of chairs is depicted, and for each group, their proportions (%) are averaged in 5-year intervals.

^b Other is unspecified in the dataset.

^c URiM included American Indian or Alaska Native, Black or African American, Hispanic, and Native Hawaiian or Other Pacific Islander.

Figure 1 depicts the intersectionality of race or ethnicity (URiM status) with gender across all faculty (tabulated in eTable 5 in Supplement 1). In summary, non-URiM men predominated representation across ophthalmology faculty, and over time, appreciable improvements were only noted for non-URiM women, as opposed to URiM women and men. eFigures 9A to 9E in Supplement 1 depict the intersectionality of race or ethnicity (URiM status) with gender across strata of academic rank. In general, lower academic ranks saw greater improvements in representation of non-URiM women over time, albeit URiM women and men did not experience an appreciable improvement over the study period. Over the study period, URiM women and men were significantly less likely than non-URiM women or men to hold a given academic rank, with exception of when compared with each other (eTable 6 in Supplement 1).

Figure 1. Intersectionality of Groups Underrepresented in Medicine (URiM) and Gender Across All Faculty.

Figure 2 depicts the intersectionality of race or ethnicity (URiM status) with gender across all department chairs (eTable 7 in Supplement 1). A similar trend is observed among department chairs, albeit for this group, department chair roles were relinquished by non-URiM men at a more modest rate over time than for faculty positions at large. Over the study period, non-URiM men were more represented as chairs than any other group; non-URiM women were more represented than URiM women, URiM men were more represented than URiM women, and only URiM men and non-URiM women did not have differences in representation (eTable 8 in Supplement 1).

Figure 2. Intersectionality of Groups Underrepresented in Medicine (URiM) and Gender Across All Department Chairs.

Discussion

Diversity among health care teams is a modifiable factor that has been associated with the delivery of high-quality health care.^14,15 In this retrospective analysis of over a half-century of workforce trends among full-time US academic ophthalmology faculty and department chairs, we identified both progress and lingering gaps in demographic representation.

We noted a marked increase in full-time women academic faculty from 12.2% in 1966 to 41.8% in 2021. This positive trend likely reflects cultural shifts in the institutional acceptance of women in academic medicine. The rate of women representation during the 1980s onward was markedly elevated compared with before 1980 and is temporally consistent with societal movements such as Title IX of the 1972 Education Amendments in the US.¹⁶ Nonetheless, women face barriers in other, often less visible, metrics such as slower career progression and reduced income in both general medicine¹⁷ and ophthalmology.^18,19 We found that although women universally saw increased representation across all academic ranks over the last 50 years, the degree of this improvement was lower at higher academic ranks. Notably, the proportion of women chairs grew only from 0% to 16.35% over the study period, highlighting the “sticky floor, broken ladder, and glass ceiling” effect that is most severe at the higher academic ranks and leadership.^4,5,6 These impediments to career advancement are not unique to ophthalmology and have been identified broadly across medical specialties, although our findings suggest a more extreme disparity in ophthalmology. One survey²⁰ of 1273 faculty at 24 medical schools in the US over 17 years found that 60% of women respondents (across primary care, medical specialties, surgical specialties, and basic science) achieved professorship compared with 71% of men, the former being much higher than our reported metric on women in full professor roles (22.70% by 2021). A cross-sectional study in 2014 found that women composed 65% of assistant professors, 20% of associate professors, and 13% of professors in ophthalmology.¹⁹ Our findings indicate that women underrepresentation has lessened across academic ranks since 2014, although a glass-ceiling effect appears to persist. Regarding department chairs, a 2016 study found that women composed 10% of ophthalmology chairs.²¹ Our results from 2021 (16.30% women ophthalmology chairs) indicate improvement, but further intervention is needed to reach gender equity.

Between 1966 and 2021, the proportion of full-time faculty with minoritized race grew from 17.20% in 1966 to 41.10% in 2021. Much of the transition to racialized individuals is accounted for by Asian faculty, whereas URiM groups predominantly experienced near-zero year over year growth. These trends mirror evidence showing overrepresentation of Asian individuals but slow rise of URiM participation among US medical students in general,^8,22 medical students who apply to ophthalmology residency,²³ ophthalmology postgraduate trainees,²³ and ophthalmology academic faculty.^9,23,24 Altogether, these results suggest that despite the current array of advocacy efforts, further commitment to evidence-based initiatives is needed to promote equitable URiM representation in ophthalmology.

In our analysis, participants with minoritized race were less likely to hold any given academic rank compared with White individuals. Similar to gender, racial disparities appeared to widen with increasing academic rank, particularly for URiM groups. Black or African American and Hispanic, Latino, and Spanish individuals composed no more than 5% of any academic stratum across the study period. Moreover, the prevalence of American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander individuals was nearly zero between 1966 and 2021. Recent data suggest a short-term increased rate of URiM groups applying and matching to ophthalmology, although longer-term studies fail to show increases of these groups among ophthalmology residents.²⁴ Thus, we caution against affirmative action bans, which have been implemented in several states at the level of medical school matriculation and exacerbated underrepresentation of students with minoritized race.²⁵

We saw similar trends (ie, growth surpassing census estimates of Asian populations in the US population, and persistent underrepresentation of URiM populations despite parallel growth in census estimates) among ophthalmology department chairs. Lack of URiM participation is seen not only across medical specialties but also in nonphysician hospital leadership ranks.²⁶ One national survey of US hospitals reported that URiM individuals composed only up to 15% of hospital board members, leadership executives, and first-level or midlevel management roles.²⁷ However, URiM groups were far better represented as chief diversity officers (60%) than other chief executive roles (no more than 16%), suggesting a “minority tax” that limits the scope of advancement beyond token roles.^22,27,28 Future work may investigate the participation of URiM groups in leadership positions other than department chairs, including diversity roles.

Regarding intersectionality analysis, we report that among ophthalmology faculty, non-URiM men significantly outnumbered non-URiM women in all academic ranks across the study period, whereas both groups had significantly better representation than non-URiM groups. Among department chairs, a similar stratification of representation was found where non-URiM status and men were significantly better represented than URiM status and women. Interestingly, no difference was found between URiM men and non-URiM women over the study period, suggesting that URiM and gender statuses had an approximately balanced association with representation. Our findings from latter years of the study period (2000-2021) largely mirror that reported by Ali and colleagues,⁹ although our results from decades before 2000 suggest that the intersectionality gap had once been much wider. Altogether, our results suggest a continued degree of intersectionality among ophthalmology faculty and department chairs.

The findings of this work delineate over a half-century of progress, yet also reveal a considerable gap in representation of women, racialized, and ethnic groups, particularly at the upper echelons of institutional hierarchies. These results corroborate extensive evidence of disproportionate representation in US academic ophthalmology and emphasize the pressing need for continued promotion of diversity, equity, and inclusion.^10,19,24 Strategies for such an endeavor may include the implementation of same-group role models and mentorship programs, transparent promotion guidelines, ongoing support of diversity initiatives, and cultural competency and implicit bias training for selection committees. Selection committees may also benefit from involving members outside of the institution to facilitate meritocratic selection. Criteria for academic advancement and leadership should look beyond traditional scholarship metrics such as h-index (ie, a number that attempts to represent the productivity and impact of a scientist or scholar). For instance, the m-index accounts for variations in career length, and despite having shortcomings, may better identify younger and diverse applicants for consideration of promotion. The search for leadership aspirants beyond the pool of traditional candidates should be considered.

Briefly, we note that the number of professors and department chairs increased by approximately 14-fold and 1.4-fold over the study period, respectively. This growth may reflect aging of the general population, which has increased demand for eye care and driven funds toward supporting the practice and research of ophthalmology faculty.²⁹

Strengths and Limitations

The strengths of this study include its use of AAMC data, which has standardized demographic reporting practices, and its longitudinal span of over 50 years. Previous works on similar topics consisted of cross-sectional analyses or retrospective studies with shorter study periods.^10,23,24

However, several limitations should be considered. First, the AAMC dataset did not capture sex, an entity distinct from gender, nor did it capture the nonbinary spectra of gender, which deserves further study. Second, though the dataset does report gender at this time, it is important that gender is a social construct, and it is not known whether survey participants in the past responded using an understanding of gender vs sex assigned at birth. Third, we acknowledge that diversity is a complex construct for individuals, encompassing more than gender, race, and ethnicity domains, and extends to areas including socioeconomic status, sexual orientation, and culture, among others. Fourth, although the rates of unknown demographics were less than 10% for nearly all years, the missing data may have nonetheless skewed our results, and it was unclear what groups composed other race or academic rank. Fifth, the representation of multiracial faculty was lower than expected compared with US census estimates. Potential reasons include that faculty are more likely than the general population to self-identify as one predominant race, despite being multiracial, or that having multiracial backgrounds is in and of itself a form of intersectionality. Sixth, we could not investigate drivers of disproportionate representation, which may include access to research funding, cultural factors, and institutional promotion policies. Seventh, this work does not account for academic physicians solely affiliated with non–AAMC-member medical schools nor nonacademic physicians. Finally, the AAMC dataset considers individuals with doctoral degrees (doctor of medicine, doctor of philosophy, or other doctoral) and not exclusively medical degrees faculty. As well, it does not account for osteopathic medical doctoral degrees, non–full-time faculty, and nonacademic roles.

Conclusions

In summary, in this cohort study, we reported a comprehensive overview of ophthalmology faculty trends by gender, race, and ethnicity between 1966 to 2021. Continued advocacy toward equitable representation within ophthalmology is needed to ensure the field reflects the diverse society it serves. Further work may investigate ophthalmology faculty by other domains of diversity not covered in this analysis, such as sexual orientation and family socioeconomic status. Given their considerable prevalence in ophthalmology practices, we highlighted persons with disabilities as an important group deserving of advocacy, whose increased representation may promote deeper patient understanding and care.³⁰ Future investigations should also evaluate mechanistic factors that underlie the demographic trends reported in this study, including regional and institutional (private vs public) factors.

Supplement 1.

eFigure 1. Representation of Academic Faculty by Gender

eTable 1. Trends in Sex, Race, and Ethnicity Among the US Population Using Decennial Census Data From 1960-2020

eTable 2. Representation by Race and Ethnicity, 1966-2021

eFigure 2. Five-Year Mean Proportions by Race and Ethnicity Among Full-Time Academic Ophthalmology Faculty Between 1966 to 2021

eFigure 3. 50-Year Mean Proportion by Race and Ethnicity Among Full-Time Academic Ophthalmology Faculty by Academic Rank Between 1966 to 2021

eFigure 4. Representation of Race and Ethnicity, 1966-2021, Stratified by Academic Rank

eTable 3. Demographic (Race and Ethnicity) Comparisons With Academic Rank

eFigure 5. Five-Year Mean Proportions by Race and Ethnicity Among Ophthalmology Department Chairs Between 1977 to 2021

eFigure 6. 50-year Mean Proportion by Race and Ethnicity Among Ophthalmology Department Chairs by Academic Rank Between 1977 to 2021

eFigure 7. Representation of Department Chairs by Gender

eFigure 8. Representation of Department Chairs by Race and Ethnicity

eTable 4. Demographic (Race and Ethnicity) Comparisons With Department Chair Status

eTable 5. Intersectionality of URiM Status and Gender Among Ophthalmology Faculty

eFigure 9. Intersectionality of Underrepresented in Medicine (URiM) Groups and Gender, 1966-2021, Stratified by Academic Rank

eTable 6. Intersectional Demographic Comparisons Among Ophthalmology Faculty and Stratified by Academic Rank

eTable 7. Intersectionality of URiM Status and Gender Among Department Chairs

eTable 8. Intersectional Demographic Comparisons With Department Chair Status

Supplement 2.

Data Sharing Statement.