Racial, Gender Disparities Seen in Surgery Board Certification

Women and ethnic and racial minorities who, while in medical school, declare their intention to become board-certified general surgeons, are more likely to fall off that career path and into other specialties. And even if they remain in surgery, this group is less likely to complete the surgery board-certification process, a study shows.

Dorothy A. Andriole, MD, coauthor of the study, which appears in the May issue of the Journal of the American College of Surgeons, says she hopes the findings will spur surgical leaders to develop strategies to encourage women and minorities to pursue surgery and achieve board certification.

"If you want to create a workforce of great people and you are only tapping into half the workforce, you are missing a lot of great people," says Andriole, an associate professor in the Department of Surgery at Washington University School of Medicine, in St. Louis. "Physicians from groups that have been historically underrepresented in medicine tend to provide care for those populations."

Andriole told HealthLeaders Media that women represent about half of all medical students, but only about 13% of surgeons. "It is well worth examining why we would be seeing gender, race and ethnicity differences among those people who graduated and wanted to become surgeons," she says.

"There is always going to be some attrition. Having said that, we looked at academic performance and other measures, and even after accounting for those other measures we found women more likely to leave and more likely to be practicing but not as board certified surgeons."

The study examined the records of 3,373 medical school graduates from 1997 to 2002 who at the time of graduation, stated their intention to become board certified in surgery and entered general surgery training.

Andriole and coauthor Donna B. Jeffe tracked these physicians through July 2009 to see if they had achieved their goal. The researchers found that 60% of the graduates in the study achieved American Board of Surgery certification, 10% were certified by another American Board of Medical Specialties-member board, and the remaining 30% weren’t certified by any ABMS member board.

"It is not so much an issue of whether surgery is attracting women, but that the women they do attract are less likely to be retained. The same is true for graduates of non-white race or ethnicity," Andriole says.

Among graduates who remained in the surgery workforce, women, Asian/Pacific Islander graduates, and graduates from racial/ethnic groups historically underrepresented in medicine were more likely to be non-board certified, as were graduates who had initially failed Step l or Step 2 of the U.S. Medical Licensing Examination sequence, the report said.

Jeffe said that physicians who are not board certified often become marginalized. "They may not be able to access the same quality of medical services for their patients as can board-certified physicians," Jeffe said in prepared remarks. "Many practicing physicians from underrepresented groups in medicine provide care for other underrepresented or disadvantaged populations, so this speaks to the disparities in health outcomes for their patients as well."

The study did not speculate on the reasons for the gender gap, but Andriole says it could be linked to "the lengthier training requirements for board certification. That is often more of an issue for young women than young men because they are thinking about starting a family," she says.

Andriole concedes that some of the disparities could be self-correcting as more women and minorities enter medicine. "The graduates we looked at had graduated from 1998-2002," she says. "We are just now seeing women graduate in the current era of work-hour restrictions during graduate medical education and possibly some increased flexibility regarding maternity leave policies during residencies. Those may to some extent help."

"Although the women in our study weren’t as likely to complete the board certification as the men were, there are still a net increase in the numbers of women becoming surgeons, and the numbers of women surgeons who are on faculty," Andriole says. "Slowly the increase number of role models for women may help."