UPJ INSIGHT Fostering Diversity in Urology: Addressing Ethnic Disparities in Applicant and Resident Recruitment

By: Bruna Pino, BA, Boston University Chobanian and Avedisian School of Medicine, Massachusetts; Jonathan Song, BA, Boston University Chobanian and Avedisian School of Medicine, Massachusetts; Andrew Orlando, MD, Boston University Chobanian and Avedisian School of Medicine, Massachusetts Boston Medical Center, Massachusetts; David S. Wang, MD, Boston University Chobanian and Avedisian School of Medicine, Massachusetts Boston Medical Center, Massachusetts | Posted on: 20 May 2024

Pino B, Song J, Orlando A, Wang D. Fostering diversity in urology: addressing ethnic disparities in applicant and resident recruitment. Urol Pract. 2024;11(3): 559-566. doi:10.1097/UPJ.0000000000000521

Study Need and Importance

Despite physician diversity being valuable to patients, the current state of ethnic representation in medicine can fall short, particularly in small and competitive fields like urology. Better representation in urology residencies will likely increase diversity in academia and leadership positions, in addition to improving patient care and achieving culturally focused health equity.

What We Found

In our retrospective review on the trends of self-reported ethnicity data of urology applicants and residents, we found some evidence supporting an increase in diversity, such as a statistically significant improvement in residency recruitment of Hispanic applicants (Table). However, there was also evidence to suggest more can be done to bolster diversity. The number of Black or African American applicants into urology has remained low, with a recruitment gap noted in one of the cycles analyzed. Despite the increase we found in applicants identifying as having multiple races/ethnicities, their recruitment rate remains disproportionately low. Additionally, despite our analysis showing a decrease in White urology applicants, there was no concomitant decrease in White urology residents or change in their recruitment rates, suggesting that White applicants continued to be proportionately represented among residents.

Table. Comparing Applicants From Academic Year 2016 to 2020 to Residents in Academic Year 2020 by Ethnicity

Ethnicity	2016-2020 applicants n = 1823)	2020-2021 residents (n = 1768)	P
American Indian or Alaska Native, No. (%)	2 (0.1)	1 (0.1)	1.000
Asian, No. (%)	411 (22.5)	394 (22.3)	.712
Black or African American, No. (%)	92 (5.0)	65 (3.7)	.044
Hispanic, Latino, or of Spanish origin, No. (%)	95 (5.2)	130 (7.4)	.013
Native Hawaiian or Other Pacific Islander, No. (%)	0 (0.0)	0 (0.0)	—
White, No. (%)	1020 (56.0)	1043 (59.0)	.182
Other, No. (%)	32 (1.8)	41 (2.3)	.308
Multiple race/ethnicity, No. (%)	130 (7.1)	67 (3.8)	< .001
Unknown race/ethnicity, No. (%)	16 (0.9)	27 (1.5)	.112
Bolded text indicates a statistically significant value.

Limitations

One limitation is that ethnicity is a very personal and fluid identity and is self-reported. Second, match rates for specific applicant cohorts could not be determined. Third, there are other factors that may affect our estimation of the ethnic composition of resident classes, such as training programs longer than 5 years or resident attrition.

Interpretation for Patient Care

Our results show that going forward, further effort is needed to improve diversity in urology. We highlight the work of excellent programs such as PROSPECT, Michigan Urology Academy, Urology Unbound, and the UReTER mentorship program. However, we suggest that a more unified approach to the ethnic disparities in urology applicant and resident recruitment is necessary.