Gender, Racial, and Socioeconomic Determinants of Choosing a Surgical Career

Elsevier

Available online 28 October 2022

Journal of Surgical EducationObjective

Surgical specialties continues to struggle with achieving proportionate representation of women, racial and ethnic minorities, and LGBTQ individuals at all levels of training and academic positions. This study aimed to analyze how socioeconomic determinants and demographic variables including gender and race/ethnicity affect choice of specialty.

Design

A 25-question survey was distributed via Qualtrics to residents at a single institution between September 2021 and February 2022.

Setting

This study was performed at a single-institution, at an academic university center.

Participants

All resident physicians at the institution, ranging from post-graduate year 1 to post-graduate year 9, were invited to participate in the survey. All specialties were invited to participate.

Results

A total of 294 responses (86 in surgical fields, 204 in medical fields) were collected, with an overall response rate of 47%. The average amount of reported student debt was USD 183,000. Underrepresented in medicine (UIM) students chose significantly shorter residencies (p=0.046), had significantly lower average household incomes and grew up in poorer communities (p<0.001), were more likely to have an urban upbringing (p<0.001), and were more likely to have parents without graduate education (p=0.016). Average household income growing up was higher for those from surgical specialties than those from medical specialties (USD 167,000, 144,000, p=0.051). In a multiple logistic regression, race (p=0.041) and ethnicity (p=0.046) were the most significant unique predictors of choosing a medical residency over a surgical residency. Female gender (p=0.014), being the sole source of income (p=0.018), and lower parent/guardian educational status were factors predictive of not pursuing a top 10 paying residency.

Conclusions and Relevance

Understanding the socioeconomic influences in specialty choice provides important insight to guide future programs and policies focused on alleviating barriers that dissuade qualified and diverse applicants from pursuing surgical careers.

Section snippetsINTRODUCTION

All medical students are tasked with answering the question: “What specialty will I choose to dedicate my career to?” With over 5,000 programs in over 30 specialties, many students struggle to decide which residency and career will suit them best.1 Students have to juggle multiple factors, including interest, lifestyle, earning potential, controllable hours, and others.

While many medical students do express interest in surgical careers, many who are initially interested are dissuaded at various

Data Collection

A 25-question survey (see Supplemental Digital Content 1) was distributed via Qualtrics (Qualtrics, Provo, UT) to residents at a single academic institution (University of California, San Diego) between September 2021 and February 2022. Prior to dissemination, the survey was beta-tested on a group of fifteen graduate students who assessed the usability and navigability of the survey, and edits were made accordingly. The survey was distributed via email lists provided by program coordinators as

Demographics

There was a total of 294 survey responses, representing a 47% overall response rate. Seventy percent of these responses were from residents in non-surgical specialties. Fifty-seven percent of respondents were female, and there were two non-binary individuals. Racial/ethnic breakdown is as follows: 62.2% White, 19.7% Asian, 3.7% Black/African American, 0.3% Native Hawaiian/Pacific Islander, 11.6% Mixed Race, and 12.2% Hispanic/Latinx. Twenty-five percent of individuals identified as being from a

The socio-economic landscape of current medical school graduates

Socioeconomic status is a complex characterization of the social standing of an individual, most often including a combination of education, income, and occupation.12 Socioeconomic status among medical students is primarily determined by parental income and personal savings, as most students have no income during medical school. Another measure of socioeconomic status is the amount of student debt accrued by the end of medical school. Median indebtedness is now more than USD 180,000 for medical

CONCLUSION

Socioeconomic status is among the most influential factors predicting specialty choice in medicine. Specifically, those from lower socioeconomic status backgrounds are more likely to choose non-surgical careers. To improve the inclusivity of surgery, it is imperative to make surgical careers more accessible to people of diverse socioeconomic backgrounds.

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© 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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