Diversity & Inclusion

Diversity & Inclusion

Diversity & Inclusion

Ophthalmology Workforce Diversity

A diverse workforce includes those with differences in race, ethnicity, sex, sexual orientation, socioeconomic status, and other factors.1 Several benefits are associated with a more diverse workforce within medicine—to include ophthalmology:

  • Healthcare studies have demonstrated that diverse workforces are associated with better patient outcomes2
  • Increased patient satisfaction is reported when provided by a clinician of the same ethnicity3-5
  • Diversity ensures high-quality medical education, access to healthcare for underserved populations, advances in research, and improved business performance5
  • Underrepresented minorities (URMs) are more likely to research the eye diseases that affect people of color and practice in medically underserved areas6
  • Many eye diseases disproportionately affect URMs. Physicians who are part of URMs are more likely to work with URM populations, which also means they can more effectively recruit a diverse pool of candidates for clinical trials6

The Ophthalmology Diversity Landscape

Despite the advantages of a diverse ophthalmic workforce, ophthalmology and the retina subspecialty still have strides to make to increase the number of URMs. The specialty has seen some growth in this area in recent years, but there is room for improvement. Here are some examples of diversity (or lack thereof) within ophthalmology and retina:

  • Although URMs are more than 30% of the total population in the United States, they are only 6% of practicing ophthalmologists.6,7 Underrepresented minorities make up only 5.7% of ophthalmology faculty and 7.7% of ophthalmology residents, according to the same study.6 However, URMs increasingly applied to work within the specialty, going from 5.9% to 11.8% of all applications between 2016 and 20198
  • Women make up 22.7% of practicing ophthalmologists, 35.1% of ophthalmology faculty, and 44.3% of ophthalmology residents.6 Study researchers found some increases in female participation over the study period but did not find an increase in URM ophthalmologists
  • Among the subspecialties in ophthalmology, retina care attracts the smallest percentage of women, according to a report that included data from the American Academy of Ophthalmology (AAO). Only 19% of US retinal specialists in 2018 were women, compared with 26% in oculoplastics, 29% in cornea, 34% in glaucoma, and 47% in pediatric ophthalmology9 Research from 2021 found that 25% of retinal specialists were female, compared with 29% in cornea, 38% in glaucoma, and 50% in pediatric ophthalmology10
  • In an analysis of 276 clinical trials within ophthalmology, women were the lead author for only 20% of them. Retina was the most common specialty for a lead female author in clinical trials10
  • A retrospective trend study found that women made up fewer than 25% of the main podium faculty roles at vitreoretinal meetings over a 5-year period.11 The researchers analyzed 30 vitreoretinal meetings between 2015 and 2019 and recorded genders of program committee members as well as first-author podium presenters and other roles. A trend toward an increased proportion of female faculty during the study years was observed, from 19.6% in 2015 to 25.5% in 2019 (P = .002)11
  • From 2000 to 2021, there was just a 2% increase in the number of female ophthalmology faculty, according to an analysis of the American Association of Medical Colleges faculty roster. In that same time period, the increase in URM faculty members within the specialty was just one-fourth of the increase seen in the overall US minority population12
  • When comparing 18 clinical specialties from the 2019 American Association of Medical Colleges faculty roster, ophthalmology was the third lowest for its proportion of URM faculty. The only two specialties that had lower representation were orthopedics and radiology13

Changing for More Diversity

Recognizing the need for greater diversity within the ophthalmic workforce, prominent medical societies and ophthalmologists at the academic and practice level can and are making changes to include a more diverse group of physicians.

“Given the current state of representation in ophthalmology indicating that women and URM students are further underrepresented at each achievement level in ophthalmology, it will take more than status quo practices for the field to become more diverse,” according to Jeffrey Gluckstein, author of a 2023 report on diversity in ophthalmology.14

The AAO has made several changes to encourage diversity within the specialty:

  • It began a Minority Ophthalmology Mentoring (MOM) program, which started as a pilot program in 2016 between the AAO and the Association of University Professors of Ophthalmology. The goal of the program is to attract talented URMs who are in their first 2 years of medical school to ophthalmology. Within MOM, students are matched with ophthalmology mentors. The class of 2023 included 63 qualified students.15,16 Those who are part of MOM receive mentorship, medical career planning guidance, and networking opportunities.
  • The AAO now has an online LGBTQ+ community17 The AAO website also has background information and videos, such as “The LGBTQ Survival Guide for Applying to Residency” and “How to Talk to Transgender Patients”17
  • Task forces within the AAO focus on diversity and inclusion, including the promotion of change in the makeup of the ophthalmic workforce1,16
  • The creation of clinician educational resources highlight the impact that the lack of diversity has on healthcare outcomes, and the AAO seeks to enhance diversity education and initiatives16

At the academic and practice level, other ways that leaders can and are focusing on workforce diversity include the following:

  • Creating and marketing recruitment and retention strategies aimed toward females and URMs7,12
  • Providing research and presentation experience to URMs10
  • Looking beyond standardized test scores to also focus on candidates’ characters, service, and scholarship18
  • Creating more mentorship programs and serving as mentors at schools without any ophthalmology programs18
  • Including cultural competency and implicit bias training for all ophthalmologists, starting in medical school and residency19
  • Staying aware of and providing resources for burnout, which can become a larger problem for female ophthalmologists balancing work and life responsibilities14
  • Using more inclusive curricula and training programs12
  • A greater focus on resources to assist LGBTQ + ophthalmologists7
  • Speaking with trainees about the current state of retina care. Retina care has had a stronger association with perceived disruptions to work-life balance; however, complex ophthalmic conditions persist regardless of ophthalmic specialty. Advancements in the field have led to shorter retina cases and recent management trends favoring more in-office pharmaceutical treatments, potentially increasing the appeal of retina subspecialization.11

Another strategy that can help encourage more diversity within ophthalmology is to speak with medical students as they search for a specialty. “When they are deciding on a specialty, we want them to see ophthalmology as a meaningful, achievable option,” said Purnima S. Patel, MD, in an AAO EyeNet article.18 Active engagement before medical school may also encourage future workforce diversity, such as with Oregon Health and Science University’s Casey Advancement of Diversity and Inclusion in Ophthalmology (CADIO) program, in which minority high school and college students are targets for outreach.18 This program lets URM students know about the benefits of working within ophthalmology as well as the potential to have a positive impact on field-related disparites.18

References

  1. American Academy of Ophthalmology. Diversity, Equity, and Inclusion. https://www.aao.org/diversity-equity-and-inclusion
  2. Gomez LE, Bernet P. Diversity improves performance outcomes. J Nat Med Assoc. 2019;111:383-392. https://pubmed.ncbi.nlm.nih.gov/30765101/
  3. Laveist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43:296-306. https://pubmed.ncbi.nlm.nih.gov/12467254/
  4. Takeshita J, Wang S, Loren AW, et al. Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open. 2020;3:e2024583. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772682
  5. Reede JY. A recurring theme: The need for minority physicians. Health Aff (Millwood). 2003;22:91-93. https://www.healthaffairs.org/doi/epdf/10.1377/hlthaff.22.4.91
  6. Xierali IM, Nivet MA, Wilson MR. Current and future status of diversity in ophthalmologist workforce. JAMA Ophthalmol. 2016;134:1016-1023. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2532380
  7. Uguwa TA, Srikumaran D, Canner J, et al. Trends in racial and ethnic diversity of ophthalmology residents and residency applicants. Am J Ophthalmol. 2022;240:260-264. https://www.ajo.com/article/S0002-9394(22)00098-8/abstract
  8. Randolph JD, Zebardast N, Pérez-González CE. Improving ophthalmic workforce diversity: A call to action. Ophthalmology. 2022; 129:1081-1082. https://www.aaojournal.org/article/S0161-6420(22)00491-2/fulltext
  9. Finn A, Baumal C. Closing the gender gap in retina. Retina Today. March 2020. https://retinatoday.com/articles/2020-mar/closing-the-gender-gap-in-retina
  10. Menard M, Ji X, Chen Q, Law JC, Baumal CR, Finn AP. Women’s representation among lead investigators of clinical trials in ophthalmology. Ophthalmology. 2023;130:223-225. https://www.aaojournal.org/article/S0161-6420(22)00857-0/abstract
  11. Sridhar J, Kuriyan AE, Yonekawa Y, et al. Representation of women in vitreoretinal meeting faculty roles from 2015 through 2019. Am J Ophthalmol. 2021;221:131-136. https://pubmed.ncbi.nlm.nih.gov/32918901/
  12. Ali AA, Chauhan MZ, Doty M, Bui T, Phillips PH, Sallam AB. Ophthalmology faculty diversity trends in the U.S. JAMA Ophthalmol. 2023;141:1021-1028. https://pubmed.ncbi.nlm.nih.gov/37824107/
  13. Fairless EA, Nwanyanwu KH, Forster SH, Teng CC. Ophthalmology departments remain among the least diverse clinical departments at United States medical schools. Ophthalmology. 2021;128:1129-1134. https://pubmed.ncbi.nlm.nih.gov/33440211/
  14. Gluckstein J. Diversity in academic ophthalmology: Disparities and opportunities from medical school to practice. Semin Ophthalmol. 2023;38:4:338-343. https://pubmed.ncbi.nlm.nih.gov/36524756/
  15. Coleman AL. Overview of disparities in eyecare. Presented at the American Academy of Ophthalmology 2021 annual meeting, New Orleans, Louisiana.
  16. American Academy of Ophthalmology. Minority Ophthalmology Mentoring. https://www.aao.org/minority-mentoring
  17. American Academy of Ophthalmology. Ophthalmology and the LGBTQ+ Community. https://www.aao.org/lgbtq-community
  18. Stuart A. Improving diversity, equity and inclusion in ophthalmology. EyeNet. September 2021. https://www.aao.org/eyenet/article/improving-diversity-equity-and-inclusion
  19. Aguwa UT, Srikumaran D, Brown N, Woreta F. Improving racial diversity in the ophthalmology workforce: A call to action for leaders in ophthalmology. Am J Ophthalmol. 2021;223:306-307. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578664/

All URLs accessed February 21, 2024

This activity is provided by Med Learning Group.
This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc.

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