j o u r n a l o f s u r g i c a l r e s e a r c h 1 8 2 ( 2 0 1 3 ) 2 1 2 e2 1 8

Available online at www.sciencedirect.com

journal homepage: www.JournalofSurgicalResearch.com

Minorities struggle to advance in academic medicine:

A 12-y review of diversity at the highest levels of Americas
teaching institutions
Peter T. Yu, MD,a,* Pouria V. Parsa, MD,a Omar Hassanein, MD,a
Selwyn O. Rogers, MD, MPH,b and David C. Chang, PhD, MPH, MBAa
a
b

Department of Surgery, University of California, San Diego, San Diego, CA, USA
Department of Surgery, Harvard Medical School, Boston, Massachusetts

article info

abstract

Article history:

Background: Blacks, Hispanics, and women are underrepresented in academic medicine.

Received 1 November 2011

This study sought to identify recent trends in the academic appointments of underrepre-

Received in revised form

sented groups at all levels of academic medicine.

16 June 2012

Methods: This was a retrospective cross-sectional analysis of the Association of American

Accepted 21 June 2012

Medical Colleges data on faculty at U.S. medical schools from 1997 to 2008. The distribu-

Available online 17 July 2012

tion across race and gender at different academic ranks (instructor, assistant professor,
associate professor, and full professor) and the leadership positions of chairperson and

Keywords:

dean were calculated for each year of the study.

Diversity

Results: Averaged over the 12-y study period, whites accounted for 84.76% of

Underrepresented minorities

professors, 88.26% of chairpersons, and 91.28% of deans. Asians represented 6.66% of

Women

professors, 3.52% of chairpersons, and 0% of deans. Blacks represented 1.25% of

Faculty

professors, 2.69% of chairpersons, and 4.94% of deans. Hispanics represented 2.76%

Promotion

of professors, 3.37% of chairpersons, and 2.91% of deans. Women represented 14.7%

Academic medicine

of professors, 9.2% of chairpersons, and 9.3% of deans. Overall, there was a net
positive increase in the percentage of minority academic physicians in this study
period, but at the current rate, it would take nearly 1000 y for the proportion of
black physicians to catch up to the percentage of African Americans in the general
population. Additionally, year-by-year analysis demonstrates that there was a reduction in the percentage of each minority group for the last 2 y of this study, in 2007
and 2008.
Conclusions: Minorities, including Asian Americans, and women remain grossly underrepresented in academic medicine. Blacks have shown the least progress during this 12-y
period. The disparity is greatest at the highest levels (professor, chairperson, and dean)
of our field. We must redouble our efforts to recruit, retain, and advance minorities in
academic medicine.
2013 Elsevier Inc. All rights reserved.

* Corresponding author. Department of Surgery, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103-8402.
Tel.: 1 858 822 5604; fax: 1 858 822 6994.
E-mail address: ptyu@ucsd.edu (P.T. Yu).
0022-4804/$ e see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jss.2012.06.049

j o u r n a l o f s u r g i c a l r e s e a r c h 1 8 2 ( 2 0 1 3 ) 2 1 2 e2 1 8

1.

Introduction

In 1847, Dr David Jones Peck became the first African American

to receive a Doctor of Medicine degree from an American
medical school [1]. Soon thereafter, Dr Elizabeth Blackwell
became the first woman to graduate from a U.S. medical school,
receiving her degree in 1849 [2]. These historic breakthroughs
marked the birth of racial or ethnic minority and female
representation in medicine in this country. Since then, these
groups have continued to push for equal status in the field.
By 2010, there were 79,070 students enrolled in U.S. medical
schools; 22% of these students were Asian, 7% were black, and
8.2% were Hispanic [3]. Whites accounted for 60.1% of all
medical students. Based on these numbers, certainly some
progress has been made in the diversification of our field.
However, for the purpose of comparison, in that same year,
there were 308,745,538 people in the United States: whites
made up 72.4% of the population, Asians 4.8%, blacks 12.6%, and
Hispanics 16.3% [4]. Given these statistics, blacks and Hispanics
continue to be grossly underrepresented in medicine, earning
the designation of underrepresented minority (URM) as defined
by the U.S. Department of Health and Human Services and the
Association of American Medical Colleges [5,6].
Although the overrepresentation of Asians in medical
school is significant, the observation raises interesting questions about their advancement into high-ranking positions
later in their career. Social determinants of health that benefit
Asians at the community level, such as higher income status,
higher education, and access to health care, also benefit their
advancement into the medical field. However, one might ask,
what are the factors that hinder advancement? Perhaps,
a factor is cultural. Discovering the in-group characteristics of
whites may be helpful in identifying inclusion criteria that
may help females and Asians, who are better represented
in medical school, advance into high-ranking positions in
academia.
Females likewise remain underrepresented in medicine,
although in a different manner. In the past decades, women
had difficulty entering the proverbial pipeline. For example, in
1982e1983, only 26.8% of MD degrees were awarded to women
[7]. Since then, women have made great strides forward in
medical school matriculation and graduation. As a result, in
2009e2010, women received 48.3% of the medical degrees
awarded. This represented the largest number of women
earning an MD of any national graduating class to date [7]. But
despite these significant advances at the entry level,
compared with their male counterparts, women have had
poor success advancing their careers and are overrepresented
in the junior faculty ranks [8,9].
In obstetrics and gynecology, the overrepresentation of
women is significant. Women serving the health care needs of
other women has been a growing trend and has been supported by their willingness to pursue specialties with longer
work hours and heavier workloads [10]. Effective planning and
greater institutional support have made their success in these
areas possible [10].
Minorities have also had difficulty climbing the academic
ladder. In 2000, Fang et al. [11] investigated the promotion
rates of minority and white medical school faculty in the

213

United States. Their analysis of data from the Association of

American Medical Colleges Faculty Roster System from 1980
through 1997 demonstrated a significantly lower rate of
promotion for Asian or Pacific Islanders and URMs, including
blacks and Hispanics.
Recently, Merchant and Omary [12] confirmed just how
great the gap continues to be between URMs and women and
the status quo in academic medicine. They showed that
blacks and Hispanics, respectively, accounted for only 3% and
4.2% of all academic faculties in 2008. Furthermore, although
the percentage of white faculty had decreased over the past
5 y, the low percentage of black and Hispanic faculty did not
change proportionally. Although there was relative gender
parity at the level of instructor, they validated findings that
females were grossly underrepresented at higher rungs of the
academic ladder (i.e., full professor). They additionally
demonstrated that female URMs were doubly underrepresented, also with worsening disproportion as the academic
rank advanced from the level of instructor to professor.
These data are extremely troubling, foremost because of
the extensive literature published in the past one to two
decades documenting the disparity in medical care provided
to minority and female patients. It is well known, for instance,
that relative to whites, blacks and women are less likely to be
referred for cardiac catheterization [13]. Black and female
stroke patients are less likely than their respective male and
white counterparts to receive adequate preventive care for
subsequent strokes [14]. Overall, minorities are more likely to
receive lower quality basic clinical services, even when
multivariate analyses control for insurance status, income,
age, comorbid conditions, and symptom expression [15].
Discouragingly, differences in care are associated with greater
mortality among minority patients [16].
Although it is difficult to prove, it is certainly logicaldif not
probabledthat there is a link between the disparate care of
female and minority patients and the underrepresentation of
women and minorities among physician ranks, specifically in
academic medicine. There is evidence that stereotyping, biases, and uncertainty on the part of health care providers can
contribute to unequal treatment of these groups [17]. Minorities encounter a range of barriers to accessing care, even when
ensured at the same level as whites, including those of
language, geography, and cultural familiarity [17]. Closing the
racial and gender gap in academic medicine may overcome
these barriers.
This study sought to expand on the previous work of Fang
et al. [11] and Merchant and Omary [12]. We hypothesize that
the problem of disparity has improved but at a slow pace and
that the disparity continues to be greater at progressively
higher levels in academic medicine.

2.

Materials and methods

This was a retrospective cross-sectional analysis of American

Association of Medical Colleges data. The database encompassed all full-time faculties at the United States medical
schools from 1997 to 2008.

214

j o u r n a l o f s u r g i c a l r e s e a r c h 1 8 2 ( 2 0 1 3 ) 2 1 2 e2 1 8

The distribution across race and gender at different

academic ranks (instructor, assistant professor, associate
professor, and full professor) and the leadership positions of
chairperson and dean were calculated for each year of the
study. Data for medical school deans were available only for
the years 1998, 2003, and 2008. The percentages of faculty
from each racial and gender groups at each academic level
were averaged over the entire 12-y study period and analyzed
for year-to-year change across the 12 y (Figure).

3.

Results

The absolute number of academic physicians steadily

increased over the 12-y study period. This was true at all levels
(instructor, assistant professor, associate professor, and full
professor), across all races (white, Asian, black, and Hispanic),
and inclusive of both genders (Table 1).
Analysis of the distribution across race and gender at
different academic ranks over the 12-y study period (see
Table 2) demonstrates numerous findings. White physicians
comprised most academic physicians in every year of the
study period (Table 2, section A). For example, in 1997, white
physicians represented 79.1% of all academicians; in 2008,
they accounted for 66.99% of the said group. Furthermore,
white physicians were the majority at every level of academic
medicine (instructor, assistant professor, associate professor,
and full professor) in every year of the study (Table 2, sections
BeE).

At successively higher rungs of the academic ladder, the

percentage of white physicians increased. For example, in
2008, white physicians made up 55.05% of all instructors,
58.36% of all assistant professors, 74.4% of all associate
professors, and 82.81% of all professors. This trend was true
for every year from 1997 to 2008.
Although the absolute number of white physicians steadily
increased across all academic levels, and white physicians
perennially comprised the majority, the percentage of white
physicians among all academic physicians decreased each
year from 1997 to 2008. There was a relative change of "15.3%
over this period (Table 2, section A), and this was true at each
academic level (Table 2, sections BeE). The decrease in the
white majority was greatest at the lowest academic level
(22.9% decrease at the level of instructor) and least at the
highest academic level (3.7% decrease at the level of
professor).
The decrease in percentages of white academic physicians
was reflected by an increase in the percentages of Asian,
black, and Hispanic academic physicians in this period. This
was true at every academic level from instructor through
professor. The increase was greatest at the lowest academic
level and least at the highest academic level for each of these
minority groups.
Asian physicians were the ethnic group that showed the
greatest percentage increase among all academic physicians
during the study period. Furthermore, they showed the most
growth of any ethnic group at every academic level from
instructor to professor. Their increase was largest in the
middle tiers of academia (assistant professorships, 48.7% and

Fig. e Racial and gender representation in academic medicine: 12-y averages.

j o u r n a l o f s u r g i c a l r e s e a r c h 1 8 2 ( 2 0 1 3 ) 2 1 2 e2 1 8

Table 1 e Absolute change in academic physicians from

1997 to 2008.
Academic levels

1997

2008

Absolute change

All academic physicians

White
Asian
Black
Hispanic
Female

93,378
73,863
8579
2674
3350
25,434

125,295
83,934
16,255
3722
5236
42,804

31,917
10,071
7676
1048
1886
17,370

Full professors
White
Asian
Black
Hispanic
Female

24,020
20,658
1494
281
599
2778

29,982
24,828
2222
395
914
7737

5962
4170
728
114
315
4959

Associate professors
White
Asian
Black
Hispanic
Female

21,774
17,964
1598
515
729
5067

26,376
19,624
2945
677
1015
21,023

4602
1660
1347
162
286
15,956

Assistant professors
White
Asian
Black
Hispanic
Female

36,463
27,318
4068
1431
1563
12,409

51,673
30,155
8578
2053
2629
21,023

15,210
2837
4510
622
1066
8614

9383
6696
1182
406
407
4272

14,101
7763
2078
527
562
7232

4718
1067
896
121
155
2960

Instructors
White
Asian
Black
Hispanic
Female

associate professorships, 52.2%) and least at the highest

professorship level (19.1%). Despite this growth, Asians
accounted for only 7.4% of all professors in academic medicine in 2008.
Black physicians showed the smallest percentage increase
among all minority academic groups. Likewise, among
minorities, they showed the smallest percentage growth at
every academic level. The percentage of black instructors was
3.74% in 2008, down from 4.33% in 1997, which equates to
a 13.6% relative decrease (Table 2, section E). The percentage
of black professors in 2008 was 1.3%, lowest of all groups
(Table 2, section B).
Although there was a net positive increase in the
percentage of minority academic physicians from 1997 to
2008, year-by-year analysis demonstrates that there was
a reduction in the percentage of each minority group for at
least the last two of this study (2007 and 2008). The representation of black physicians among all academic physicians
particularly declined, showing a steady decrease in each year
from 2005 to 2008 (Table 2, section A).
With regard to gender, although females remained the
minority in academic medicine, they steadily increased their
representation from 1997 to 2008. Females accounted for 34%
of all academic physicians in 2008, up from 27% in 1997, which
equates to a 25% relative increase. With regard to the highest
level of academia, in 2008, only 17% of all professors of

215

medicine were females. In comparison with 1997, this represents a relative change of 51.7%, which was the greatest
relative increase of all underrepresented groups at this
academic level. Females also made up most physicians at the
level of instructor (51.3%) in 2008.
It should be noted that professors of medicine that are both
females and an URM were incredibly rare. As an example, in
2008, there were 91 black female professors. This represents
1.7% of all female professors and 0.3% of all professors
regardless of gender.
With regard to leadership in academic medicine (i.e.,
department chair and medical school dean), white physicians
comprised an even greater majority than seen at the level of
full professor (Table 3). In 2008, white physicians filled 86% of
all chair positions. Asian, black, and Hispanic physicians
accounted for 3.8%, 2.95%, and 3.66% of these positions,
respectively. Women made up 11.05% of department chairs
that year. Over the 12-y study period, the relative percent
change for white chairpersons was "3.6%, whereas the relative percent change for each minority group was positive.
Females showed the greatest relative percent change from
1997 to 2008 (58.8%), followed by Hispanics (32.6%), blacks
(31.1%), and Asians (15.6%). Although the relative percent
change was great, the absolute change was small: females
increased their numbers by 4.09%, Hispanics by 0.90%, blacks
by 0.70%, and Asians by 0.51%.
In 2008, white physicians accounted for nearly 90% of all
deans. Black, Hispanic, and female physicians made up 5.13%,
2.56%, and 11.96% of these positions, respectively. There were
no Asian deans reported during any year of this study. The
number of white deans decreased from 91.30% in 1998 to
89.74% in 2008, representing an absolute decrease of 1.56%.
Over this same period, black and Hispanic deans also
decreased in number ("0.09% and "0.92% absolute change,
respectively). Females increased in number from 6.96% in 1998
to 11.96% in 2008, representing a 5% absolute increase and
a robust percent change of 71.8%.

4.

Discussion

Several results found in this study merit close attention. First,

this study validates the recent results of Merchant and Omary
[12] and indicates that the problem of disparate minority
promotion first noted by Fang et al. [11] more than a decade ago
continues to this day. Clearly, whites comprise most academic
physicians, such that in 2008, they accounted for nearly 83% of
full professors, 86% of chairpersons, and almost 90% of deans.
Although the field has become more diverse in this 12-y
period, closer examination reveals that the rate of this diversification is extremely slow, especially at the higher tiers of
academia. For example, at the level of full professor, the
absolute decrease in the percentage of whites over the 12-y
study period was approximately 3%. If this rate was to
continue linearly, it would take nearly 40 y for the percentage
of white professors to roughly equal the percentage of whites
in the U.S. population (assuming no decrease in the percentage
of whites in the general population over this period).
More strikingly, the absolute increase in black professors
from 1997 to 2008 was 0.15%. At this rate, it would take nearly

216

Table 2 e Yearly percentage of academic physicians by race or female gender.

Academic levels

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Absolute
change (%)*

Relative
change (%)y

A. All academic physicians

White
79.10
Asian
9.19
Black
2.86
Hispanic
3.59
Female
27.24

78.31
9.63
2.92
3.64
27.96

77.34
10.22
2.97
3.71
28.61

76.17
10.66
3.00
3.80
29.35

74.93
11.07
3.05
3.94
30.05

73.65
11.54
3.10
4.03
30.71

72.56
12.02
3.04
4.07
31.44

71.34
12.45
3.08
4.13
32.13

70.55
12.77
3.05
4.17
32.68

68.86
13.14
3.04
4.22
33.50

67.25
13.03
2.95
4.19
34.06

66.99
12.97
2.97
4.18
34.16

"12.11
3.78
0.11
0.59
6.92

"15.3
41.1
3.8
16.4
25.4

B. Full professors
White
Asian
Black
Hispanic
Female

86.00
6.22
1.17
2.49
11.6

85.86
6.26
1.18
2.55
12.2

85.73
6.31
1.20
2.62
12.8

85.57
6.39
1.20
2.63
13.4

85.42
6.38
1.22
2.66
13.9

85.13
6.50
1.24
2.73
14.4

84.92
6.57
1.24
2.76
15.0

84.64
6.68
1.29
2.82
15.5

84.33
6.81
1.35
2.87
16.2

83.63
7.10
1.30
2.95
16.8

83.06
7.28
1.31
3.01
17.4

82.81
7.41
1.32
3.05
17.6

"3.19
1.19
0.15
0.56
6.00

"3.7
19.1
12.8
22.5
51.7

C. Associate professors
White
82.50
Asian
7.34
Black
2.37
Hispanic
3.35
Female
23.3

82.18
7.57
2.37
3.38
23.7

81.58
7.99
2.35
3.46
24.4

81.01
8.27
2.45
3.48
25.0

80.32
8.65
2.54
3.56
25.7

79.66
8.96
2.60
3.62
26.1

79.06
9.13
2.62
3.61
26.8

78.08
9.70
2.60
3.67
27.4

77.23
10.14
2.58
3.71
28.0

76.19
10.50
2.54
3.75
28.6

74.94
10.90
2.52
3.86
29.1

74.40
11.17
2.57
3.85
29.3

"8.10
3.83
0.20
0.50
6.00

"9.8
52.2
8.4
14.9
25.8

D. Assistant professors
White
74.92
Asian
11.16
Black
3.92
Hispanic
4.29
Female
34.0

73.82
11.70
4.02
4.35
34.9

72.18
12.77
4.10
4.46
35.4

70.62
13.35
4.09
4.62
36.0

68.88
13.96
4.08
4.86
36.3

67.09
14.67
4.10
4.94
36.8

65.38
15.46
4.04
4.98
37.6

63.71
16.02
4.15
5.05
38.3

62.47
16.46
4.08
5.12
38.7

60.56
16.70
4.11
5.21
39.7

58.83
16.62
3.96
5.13
40.5

58.36
16.60
3.97
5.09
40.7

"16.56
5.44
0.05
0.80
6.7

"22.1
48.7
1.3
18.6
19.7

E. Instructors
White
Asian
Black
Hispanic
Female

69.83
13.68
4.32
4.39
46.0

68.44
14.12
4.56
4.33
47.5

66.79
14.47
4.57
4.42
48.0

65.29
14.75
4.59
4.48
48.2

63.89
14.94
4.65
4.60
49.2

62.83
15.30
4.30
4.68
49.9

62.31
15.33
4.08
4.65
50.2

61.57
15.42
3.95
4.56
50.8

58.47
16.10
3.89
4.40
51.3

55.49
15.11
3.70
4.09
51.2

55.05
14.74
3.74
3.99
51.3

"16.31
2.14
"0.59
"0.35
5.8

"22.9
17
"13.6
"8.1
12.7

71.36
12.60
4.33
4.34
45.5

* Absolute change from 1997 to 2008.

y
Percent change from 1997 to 2008.

j o u r n a l o f s u r g i c a l r e s e a r c h 1 8 2 ( 2 0 1 3 ) 2 1 2 e2 1 8

1997

217

j o u r n a l o f s u r g i c a l r e s e a r c h 1 8 2 ( 2 0 1 3 ) 2 1 2 e2 1 8

Table 3 e Yearly percentage of academic medicine leaders by race or female gender.

Academic level

1998

2003

2008

Absolute change (%)*

Percent changey

A. Medical school deansz

White
Asian
Black
Hispanic
Female

91.30
0
5.22
3.48
6.96

92.86
0
4.46
2.68
8.93

89.74
0
5.13
2.56
11.96

L1.56
0
L0.09
L0.92
5.00

L1.7
0
"1.7
L26.4
71.8

Academic
level

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Absolute
change (%)x

Percent
changek

B. Chairpersons{
White
89.22
Asian
3.26
Black
2.25
Hispanic
2.76
Female
6.96

89.92
3.23
2.54
2.77
7.51

88.25
3.33
2.37
2.99
7.69

87.95
3.39
2.71
3.05
8.34

87.51
3.49
2.79
3.35
8.59

86.97
3.89
2.61
3.48
8.88

86.80
3.67
2.88
3.52
9.91

87.27
3.53
2.62
3.65
9.73

86.99
3.42
2.73
3.69
10.21

86.27
3.60
2.89
3.79
10.44

86.13
3.62
2.99
3.78
10.80

86.00
3.77
2.95
3.66
11.05

L3.22
0.51
0.70
0.90
4.09

L3.6
15.6
31.1
32.6
58.8

* Absolute change from 1998 to 2008.

y
Percent change from 1998 to 2008.
z
Entries in bold denote failure of growth from previous time point (or, in the case of absolute or percent change, from 1998 to 2008).
x
Absolute change from 1997 to 2008.
k
Percent change from 1998 to 2008.
{
Entries in bold denote failure of growth from previous year (or, in the case of absolute or percent change, from 1997 to 2008).

a millennium for the percentage of black professors to mirror

the percentage of blacks in the general population. Obviously,
there are too many other factors that influence the growth or
decline of any group in medicine, but these projections illustrate the point that acceptance of the current rate of diversification in our field is tantamount to accepting no change at all.
Interestingly, although Asians are not considered as
a URM, they face the same difficulty as all minorities
advancing up the academic ladder. The 12-y mean proportion
of all Asian faculty members at progressively higher levels of
academic medicine decreased from 14.7% (instructor) to 14.6%
(assistant professor), 9.2% (associate professor), 6.7% (full
professor), and finally 3.5% (chairperson). There were no Asian
deans reported from 1998 to 2008. Thus, relative to the U.S.
population, Asian Americans actually are URMs at the level of
full professor and at the leadership positions of chairperson
and dean. Relative to their enrollment in U.S. medical schools
(22% in 2010), they are underrepresented at every level of
academic medicine.
The trends for female academic physicians actually mirror
that of Asians in medicine. Even though by 2008, women had
closed the gap in representation at the level of instructor, the
lowest level of academic medicine, there still remains
a serious discrepancy in the percentage of female representatives at higher levels of our field. The shared experience of
both women and Asians negates the theory that underrepresentation at these high levels is simply because of an issue in
recruiting a diverse population of medical students. This is no
longer just a problem of entering the pipeline; there are clearly
deeply entrenched issues inhibiting the promotion of
nonwhite nonmale physicians that must be identified and
addressed.
A very concerning finding in this study is the reduction in
percentage of all minority groups among academic physicians
for the last 2 y of this study (2007 and 2008). More noteworthy
is the fact that the percentage of black academicians declined

for the last 4 consecutive years and 5 of the last 6 y examined.

If allowed to continue, this regression in diversification will
compromise forward progress to this point. The cause of this
trend is unknown but is likely to be multifactorial. Lower
career satisfaction among minorities in academic positions is
well documented [18e20]. Also, just as most Americans
believe, erroneously, that blacks receive the same quality of
health care as whites [21], it is plausible that most physicians
believe that minority physicians share equal opportunities in
advancing their academic careers. If true, this erroneous belief
may detract from efforts to level the playing field.
As with any study, our study has strengths and limitations.
Our major strength is our analysis of national data for 12 y.
Additionally, to our knowledge, this is the first study to
analyze the representation of minorities and women in the
leadership roles of chairperson and dean. Also, by performing
a year-by-year analysis on the distribution of these groups at
different academic ranks from 1997 to 2008, we were able to
better identify current trends, a unique addition to the literature. Our study is limited by our reliance on cross-sectional
data instead of longitudinal data. However, cross-sectional
data may be a more valid representation of the academic
environment, especially for more recent years; a longitudinal
analysis would not be helpful for recent data because there
would be little follow-ups to draw valid conclusions.
Our study has important implications. In 1847 and 1849,
American medicine saw the graduation of the first black and
female physicians. More than 150 y later, racial minorities and
women are still struggling to find their place in the field in
high-ranking academic positions. Women and Asians have
largely been more successful than black and Hispanic
minorities in entering the pipeline. Medical institutions have
put forth more proactive efforts in the admissions and
undergraduate training process. This problem is pervasive
and not simply because of inadequate numbers entering the
pipeline. This problem is ongoing, despite 50 y of proactive

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j o u r n a l o f s u r g i c a l r e s e a r c h 1 8 2 ( 2 0 1 3 ) 2 1 2 e2 1 8

efforts to resolve it. Most importantly, this problem compromises the care of our patients. We know that diversifying all
levels of academic medicine is not only politically correct but
also the way to make medical institutions better [22].
In conclusion, we confirmed in this national study that
whites and males predominate at every academic level. The
disparity in minority and female representation widens at
progressively higher positions in academia. Even though
Asians and women have succeeded in entering medicine, they
struggle to climb the academic ladder and remain underrepresented at the senior ranks. There has been an overall
improvement in diversity over the 12-y study period, but the
rate at which progress is being made is very slow. In fact, there
is a concerning trend toward regression of diversity in at least
the last 2 y examined. We must redouble our efforts to recruit,
retain, and advance minorities in academic medicine.

[9]
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