Trends in the Diversity of Pediatric Faculty: 2000 to 2020

We performed a repeat cross-sectional study of race, ethnicity, sex, and rank of pediatric faculty using AAMC Faculty Rosters from 2000 to 2020. The AAMC Medical Minority Applicant Registry defines URiM as self-identification as African American/Black, Hispanic, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander.¹⁸  This report follows the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline for cross-sectional studies. This study was considered exempt from human subject research by the Wake Forest University Health Sciences Institutional Review Board.

The AAMC initiated the Faculty Roster in 1966 to collect information on the characteristics of full-time faculty members at US medical schools accredited by the Liaison Committee on Medical Education.¹⁹  On the basis of data collected by the AAMC Faculty Roster Survey, race and ethnicity in this study were defined as non-Hispanic African American/Black, referred to as African American/Black, non-Hispanic Native American/Alaska Native, referred to as Native American/Alaska Native, non-Hispanic Native Hawaiian/Pacific Islander, referred to as Native American/Pacific Islander, and Hispanic or Latino (of any race, including multirace, Hispanic), referred to as Hispanic. The non-Hispanic Asian, non-Hispanic White, non-Hispanic multiracial, and non-Hispanic other categories were included in the totals but not separately characterized. We obtained 2020 US population data from the US Census Bureau.²⁰  We obtained revised US Census Bureau pediatric population estimates from 2000 to 2020 from the KIDS COUNT Data Center.²¹  The racial and ethnic categories used throughout this article reflect those reported in the original data sources.

Results were analyzed by using descriptive statistics. The inclusion of racial and ethnic groups in the URiM category was based on the AAMC definition of URiM. Therefore, multiracial and “other” race and ethnicity categories were not included in the URiM category. Because the unknown race category could not be further characterized, it was excluded from analyses. URiM proportions (number of URiM faculty/total number of faculty) were calculated for all years (2000–2020) by race, ethnicity, sex, and rank; the Clopper-Pearson exact binomial method was used to calculate 95% confidence intervals. To determine if there was a significant trend in URiM representation over time, proportions (URiM/total) were compared by race and ethnicity, sex, and rank with the Cochran-Armitage test from all years, 2000 to 2020. Results were considered statistically significant at a 2-tailed P value <.05. SAS (version 9.4, Cary, NC) was used for all analyses.

A total of 367 863 pediatric faculty members were included. Overall, the unknown race and ethnicity category accounted for 9417 (2.6%) of pediatric faculty; the non-Hispanic multiracial category accounted for 7470 (2.0%) of pediatric faculty.

Between 2000 and 2020, the total number of pediatric faculty increased from 9510 (2000) to 17 033 (2020). Significantly increased trends occurred in URiM faculty representation at all ranks: professor (4.2% in 2000 to 7.7% in 2020, P < .0001), associate professor (7.4% in 2000 to 10.4% in 2020, P < .0001), and assistant professor (11.3% in 2000 to 13.9% in 2020, P < .0001) (Table 1; Fig 1).

URiM male representation remained unchanged over time at all ranks (4.0% in 2000 to 4.0% in 2020, P = .14), whereas a significantly increased trend occurred in URiM female representation at all ranks (4.4% in 2000 to 7.8% in 2020, P < .0001) (Table 1; Fig 2). Among the different URiM groups, female faculty significantly increased representation at all ranks except for American Indian/Alaska Native professors and assistant professors.

American Indian/Alaska Native males significantly decreased representation at the assistant professor rank (0.17% in 2000 to 0.04% in 2020, P < .0001). African American/Black males significantly decreased representation at the associate (1.4% in 2000 to 1.0% in 2020, P = .04) and assistant professor ranks (1.6% in 2000 to 1.0% in 2020, P < .0001), and significantly decreased representation across all ranks (1.32% in 2000 to 1.04% in 2020, P < .0001). Hispanic males significantly increased representation at the professor rank (2.15% in 2000 to 2.76% in 2020, P = .05); and Native Hawaiian/Pacific Islander males significantly increased representation at the professor rank (0% in 2000 to 0.05% in 2020, P = .001) (Table 2).

In 2020, URiM pediatric faculty representation was considerably lower compared with representation in the 2020 US population: African American/Black, 4.4% versus 12.1%, American Indian/Alaska Native, 0.2% versus 1.1%, Native Hawaiian/Pacific Islander, 0.08% versus 0.2%, Hispanic, 7.1% versus 18.7% (Fig 3). Between 2000 and 2020, URiM pediatric faculty representation did not reflect the changing demographic profile of the US population of racially and ethnically concordant (Fig 4).

This repeat cross-sectional study of US pediatric faculty from 2000 to 2020 provides a specialty-specific examination of the trends in racial, ethnic, and sex diversity by rank in departments of pediatrics. This analysis advances the field by highlighting the progress that has been in increasing the diversity within pediatric departments, but also identifying areas in which reinforcement of the pipeline is needed. Overall, our study suggested an increase in representation of individuals identifying as URiM; however, a more nuanced examination revealed that the improvements in representation were driven primarily by individuals identifying as female. Representation of individuals who identified as UriM male did not increase and for certain groups, decreased in representation. In addition, UriM pediatric faculty did not reflect the racial and ethnic diversity of the 2020 US overall population or the changing child demographic between 2000 and 2020.

Understanding the source of the increase in representation of UriM pediatric faculty will need additional investigation, especially because the AAMC data does not delineate between clinical and nonclinical pediatric faculty. It is unclear what group is driving the increase. Previous work examining UriM pediatric trainee trends revealed significantly increased representation trends among certain specialties.¹⁵  Similarly, an examination of the pediatric subspecialty workforce by Rimsza et al found that most subspecialists are academic faculty, and the percentage of women and those from “minority groups” increased over time.²²  Another possibility is that female UriM pediatricians are increasingly entering the academic workforce beyond training due to a desire to teach, mentor, and other lifestyle factors.^23–26 

The decrease in representation of UriM males suggests the pathway of UriM males entering academic pediatrics may be especially vulnerable and require targeted attention. The pathway into academic medicine begins long before entering medical school. Boys and young men of color and, particularly, Black boys and young men are disproportionately impacted by racialized educational environments. Starting in primary school, Black boys are subjected to higher rates of disciplinary actions compared with White-identifying peers.^27–29  As they advance to secondary school, Black adolescents and young men are subject to increased policing, and the disciplinary consequences grow in scale and impact.^30–32  A downstream consequence is that Black men enroll in higher education and graduate at lower rates than Black women.³³  In addition, there has been a decreasing trend of applications and matriculation rates of Black males to medical school that has only modestly shifted in the past few years.³⁴  When Black males do enter academic medicine, they have the highest rates of not being promoted and leaving academic medicine among all racial, ethnic, and gender groups at the assistant professor level and the second-highest rate at the associate professor level.³⁵ 

Although the field of pediatrics is limited in its scope to influence the academic pathway before medical school entry, there may be opportunities for pediatricians to engage UriM medical students, especially UriM male medical students, about pediatrics as a career. Mentorship is a known factor that is important to the success of UriM medical students, trainees, and faculty.^25,36,37  Although effective mentorship can occur between racially and/or ethnically discordant mentors and mentees, the literature suggests concordant mentor and mentee relationships are actively sought out by URiM trainees because of shared lived experiences and having a mentor “who looks like you.”³⁸  URiM faculty mentors strongly influence URiM trainees’ career decisions to pursue academic careers.^25,36,39,40  The lack of URiM faculty may make it hard to envision a career in academics. For men, finding a mentor who shares the same sex, race, and ethnicity can be a significant challenge in pediatric medicine in which 72.4% of trainees and 63.8% of practicing US pediatricians identify as women.^41–43  This has the potential to limit the potential viability of pediatrics as a career for Black men because of a lack of mentors.

Studies focused specifically on URiM academic pediatric faculty highlight additional barriers to advancement, such as implicit bias and racial discrimination by peers and patients, lack of community, and feelings of isolation.^44,45  The paucity of diversity in the academic pediatric workforce may impede efforts to create more equitable health care environments for the rapidly diversifying patient populations. Additionally, faculty diversity is an important factor in enriching the learning environment for all trainees, and even more so for those who identify as URiM.⁴⁶  Recommendations from the American Academy of Pediatrics Policy Statement, Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making, emphasize the need for institutional commitment to advancing diversity, especially in leadership roles.⁴⁷  Tracking the hiring and promotion of URiM faculty will help academic medical centers better understand gaps, opportunities for change, and strategic planning. URiM faculty should be included on all faculty search and hiring committees.⁴⁸  Structured programs that pair URiM faculty with peer and senior mentors can be beneficial.^25,38  The role of sponsorship has been highlighted as a means of combating the multitude of barriers that lead to attrition among URiM faculty.^49–52  Other recommendations include more robust upstream efforts through mentorship partnerships with medical student organizations like the Student National Medical Association and the Latino Medical Student Association, and URiM-specific programs for URiM trainees and early career faculty, such as the APA New Century Scholars and APA Research in Academic Pediatrics Initiative on Diversity scholars program.^53–55 

There are several limitations to this study that should be acknowledged. First, the authors of this study relied on data obtained from the AAMC Faculty Roster for which medical schools provided faculty sex, race, and ethnicity; therefore, we were unable to verify whether these data were self-reported or based on secondary data. In addition, not all faculty are necessarily pediatricians, a level of granularity unavailable in the AAMC Roster; as such, we were unable to measure nonphysician faculty, and different approaches may be necessary to enhance nonphysician diversity. The AAMC Faculty Roster is limited to full-time faculty, so we are unable to evaluate whether increases in representation were due to shifts in part-time versus full-time appointments. Moreover, the non-Hispanic multiracial and unknown categories may have undercounted the URiM population, but these categories were a small percentage of the overall sample. Additionally, we recognize there is a spectrum of gender identities that were not captured in the AAMC Faculty Roster, which may require targeted diversity and inclusion efforts. Finally, in the absence of individual-level data, our analysis does not allow us to measure factors associated with changes in observed rates, so a causal relationship cannot be established.

We recommend that future data be disaggregated, institution-specific, and provide race, ethnicity, sex, and rank information, including hiring and promotion details. Academic medical institutions already collect these data voluntarily as part of their accreditation process.^56,57  These data should be publicly available to visualize trends. Dashboards could highlight institutions successful at the recruitment and retention of diverse faculty, allowing for programmatic sharing and potential innovation. It may also encourage accountability.

In the past 20 years, the percentage of URiM pediatric academic faculty significantly increased but was primarily driven by the increase in URiM female representation, whereas male URiM representation remained stagnant and even decreased in African American/Black males. The percentage of URiM faculty representation was considerably lower in comparison with the overall US representation and US population of racially and ethnically concordant children. The stagnation of URiM male representation and lack of faculty diversity reflective of the US population may have a critical impact on the field of pediatrics’ ability to recruit and retain a diverse workforce and promote equitable care. Academic centers should examine their recruitment and hiring practices to identify and root out areas of potential bias. Retention efforts should focus on early and specific mentorship, deliberate sponsorship, an awareness of the multiple challenges experienced by URiM faculty, and regular progress monitoring through dashboards and faculty climate surveys.

AA

African American

AAMC

Association of American Medical College

AI

American Indian

AN

Alaska Native

APA

Academic Pediatric Association

NH

Native Hawaiian

Hisp

Hispanic

URiM

underrepresented in medicine

US

United States