ONLINE EXCLUSIVE
December 2021
by Liz Hillman
Editorial Co-Director
Despite the strides that females have made in increasing representation in various areas of medicine, female representation in ophthalmology is still lagging behind the proportion of women in the U.S population and in medical school, according to research published in JAMA Ophthalmology.1 This wasn’t what the authors of the study expected to find, Divya Srikumaran, MD, coauthor of the study, told EyeWorld.
“We found, over time, more medical students are female, yet [when it came to matching in ophthalmology,] there is a disconnect there,” Dr. Srikumaran said. “It surprised us.”
The cross-sectional study included data from the San Francisco Match, the Association of University Professors of Ophthalmology, the Accreditation Council for Graduate Medical Education, the Association of American Medical Colleges, and the American Academy of Ophthalmology (AAO) from January 1, 2011 through December 31, 2019, looking at match applicants, residents, and clinical faculty.
The data included 2,807 ophthalmology applicants (35.3% female), 1,004,563 residents (43.8% female), 463,079 clinical faculty members (42.5% female), and 78,968 AAO members (26.1% female). The ratio of male to female applicants in ophthalmology residency was 1.6:1 between 2016 and 2019. The percentage of female applicants who matched in 2016 was 40% and 39% in 2019. Across all medical specialties, there was a 2.3% increase in percentage of female residents from 2011 to 2019, but there was a 2.5% decrease in female ophthalmology residents. The percentage of female ophthalmologists on clinical faculty increased 2% between 2017 and 2019. The research found that the ratio of male to female practicing ophthalmologists who were members of AAO was 3:1. Fasika Woreta, MD, the study’s corresponding author, noted that when they looked at AAO members in training, the ratio was better (40% female). She said she expects the ratio of full membership to change in the coming years.
“The decrease in the number of females entering ophthalmology in recent years is indeed concerning,” Dr. Woreta said. “We need to stay ahead of this and figure out what factors might be contributing to this so we can address them. For example, lack of adequate parental leave policies and absence of a couples match may be important factors that we need to address.”
Dr. Woreta said that as a residency program director and a minority female, she thinks it’s important to monitor diversity in the field to assess areas for improvement.
“We know lack of diversity within our workforce can actually affect patient outcomes, and thus it is important for educators and leaders to use objective data to monitor how well we are doing,” Dr. Woreta said.
Dr. Srikumaran said looking at trends of representation in the specialty over time is important to make sure that there aren’t systemic biases in applications, recruitment, faculty, or retention, and it can help identify if systems put in place to counter possible bias or pipeline blocks are working.
While the paper didn’t explore the reasons for this trend, one reason Dr. Srikumaran hypothesized could be that medical students are getting less exposure to ophthalmology in school.
“Ophthalmology is getting more and more marginalized from medical school curricula. The amount of time that students are getting exposed to ophthalmology is getting gradually more limited just because they have so much to learn,” she said.
Other possible reasons Dr. Srikumaran mentioned could be that the specialty is viewed as very competitive, and it is unclear if this might deter some women from applying. Ophthalmology is also one of the specialties that does not offer a couples match with a significant other, and we don’t know if this would affect the number of female applicants applying in the specialty, Dr. Srikumaran said.
Dr. Woreta said gender diversity among ophthalmologists plays a role in patient outcomes.
“Patient/provider concordance has been shown to impact patient satisfaction,” she said.
Dr. Srikumaran offered a similar perspective. Often patients have a preference for a physician who is the same gender, race, or ethnicity as them.
“Patients should be able to have a choice to see different providers, to find someone they can connect with,” she said, adding that with the connection can come trust and with that trust might come a higher likelihood of following through with treatment plans, etc.
The first step to making sure the ophthalmology physician workforce is representatively diverse, Dr. Srikumaran said, is to be more aware of the issue from the get-go. She advocated for there to be more awareness that there are people who might be coming through medical school, training, and beyond who are having different experiences. Dr. Srikumaran said diversity of those in leadership positions can have an impact on applicants and acceptances as well.
Dr. Woreta said that mentorship programs through ophthalmology organizations have helped increase diversity in the workforce, and continued support and expansion of these programs are critical to recruit the best medical students and a diverse pipeline.
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About the physicians
Divya Srikumaran, MD
Vice Chair for Education
Associate Professor of Ophthalmology
Wilmer Eye Institute
Johns Hopkins School of Medicine
Baltimore, Maryland
Fasika Woreta, MD, MPH
Ophthalmology Residency Program Director
Associate Professor of Ophthalmology
Wilmer Eye Institute
Johns Hopkins School of Medicine
Baltimore, Maryland
Reference
- Aguwa UT, et al. Analysis of sex diversity trends among ophthalmology match applicants, residents, and clinical faculty. JAMA Ophthalmol. 2021;139:1184–1190.
Relevant disclosures
Srikumaran: None
Woreta: None
Contact
Srikumaran: dsrikum1@jhmi.edu
Woreta: fworeta1@jhmi.edu
