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, including within ophthalmology:

Healthcare studies have demonstrated that diverse workforces are associated with better patient outcomes.²
Increased patient satisfaction and positive associations with receiving preventative care are reported when provided by a clinician of the same ethnicity.^3-5
Diversity ensures high-quality medical education, access to healthcare for underserved populations, advances in research, and improved business performance.⁵
Underrepresented minorities (URMs) are more likely to research the eye diseases that affect people of color and practice in medically underserved areas.⁶
Many eye diseases disproportionately affect URMs. Physicians who are part of URM groups are more likely to work with URM populations, which also means they can more effectively recruit a diverse pool of candidates for clinical trials.⁶

The Ophthlamology 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, according to an analysis that focused on ophthalmology from 2005 to 2015.⁶ Underrepresented minorities make up only 5.7% of ophthalmology faculty and 7.7% of ophthalmology residents, according to the same study. 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 within ophthalmology 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 ophthalmology.⁷
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.⁸ 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).⁸
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 radiology.⁹

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.

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 2021 included 103 qualified students.¹⁰ Those who are part of MOM were able to attend the 2021 annual AAO meeting and network, attend skills transfer sessions, and visit the exhibit floor.
The AAO now has an online LGBTQ+ community.¹¹ The development of an LGBTQ+ mentorship program is also underway.
Task forces within the AAO focus on diversity and inclusion, including the promotion of change in the makeup of the ophthalmic workforce.^1,12
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 initiatives.¹³

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

Providing research and presentation experience to URMs¹⁴
Looking beyond standardized test scores to also focus on candidates’ characters, service, and scholarship¹⁴
Creating more mentorship programs and serving as mentors at schools without any ophthalmology programs¹⁴
Including cultural competency and implicit bias training for all ophthalmologists, starting in medical school and residency¹⁵
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.⁷

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

Providing research and presentation experience to URMs¹⁴
Looking beyond standardized test scores to also focus on candidates’ characters, service, and scholarship¹⁴
Creating more mentorship programs and serving as mentors at schools without any ophthalmology programs¹⁴
Including cultural competency and implicit bias training for all ophthalmologists, starting in medical school and residency¹⁵
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.⁷

Another strategy that can help encourage more diversity within ophthalmology is to speak with medical students early on as they search for a specialty. “[W]hen 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.¹⁴ 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.¹⁴This 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.¹⁴

References

American Academy of Ophthalmology. Diversity, equity, and inclusion. https://www.aao.org/diversity-equity-and-inclusion
Gomez LE and Bernet P. Diversity improves performance outcomes. J Nat Med Assoc. 111:383-392. https://pubmed.ncbi.nlm.nih.gov/30765101/
Laveist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43(3):296-306. https://pubmed.ncbi.nlm.nih.gov/12467254/
Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, Sawinski DL. Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open. 2020;3(11):e2024583. https://jamanetwork.com/journals/ jamanetworkopen/fullarticle/2772682?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110920
Reede JY. A recurring theme: the need for minority physicians. Health Affairs. 2003;22:91-93. https://sci-hub.se/10.1377/hlthaff.22.4.91
Xierali IM, et al. Current and future status of diversity in ophthalmologist workforce. JAMA Ophthalmol. 2016;134(9):1016-1023. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2532380
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
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/
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/
Coleman AL. Overview of disparities in eyecare. Presented at the American Academy of Ophthalmology 2021 annual meeting, New Orleans, Louisiana.
Ramirez D. Embracing our LGBTQ community. Presented at the American Academy of Ophthalmology 2021 annual meeting, New Orleans, Louisiana.
Charters L. Pulling back the curtain on racial inequities in ocular health care. Ophthalmology Times. June 15, 2021. https://www.ophthalmologytimes.com/view/pulling-back-the-curtain-racial-inequities-ocular-health-care
Diversity and inclusion education. https://www.aao.org/diversity-and-inclusion-education
Stuart A. Improving diversity, equity and inclusion in ophthalmology. EyeNet. September 2021. https://www.aao.org/eyenet/article/improving-diversity-equity-and-inclusion
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/pdf/main.pdf