2019 HSC Section 2 - Practice Management

J.S. Abelson et al. / The American Journal of Surgery 216 (2018) 678 e 682

Fig. 2. Retention of surgery assistant and associate professors by race/ethnicity (p < 0.01; p ¼ 0.92, respectively).

suggests that URM junior faculty may face different professional challenges to develop their academic career than their White col- leagues. These may include diversity-related responsibilities, im- plicit biases, or non-ef fi cacious mentorship. These results should be used to in fl uence the development of interventions to target junior faculty rather than mid-level or senior faculty. Racial disparities in promotion and retention of URMs in aca- demic medicine is not limited to surgery. Similar disparities were found in OB/GYN, internal medicine, and pediatrics. Previous re- ports have either not separated out faculty by department, 17 e 19 or used data that are over 15 years old. 20 Our study has the advantage of using the most updated data and providing robust detail to better describe the breadth and depth of the current issue. Our fi ndings provide a more nuanced understanding of a known sys- temic issue in academic medicine, enabling better targeting of future research and resource allocation to URM junior faculty. Well- designed solutions are needed to address this inequality to increase the likelihood that leaders in academic medicine are re fl ective of the diverse U.S. population. A few solutions to consider for increasing promotion and retention of all faculty include improved mentorship, better delineation of expectations for success, and increasing access to scholarly activities. 21 Similar interventions have proven effective for underrepresented minorities in one single institutional study that demonstrated improved promotion and retention after implementing a junior faculty development program. 22 This has been done in surgical specialties, but likely requires renewal of resources as the program is no longer recruiting new participants. 23 Another option is providing small intramural grants for junior faculty to support academic career development. 24 Interventions will likely be more robust if they acknowledge the unique burdens that racial/ethnic minority faculty face in the name of diversity, which may contribute to poor retention among early-career academicians. 25 There are several limitations to this study. First, we were unable to determine the primary etiology for why faculty may or may not have been promoted, or why they decided to leave full-time aca- demic medicine. Our prospective study using a national cohort provided a big-picture view of racial/ethnic disparities, but comprehensive qualitative work will better elucidate the reasons

why minority faculty leave academia. Future work will also need to investigate why there was a difference the assistant level but not associate level. Second, although we included a large cohort for analysis, there were some noticeable differences in promotion and retention that were not statistically signi fi cant, which may be due to insuf fi cient power. Third, policies for promotion and retention vary by institution; this could not be controlled for given our study methodology. Fourth, AAMC was unable to provide gender com- bined with race and ethnicity as this would have made subjects potentially identi fi able. There are major racial and ethnic disparities in promotion and retention rates among assistant professors in surgery, ob/gyn, in- ternal medicine, and pediatrics. Speci fi cally, Black assistant pro- fessors had signi fi cantly lower promotion rates for all specialties and retention was signi fi cantly higher for White assistant pro- fessors. These fi ndings highlight the need to develop institutional programs to better support and develop minority faculty members in academic medicine. Potential interventions include dedicated mentorship programs and provision of intramural funds to URM junior faculty. Conclusion

Funding

This study was funded by the Weill Cornell Medicine, Center for Effectiveness and Surgical Outcomes Research. JSA, MMS, GE received support from the Agency for Healthcare Research and Quality, NRSA T32-HS000066-23.

Acknowledgements

The authors thank Rae Anne Sloane, Faculty Roster Coordinator, Data Operations and Services, Association of American Medical Colleges for her support with data acquisition.

Appendix A. Supplementary data

Supplementary data related to this article can be found at

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