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UPJ INSIGHT Factors Influencing Underrepresented in Medicine Urologist Recruitment to Academic Institutions
By: David Barquin, MD, Duke University, Durham, North Carolina; David Tella, MD, University of Virginia, Charlottesville; Mei Tuong, MD, University of Virginia, Charlottesville; Kirsten L. Greene, MD, University of Virginia, Charlottesville; Tracy Downs, MD, University of Virginia, Charlottesville; Nora G. Kern, MD, University of Virginia, Charlottesville | Posted on: 20 Apr 2023
Barquin D, Tella D, Tuong M, Greene KL, Downs T, Kern NG. Factors influencing underrepresented in medicine urologist recruitment to academic institutions. Urol Pract. 2023;10(2):186-194.
Study Need and Importance
The intent of our study was to characterize factors associated with recruitment of underrepresented in medicine (URiM) urology residents and faculty to academic institutions given the excessive disparity of URiMs in urology compared to other fields. Since urology only has demographic data available in census form, we felt this study would be important as it individualizes the data and attempts to identify where URiMs are training/practicing. By identifying these factors, we hope to bring awareness to institutions regarding who may be disadvantaged based on program location and prestige. This may encourage additional recruitment methods to strengthen the pool of URiMs in the urology workforce.
What We Found
URiM residents and faculty were more likely to be women compared to non-URiMs (see Table). Specifically, the woman-to-man ratio was 1:4 for non-URiMs residents and closer to 1:1 for URiM residents. URiM urologists were found to practice predominantly in the South Central AUA section and in medium metro areas. URiM residents were found to train mostly in medium metro areas and in top 10 training programs based on U.S. News and World Report rankings. We did not find any associations for URiM faculty regarding location or prestige. There was also no correlation between presence of URiM faculty and URiM residents.
Table. Demographics by Underrepresented in Medicine Status for Faculty and Residents Combined
| Non-URiM, No. (%) N=3,447 |
URiM, No. (%) N=328 |
P value | |
|---|---|---|---|
| Title | .85 | ||
| Faculty | 1,948 (91.4) | 183 (8.6) | |
| Resident | 1,499 (91.2) | 145 (8.8) | |
| Gender | < .001 | ||
| Men | 2,713 (92.3) | 225 (7.7) | |
| Women | 734 (87.7) | 103 (12.3) | |
| AUA section | .05 | ||
| Northeastern | 174 (94.6) | 10 (5.4) | |
| New England | 294 (90.7) | 30 (9.3) | |
| New York | 388 (90.9) | 39 (9.1) | |
| Mid-Atlantic | 405 (92.5) | 33 (7.5) | |
| Southeastern | 587 (91.1) | 57 (8.9) | |
| South Central | 375 (88.0) | 51 (12.0) | |
| North Central | 775 (93.5) | 57 (6.9) | |
| Western | 449 (89.8) | 51 (10.2) | |
| Census statistical areas | .04 | ||
| Small metro (<1.5 million) | 1,237 (35.9) | 95 (29.0) | |
| Medium metro (1.5-6 million) | 1,181 (34.3) | 129 (39.3) | |
| Large metro (>6 million) | 1,029 (29.9) | 104 (31.7) | |
| USNWR rankings | .18 | ||
| >50 | 2,209 (64.1) | 208 (63.4) | |
| 26-50 | 433 (12.6) | 38 (11.6) | |
| 11-25 | 428 (12.4) | 34 (10.4) | |
| 1-10 | 377 (10.9) | 48 (14.6) | |
| Abbreviations: AUA, American Urological Association; CI, confidence interval; OR, odds ratio; Ref, reference; URiM, underrepresented in medicine; USNWR, U.S. News and World Report. P values in bold are statistically significant. |
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Limitations
Our greatest challenge was characterization of urologists for race. We used biographical information from websites, name of origin, and photo to define URiM status. We recognize the flaws in this; however, we believe our margin of error is insignificant given our overall percentage of URiM urologists (8.7%) matched census data (8%) in a sample size of >3,000 individuals. We do not know how these data could be more accurately obtained otherwise.
Interpretation for Patient Care
By increasing URiM recruitment into institutions, patient care can be improved to accommodate the vastly diverse U.S. population.
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