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Confronting Leaky Pipelines: Diversity in Plastic Surgery

  • Diversity in the Surgical Profession (S Pitt, Section Editor)
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Abstract

Purpose of Review

Although plastic surgeons treat a variety of patient populations, the specialty continues to struggle to reflect the diversity of the individuals we treat. In this review, we will discuss the continued racial and gender disparities within plastic surgery. Additionally, we aim to introduce other underrepresented groups in plastic surgery, such as LGBT+surgeons and surgeons from economically disadvantaged backgrounds.

Recent Findings

Beyond recognizing the diversity problem within plastic surgery, institutions are beginning to enact change to address this issue. We specifically highlight institutions who have intentionally aimed recruitment efforts at underrepresented trainees, created innovative applicant evaluations, and provided other support to encourage diversity. We additionally provide suggestions to improve recruitment and retention of underrepresented identities in plastic surgery.

Summary

There continues to be underrepresentation of women, physicians of color, LGBT+physicians, and physicians from economically disadvantaged backgrounds in plastic surgery. Many organizations have recognized this issue and began to implement interventions to improve diversity of their faculty and trainees. There continues to be evolving understanding of disparities in the workforce in plastic surgery and interventions to improve diversity.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Active Physicians by Sex and Specialty, 2019 | AAMC [Internet]. [cited 2021 Aug 22]. Available from: https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2019

  2. Gomez LE, Bernet P. Diversity improves performance and outcomes. Journal of the National Medical Association. J Natl Med Assoc; 2019; 111:383–92. https://pubmed.ncbi.nlm.nih.gov/30765101/

  3. Moak TN, Cress PE, Tenenbaum M, Casas LA. The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap. Aesthetic surgery journal. Aesthet Surg J; 2020; 40:1241–8. https://pubmed.ncbi.nlm.nih.gov/31665219/

  4. Plastic Surgery Statistics Report 2020. American Society of Plastic Surgeons https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-report-2020.pdf.

  5. Smith BT, Egro FM, Murphy CP, Stavros AG, Nguyen VT. An Evaluation of Race Disparities in Academic Plastic Surgery. Plastic and reconstructive surgery [Internet]. NLM (Medline); 2020 [cited 2021 Nov 17];145:268–77. Available from: https://journals.lww.com/plasreconsurg/Fulltext/2020/01000/An_Evaluation_of_Race_Disparities_in_Academic.56.aspx

  6. 2020 FACTS: Applicants and Matriculants Data | AAMC [Internet]. [cited 2021 Aug 22]. Available from: https://www.aamc.org/data-reports/students-residents/interactive-data/2020-facts-applicants-and-matriculants-data

  7. Parmeshwar N, Stuart ER, Reid CM, Oviedo P, Gosman AA. Diversity in Plastic Surgery: Trends in Minority Representation Among Applicants and Residents. Plast Reconstr Surg; 2019; 143:940–9. https://pubmed.ncbi.nlm.nih.gov/30817668/

  8. Silvestre J, Serletti JM, Chang B. Racial and Ethnic Diversity of U.S. Plastic Surgery Trainees. J Surg Education. Elsevier Inc.; 2017;74:117–23.

  9. •• Chen W, Pang JH, Butler P. If not now, when? Why diversity is important in plastic surgery – and why it’s time for action | ASPS [Internet]. 2020 [cited 2021 Aug 22]. Available from: https://www.plasticsurgery.org/for-medical-professionals/publications/plastic-surgery-resident/news/if-not-now-when-why-diversity-is-important-in-plastic-surgery-%E2%80%93-and-why-its-time-for-action. This article is presented by the American Society of Plastic Surgery and provides a broad overview of the current representation of multiple marginalized groups within Plastic Surgery.

  10. Obeid S, Fanning A, Hultman CS. Diversity and Inclusion in Plastic Surgery Education: A National Survey by the American Council of Academic Plastic Surgeons. Plastic and Reconstructive Surgery - Global Open [Internet]. Lippincott Williams and Wilkins; 2017 [cited 2021 Aug 22];5. Available from: https://journals.lww.com/prsgo/Fulltext/2017/09002/Diversity_and_Inclusion_in_Plastic_Surgery.1.aspx

  11. Meyerson J, Suber J, Shields T, Valerio I, Manders E, Vangelisti G. Understanding the Impact and Misconceptions of Rural Plastic Surgery. Annals of Plastic Surgery. Ann Plast Surg; 2019;82:133–6. https://pubmed.ncbi.nlm.nih.gov/30570564/

  12. Intersectionality | Definition of Intersectionality by Merriam-Webster [Internet]. [cited 2021 Aug 23]. Available from: https://www.merriam-webster.com/dictionary/intersectionality

  13. Keane AM, Larson EL, Santosa KB, Vannucci B, Waljee JF, Tenenbaum MM, et al. Women in Leadership and Their Influence on the Gender Diversity of Academic Plastic Surgery Programs. Plast Reconstr Surg. Lippincott Williams and Wilkins; 2021;516–26.

  14. Yuce TK, Turner PL, Glass C, Hoyt DB, Nasca T, Bilimoria KY, et al. National evaluation of racial/ethnic discrimination in us surgical residency programs. JAMA Surg Am Med Assoc. 2020;155:526–8.

    Article  Google Scholar 

  15. Torres MB, Salles A, Cochran A. Recognizing and Reacting to Microaggressions in Medicine and Surgery. JAMA Surgery [Internet]. American Medical Association; 2019 [cited 2021 Aug 23];154:868–72. Available from: https://jamanetwork.com/journals/jamasurgery/fullarticle/2738043

  16. Barnes KL, McGuire L, Dunivan G, Sussman AL, McKee R. Gender bias experiences of female surgical trainees. J Surg Education Elsevier. 2019;76:e1-14.

    Article  Google Scholar 

  17. • Capers Q, Clinchot D, McDougle L, Greenwald AG. Implicit Racial Bias in Medical School Admissions. Academic Medicine [Internet]. Lippincott Williams and Wilkins; 2017 [cited 2021 Aug 22];92:365–9. Available from: https://journals.lww.com/academicmedicine/Fulltext/2017/03000/Implicit_Racial_Bias_in_Medical_School_Admissions.32.aspx. This article outlines practices in eliminating implicit bias in medical school admission such as eliminating photos, which may be helpful for programs interested in restructuring their application process.

  18. Capers Q. How Clinicians and Educators Can Mitigate Implicit Bias in Patient Care and Candidate Selection in Medical Education. 2020;

  19. Teherani A, Hauer KE, Fernandez A, King TE Jr, Lucey C. How Small Differences in Assessed Clinical Performance Amplify to Large Differences in Grades and Awards: A Cascade With Serious Consequences for Students Underrepresented in Medicine. Acad Med. 2018 Sep;93(9):1286–1292. https://pubmed.ncbi.nlm.nih.gov/29923892/.

  20. Low D, Pollack SW, Liao ZC, Maestas R, Kirven LE, Eacker AM, Morales LS. Racial/Ethnic Disparities in Clinical Grading in Medical School. Teach Learn Med. 2019 Oct–Dec;31(5):487–496. https://doi.org/10.1080/10401334.2019.1597724. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2607210

  21. Boatright D, Ross D, O’Connor P, Moore E, Nunez-Smith M. Racial Disparities in Medical Student Membership in the Alpha Omega Alpha Honor Society. JAMA Internal Medicine [Internet]. American Medical Association; 2017 [cited 2021 Aug 22];177:659–65. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2607210

  22. Fadem B, Schuchman M, Simring SS. The relationship between parental income and academic performance of medical students. Acad Med. 1995 Dec;70(12):1142–4. https://pubmed.ncbi.nlm.nih.gov/7495461/.

  23. Nguyen M, Mason HRC, O’Connor PG, Nunez-Smith M, McDade WA, Latimore D, et al. Association of Socioeconomic Status With Alpha Omega Alpha Honor Society Membership Among Medical Students. JAMA Network Open [Internet]. American Medical Association; 2021 [cited 2021 Aug 22];4:e2110730–e2110730. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780554

  24. Sarac BA, Rangwani SM, Schoenbrunner AR, Drolet BC, Janis JE. The Cost of Applying to Integrated Plastic Surgery Residency. Plastic and Reconstructive Surgery Global Open [Internet]. Wolters Kluwer Health; 2021 [cited 2021 Aug 22];9:e3317. Available from: /pmc/articles/PMC7859384/

  25. Fees for ERAS Residency Applications | AAMC [Internet]. [cited 2021 Aug 22]. Available from: https://students-residents.aamc.org/applying-residencies-eras/fees-eras-residency-applications

  26. • Robinson IS, Silva AK, Abdou SA, Daar DA, Hazen A, Thanik V. Melting the Plastic Ceiling: Where We Currently Stand on Measures to Support Women in Academic Plastic Surgery. Plast Reconstr Surg. Lippincott Williams and Wilkins; 2020;698–707. This article is an overview of the unique challenges female plastic surgeons face in the workforce with innovative solutions.

  27. Rangel EL, Castillo-Angeles M, Easter SR, Atkinson RB, Gosain A, Hu Y-Y, et al. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surgery [Internet]. American Medical Association (AMA); 2021 [cited 2021 Aug 22]; Available from: https://jamanetwork-com.proxy.lib.umich.edu/journals/jamasurgery/fullarticle/2782357

  28. Furnas HJ, Li AY, Garza RM, Johnson DJ, Bajaj AK, Kalliainen LK, Weston JS, Song DH, Chung KC, Rohrich RJ. An analysis of differences in the number of children for female and male plastic surgeons. Plast Reconstr Surg. 2019;143(1):315–326. https://doi.org/10.1097/PRS.0000000000005097

  29. Peters GW, Kuczmarska-Haas A, Holliday EB, Puckett L. Lactation challenges of resident physicians- results of a national survey. BMC Pregnancy and Childbirth 2020 20:1 [Internet]. BioMed Central; 2020 [cited 2021 Aug 22];20:1–8. Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/https://doi.org/10.1186/s12884-020-03436-3

  30. Lyu HG, Davids JS, Scully RE, Melnitchouk N. Association of Domestic Responsibilities With Career Satisfaction for Physician Mothers in Procedural vs Nonprocedural Fields. JAMA Surgery [Internet]. American Medical Association; 2019 [cited 2021 Aug 22];154:689–95. Available from: https://jamanetwork.com/journals/jamasurgery/fullarticle/2730078

  31. •• Llado-Farrulla M, Fosnot J, Couto J, Chang B, Broach RB, Rios-Diaz A, et al. In search of workforce diversity? a program’s successful approach. Plast Reconstr Surg. Lippincott Williams and Wilkins; 2021;1229–33. This article is a description of the changes made within the University of Pennsylvania's Plastic Surgery Residency Program to improve diversity and the demonstrated results of said changes.

  32. LEAGUES Fellowship | Surgery | Michigan Medicine | University of Michigan [Internet]. [cited 2021 Aug 23]. Available from: https://medicine.umich.edu/dept/surgery/education/medical-student-education/leagues-fellowship

  33. South EC, Butler PD, Merchant RM. Toward an equitable society: building a culture of antiracism in health care. J Clin Invest [Internet]. American Society for Clinical Investigation; 2020 [cited 2021 Aug 22];130:5039–41. Available from: https://doi.org/10.1172/JCI141675

  34. Personal Leave Policy. American Board of Plastic Surgery. https://www.abplasticsurgery.org/media/18074/personal-leave-policy-final-3-19-20.pdf. Accessed 24 Jul 2021.

  35. Table C8. Full-Time Faculty-Appointment Status at U.S. Medical Schools for Residents Who Completed Residencies, by Specialty and Rank | AAMC [Internet]. [cited 2021 Aug 22]. Available from: https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2019/table-c8-full-time-faculty-appointment-status-us-medical-schools-residents

  36. Charting Outcomes in the Match: Senior Students of U.S. MD Medical Schools Characteristics of U.S. MD Seniors Who Matched to Their Preferred Specialty in the 2020 Main Residency Match 2nd Edition. 2020 [cited 2021 Aug 22]; Available from: www.nrmp.org

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Correspondence to Jennifer F. Waljee.

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This article is part of the Topical collection on Diversity in the Surgical Profession.

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Lane, M., Sears, E.D. & Waljee, J.F. Confronting Leaky Pipelines: Diversity in Plastic Surgery. Curr Surg Rep 10, 63–69 (2022). https://doi.org/10.1007/s40137-022-00308-x

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