Shifts in diversity along the spine surgery training pathway: racial, ethnic, and gender representation from medical school to fellowship.

Abstract

Racial and ethnic minorities are underrepresented among healthcare providers in the United States (US). This study analyzed the training pathway of underrepresented groups in spine surgery relative to earlier stages of training and the US population. This was a cross-sectional analysis of medical students, orthopedic surgery residents, and spine surgery fellows at accredited training programs (2014-2024). N/A. Representation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of demographic groups in spine surgery training over their prevalence in earlier stages of training cohorts. PPRs <0.80 were classified as underrepresented and PPRs>1.2 were classified as overrepresented. Self-reported demographics were compared between the US population, medical students, orthopedic surgery residents, and spine surgery fellows. There were demographic disparities between medical students, orthopedic surgery residents, and spine surgery fellows including female (48.7% vs. 16.7% vs. 6.6%, p<.001), White (54.7% vs. 73.1% vs. 52.6%, p<.001), Black (6.1% vs. 4.4% vs. 8.4%, p<.001), Native Hawaiian/Pacific Islander (0.04% vs. 0.08% vs. 0.70%, p<.001), and Asian (21.3% vs. 13.0% vs. 17.1%, p<.001) trainees. There were no significant disparities among Hispanic (5.4% vs. 5.3% vs. 7.7%, p=.292) and American Indian/Alaska Native (0.15% vs. 0.13% vs. 0.35%, p=.888) trainees. Relative to the US population, female (PPR=0.13), Hispanic (PPR=0.41), American Indian/Alaska Native (PPR=0.64), and Black (PPR=0.68) trainees were underrepresented in spine surgery. In contrast, Asian (PPR=2.85), male (PPR=1.89), Native Hawaiian/Pacific Islander (PPR=1.75) were overrepresented in accredited spine surgery training relative to the US population. Diversity by gender, race, and ethnicity in accredited spine surgery training is limited relative to the US population. There may be opportunities to recruit underrepresented groups during earlier stages of medical training to promote diversity, equity, and inclusion in the emerging spine surgery workforce.