2019 HSC Section 2 - Practice Management

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

retention and promotion rates would be signi fi cantly lower among racial/ethnic minority surgeons compared to their White peers. We hypothesized that such disparities would affect all medical spe- cialties but would be greater in surgical fi elds.

Statistical analysis

Baseline counts of full-time faculty in surgery, ob/gyn, internal medicine, and pediatrics based on race and ethnicity were re- ported. Differences in 10-year rates of promotion and retention were compared between race/ethnic groups using Chi-square tests. Times to promotion were compared using one-way ANOVA. A survival analysis using log-rank test was created to compare dif- ferences in time to event for promotion and retention by race/ ethnicity. Statistical signi fi cance was de fi ned as p < 0.05. Analyses were performed with R v3.3.3.

Materials and methods

Data source

We used the Association of American Medication Colleges (AAMC) Faculty Administrative Management Online User System (FAMOUS) database for this study. The AAMC fi rst created a Faculty Roster in 1966 to maintain a national database of medical school faculty in the United States. FAMOUS was launched in 2002 as an online version of the Faculty Roster, collecting data prospectively, updating data annually, and allowing for review of historical data. 16 This study was approved by the Institutional Review Board at Weill Cornell Medicine (Protocol # 1601016879). We performed a speci fi c query of the FAMOUS database to obtain aggregated reports of number of faculty promoted/retained each year based on gender, race/ethnicity (self-identi fi cation as White, Black, Asian, Hispanic, and ‘ Other ’ including Paci fi c Islander, Native American, and multiracial), faculty rank (including assistant, associate, full professor positions), and department. We included all full-time faculty in surgery, ob/gyn, internal medicine, and pedi- atrics who had their fi rst appointment between January 1, 2003 and December 31, 2006. Each individual faculty member then tracked over ten years after their initial appointment to determine if they met one of the following study endpoints: 1) promoted (assistant to associate professor or associate to full professor) or 2) retained (remained in full-time academia). Faculty members were followed for ten years after their date of appointment. If a faculty member stayed in academia but changed to a part-time position, they were considered to have left full-time academia. The primary outcomes of the study were differences in 10-year rates of promotion and retention between full-time surgical faculty based on race/ethnicity. Each endpoint was calculated for the overall cohort, assistant professors alone, and associate professors alone. Secondary outcomes were comparisons of promotion and retention by race/ethnicity in surgery with those outcomes in other specialties: ob/gyn, internal medicine and pediatrics. Time to pro- motion and retention were also calculated. Study population and endpoints Outcomes and de fi nitions

Results

Initial cohort

There were 20,816 full-time faculty included in the study cohort who began academic appointments from January 1, 2003 to December 31, 2006, of whom 3966 (19%) were in surgery; 1614 (8%) in OB/GYN, 10,257 (49%) in internal medicine; and 4979 (24%) in pediatrics. Initially, 62% of all assistant professors of surgery were White and 75% of all associate professors of surgery were White. In all other specialties, a higher proportion of associate professors were White compared to assistant professors ( Table 1 ). 10-Year promotion rates For assistant professors of surgery, promotion rates at 10-year follow-up were highest for White faculty (34%) and lowest for Black faculty (19%) (p < 0.01). There was no signi fi cant difference in 10-year rates of promotion among associate professors in surgery. Other specialties had similar trends at the assistant professor level, in which White faculty had the highest promotion rates and Black faculty had the lowest promotion rates (p < 0.01 for all specialties). The lowest promotion rate over the 10-year period for the entire cohort was found in Black assistant professors in ob/gyn (12%) ( Table 2 ). Average time to promotion On average, there were no differences in time to promotion based on race/ethnicity for assistant and associate professors in surgery, ob/gyn, and pediatrics. The shortest and longest average times for promotion, respectively, were observed for Asian asso- ciate professors of surgery (5.2 years) and Black ob/gyn assistant professors of surgery (7.3 years), however differences were not statistically signi fi cant. Time to promotion varied signi fi cantly by race/ethnicity for internal medicine associate professors, where Ethnic/racial disparities in promotion

Table 1 Counts of initial appointments of full-time faculty by race/ethnicity and department from 2003 to 2006.

White n (%)

Asian n (%)

Black n (%)

Hispanic n (%)

Other n (%)

Overall

All Departments

12,824 (62)

3592 (17)

820 (4)

1216 (6)

2364 (11)

20,816

Surgery

Assistant Professor Associate Professor

1660 (62) 957 (75)

417 (16) 142 (11)

108 (4)

157 (6)

341 (13)

2683 1283

40 (3)

50 (4)

94 (7)

Obstetrics and Gynecology Assistant Professor

693 (61) 357 (75)

149 (13)

104 (9)

65 (6) 24 (5)

130 (11)

1141

Associate Professor

41 (9)

26 (5)

25 (5)

473

Internal Medicine

Assistant Professor Associate Professor

3921 (53) 2039 (70)

1698 (23) 439 (15)

266 (4)

467 (6) 141 (5)

981 (13) 243 (8)

7333 2924

62 (2)

Pediatrics

Assistant Professor Associate Professor

2162 (60) 1035 (74)

555 (15) 151 (11)

176 (5)

240 (7)

452 (13)

3585 1394

38 (3)

72 (5)

98 (7)

33