IntroductionEfforts have been made to increase the number of women and physicians who are underrepresented in medicine (UIM). However, surgery has been slow to diversify, and there are limited data surrounding the impact of intersectionality.ObjectiveTo assess the combined association of race and ethnicity and sex with rates of promotion and attrition among US academic medical department of surgery faculty.Design, Setting, and ParticipantsThis was a retrospective cohort study using faculty roster data from the Association of American Medical Colleges. All full-time academic department of surgery faculty with an appointment any time from January 1, 2005, to December 31, 2020, were included. Study data were analyzed from September 2022 to February 2023.ExposuresFull-time academic faculty in a department of surgery with a documented self-reported race, ethnicity, and sex within the designated categories of the faculty roster of Association of American Medical Colleges.Main Outcomes and MeasuresTrends in race and ethnicity and sex, rates of promotion, and rates attrition from 2010 to 2020 were assessed with Kaplan-Meier and Cox time-to-event analyses.ResultsA total of 31 045 faculty members (23 092 male [74%]; 7953 female [26%]) from 138 institutions were included. The mean (SD) program percentage of UIM male faculty increased from 8.4% (5.5%) in 2010 to 8.5% (6.2%) in 2020 (P < .001), whereas UIM female faculty members increased from 2.3% (2.6%) to 3.3% (2.5%) over the 10-year period (P < .001). The mean program percentage of non-UIM females increased at every rank (percentage point increase per year from 2010 to 2020 in instructor: 1.1; 95% CI, 0.73-1.5; assistant professor: 1.1; 95% CI, 0.93-1.3; associate professor: 0.55; 95% CI, 0.49-0.61; professor: 0.50; 95% CI, 0.41-0.60; all P < .001). There was no change in the mean program percentage of UIM female instructors or full professors. The mean (SD) percentage of UIM female assistant and associate professors increased from 3.0% (4.1%) to 5.0% (4.0%) and 1.6% (3.2%) to 2.2% (3.4%), respectively (P =.002). There was no change in the mean program percentage of UIM male instructors, associate, or full professors. Compared with non-Hispanic White males, Hispanic females were 32% less likely to be promoted within 10 years (hazard ratio [HR], 0.68; 95% CI, 0.54-0.86; P <.001), non-Hispanic White females were 25% less likely (HR, 0.75; 95% CI, 0.71-0.78; P <.001), Hispanic males were 15% less likely (HR, 0.85; 95% CI, 0.76-0.96; P =.007), and Asian females were 12% less likely (HR, 0.88; 95% CI, 0.80-0.96; P =.03). Non-UIM males had the shortest median (IQR) time to promotion, whereas non-UIM females had the longest (6.9 [6.8-7.0] years vs 7.2 [7.0-7.6] years, respectively; P < .001). After 10 years, 79% of non-UIM males (13 202 of 16 299), 71% of non-UIM females (3784 of 5330), 68% of UIM males (1738 of 2538), and 63% of UIM females (625 of 999) remained on the faculty. UIM females had a higher risk of attrition compared with non-UIM females (HR, 1.3; 95% CI, 1.1-1.5; P = .001) and UIM males (HR, 1.2; 95% CI, 1.0-1.4; P = .05). The mean (SE) time to attrition was shortest for UIM females and longest for non-UIM males (8.2 [0.14] years vs 9.0 [0.02] years, respectively; P < .001).Conclusion and RelevanceResults of this cohort study suggest that intersectionality was associated with promotion and attrition, with UIM females least likely to be promoted and at highest risk for attrition. Further efforts to understand these vulnerabilities are essential.

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美国的外科医生交叉性以及学术晋升和保留

简介 我们已努力增加医学界 (UIM) 代表性不足的女性和医生的数量。然而，外科手术的多样化进展缓慢，并且关于交叉性影响的数据有限。目的评估美国学术医学系外科教员中种族、族裔和性别与晋升和自然减员率的综合关联。设计、设置、和参与者这是一项回顾性队列研究，使用美国医学院协会的教师名册数据。包括2005年1月1日至2020年12月31日期间任何时间预约的所有全职外科学术部门教师。研究数据于 2022 年 9 月至 2023 年 2 月进行分析。 暴露 外科部门的全职学术教师，其自我报告的种族、民族和性别属于美国医学院协会教师名册指定类别。 主要成果和措施通过 Kaplan-Meier 和 Cox 事件时间分析评估了 2010 年至 2020 年的种族、族裔和性别、晋升率和流失率趋势。结果共有 31 045 名教职员工（23 092 名男性 [74%]） ；来自 138 个机构的 7953 名女性 [26%]）被纳入其中。UIM 男性教师的平均 (SD) 项目比例从 2010 年的 8.4% (5.5%) 增加到 2020 年的 8.5% (6.2%)（磷< .001），而 UIM 女教员在 10 年期间从 2.3% (2.6%) 增加到 3.3% (2.5%)（磷< .001）。非 UIM 女性项目的平均比例在各个级别都有所增加（从 2010 年到 2020 年，每年增加的百分点：讲师：1.1；95% CI，0.73-1.5；助理教授：1.1；95% CI，0.93-1.3；副教授：1.1；95% CI，0.93-1.3）教授：0.55；95% CI，0.49-0.61；教授：0.50；95% CI，0.41-0.60；全部磷< .001）。UIM 女性讲师或正教授的平均课程比例没有变化。UIM女性助理和副教授的平均（SD）百分比分别从3.0％（4.1％）增加到5.0％（4.0％）和1.6％（3.2％）增加到2.2％（3.4％），磷=.002）。UIM 男性讲师、副教授或正教授的平均课程比例没有变化。与非西班牙裔白人男性相比，西班牙裔女性在 10 年内晋升的可能性降低了 32%（风险比 [HR]，0.68；95% CI，0.54-0.86；磷<.001），非西班牙裔白人女性的可能性低 25%（HR，0.75；95% CI，0.71-0.78；磷<.001)，西班牙裔男性的可能性低 15%（HR，0.85；95% CI，0.76-0.96；磷=.007），亚洲女性的可能性低 12%（HR，0.88；95% CI，0.80-0.96；磷=.03）。非 UIM 男性的晋升中位 (IQR) 时间最短，而非 UIM 女性的晋升时间最长（分别为 6.9 [6.8-7.0] 年和 7.2 [7.0-7.6] 年；磷< .001）。10 年后，79% 的非 UIM 男性（16 299 人中的 13 202 人）、71% 的非 UIM 女性（5330 人中的 3784 人）、68% 的 UIM 男性（2538 人中的 1738 人）和 63% 的 UIM 女性（ 999 人中的 625 人）仍留任教职。与非 UIM 女性相比，UIM 女性的自然减员风险更高（HR，1.3；95% CI，1.1-1.5；磷= .001) 和 UIM 男性 (HR, 1.2; 95% CI, 1.0-1.4;磷= .05)。UIM 女性的平均 (SE) 自然减员时间最短，非 UIM 男性最长（分别为 8.2 [0.14] 年和 9.0 [0.02] 年；磷< .001).结论和相关性这项队列研究的结果表明，交叉性与晋升和自然减员相关，UIM 女性晋升的可能性最小，而自然减员的风险最高。进一步努力了解这些漏洞至关重要。