Original Investigation
Equity, Diversity, and Inclusion
September 24, 2024
Race and Sex Disparities Among Emergency Medicine Chief Residents
Jennifer W. Tsai, Mytien Nguyen, Sarah N. Dudgeon, et al
JAMA Netw Open. 2024;7(9):e2432679. doi:10.1001/jamanetworkopen.2024.32679
Question Do racial disparities for selecting emergency medicine chief residency exist?
Findings This cohort study of 3408 US emergency medicine residents found significant inequities in chief resident selection across race and sex. Residents who are Black and woman residents from racial and ethnic groups that are underrepresented in medicine (URIM) were less likely to be selected as a chief resident in adjusted analyses, but White women residents were found 1.2-times more likely than White men to be chief resident, and White men were twice as likely to be chief resident compared with URIM women.
Meaning Selection for chief resident may be vulnerable to biases, which may affect career prospects for physicians and especially women URIM physicians.
Abstract
Importance Physicians who belong to minoritized racial and ethnic groups remain underrepresented and underpromoted. Serving as a chief resident is an important position of leadership and prestige, and indicates a benchmark for future professional success. However, it is unknown if disparities in race and/or sex exist in the chief resident selection process.
Objective To describe race, ethnicity, and sex of emergency medicine (EM) chief residents and determine the association of racial identity and the intersectionality of race and sex for selecting chief residents in US emergency medicine departments.
Design, Setting, and Participants This cohort study analyzed data collected from the Association of American Medical Colleges and the Electronic Residency Application Service in the graduating classes of 2017 and 2018. Data were analyzed between December 2021 and January 2023.
Main Outcomes and Measures Relative risk (RR) of selection for chief residency for Black, Asian, and Hispanic EM residents in comparison with White counterparts.
Results Among 3408 studied residents, 738 (21.7%) served as chief resident (2253 male [66.1%]; 451 Asian [13.2%], 144 Black [4.2%], 158 Hispanic [4.6%], 239 more than 1 race [7.0%], 46 other [1.3%], and 2370 White [69.5%]). Of chiefs, 81 (11.0%) identified as Asian, 17 (2.3%) as Black, and 26 (3.5%) Hispanic. Asian residents were 78% (95% CI, 63%-96%) as likely to be promoted to chief resident compared with White peers, and Black residents were 51% (95% CI, 32%-80%) as likely as White residents. In our fully adjusted model, racial differences remained significant for Black residents, who were half as likely as white residents to be selected for chief residency (adjusted risk ratio [aRR], 0.55; 95% CI, 0.36-0.82). Overall, White women were most likely to be selected for chief residency and 20% more likely to be selected than White men counterparts (aRR, 1.20; 95% CI, 1.03-1.39). In comparison, women underrepresented in medicine (a category that included residents identified as Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander) were least likely to be selected for chief promotion, and 50% as likely to be selected for chief resident compared with White men (aRR, 0.50; 95% CI, 0.06-0.66).
Conclusions and Relevance In this 2024 nationally representative study of EM residents, chief promotion was lower among residents identifying as Asian or Black, and in particular, women underrepresented in medicine. This study’s findings suggest further review of chief resident selection process by residency programs and accreditation bodies is needed to ensure workforce equity for promotion and opportunities for leadership.
