Findings from a recent study published in JAMA Ophthalmology evaluated the longitudinal changes in workforce diversity of full-time academic ophthalmology faculty and department chairs over the last 50 years in the United States.
Give me some background.
Diversity in healthcare teams is a modifiable factor that has been associated with the delivery of high-quality healthcare.
There is a notable disparity in the diversity of healthcare and academic institutions called the “sticky floor, broken ladder, and glass ceiling” phenomenon, which refers to discriminatory employment practices that limit the advancement of people with marginalized identities.
- In ophthalmology: This lack of diversity is particularly emphasized.
- Case in point: A 2021 article found that among 18 medical specialties in the Association of American Medical Colleges (AAMC), only radiology and orthopedic surgery had a lower percentage of underrepresented minority faculty.
Now talk about the study.
This cohort study included full-time U.S. academic ophthalmology faculty and department chairs registered in the AAMC from 1966 to 2021.
Investigators analyzed demographic (i.e., gender, race, and ethnicity) changes in 5-year intervals among academic faculty and department chairs.
- Note: Minoritized race refers to any racial group other than White race, and URiM stands for underrepresented in medicine.
Findings?
Notable demographic changes from 1966-2021 included:
- 1966: 221 academic physicians
- Women: 27 (12.2%)
- Minoritized race: 38 (17.2%)
- Hispanic, Latino, or Spanish ethnicity: 8 (3.6%)
- 2021: 3,158 academic faculty
- Women: 1,320 (41.8%)
- Minoritized race: 1,298 (41.1%)
- Note: Much of this increase in percentage is accounted for by Asian faculty
- Hispanic, Latino, or Spanish ethnicity: 147 (4.7%)
Keep in mind: The number of professors and department chairs increased by approximately 14-fold and 1.4-fold over the study period, respectively.
The study authors noted that this may reflect the fact that the general population is aging—which has increased the demand for eye care and driven funds toward supporting the practice and research of ophthalmology faculty.
How did this break down into annual changes?
The annual proportional change for the three groups mentioned above was as follows:
- Women: +0.63% per year (95% confidence interval [CI] 0.53%-0.72%)
- Minoritized race: +0.54% per year (95% CI 0.72%-0.36%)
- Hispanic, Latino, or Spanish ethnicity: -0.01% (95% CI -0.03% to 0%)
The annual rate of change in proportion for ophthalmology department chairs was:
- Women: +0.32% per year (95% confidence interval [CI] 0.20%-0.44%)
- Minoritized race: +0.34% per year (95% CI 0.19%-0.49%)
- Hispanic, Latino, or Spanish ethnicity: +0.05% (95% CI 0.02%-0.08%)
Talk more about racial disparities in the workforce.
Intersectionality analyses suggested that men and non-URiM status were associated with greater representation across ophthalmology faculty and department chairs.
Black or African American and Hispanic, Latino, and Spanish individuals composed no more than 5% of any academic stratum across the study period.
The prevalence of American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander individuals was nearly zero between 1966-2021.
Tie it all together for me.
These findings suggest that the ophthalmology workforce diversity has progressed slowly since 1966, and most advancements were limited to lower academic ranks and leadership positions.
Further: Intersectionality of URiM status and gender persisted in representation trends—highlighting the need for further advocacy and intervention to achieve equitable representation in the ophthalmology workforce.
Next steps?
Vitreoretinal surgeon specialist Elizabeth Atchison, MD, wrote an invited commentary on this topic and highlighted programs that have been created to address this issue, such as the:
- Rabb-Venable Excellence in Ophthalmology Research Program
- Minority Ophthalmology Mentoring program through the American Academy of Ophthalmology (AAO)
And in terms of additional research?
The study authors mentioned that future investigations could analyze ophthalmology faculty using other categories of diversity not analyzed in this study, such as:
- Sexual orientation
- Disability
- Family socioeconomic status
- Regional differences
- Institutional factors (i.e., private vs. public)