From the Journals

Women’s residency and subspecialty choices diverging



Women increased their representation in internal medicine residencies from 1991 to 2016, but a new analysis also shows that the percentage of women in subspecialty fellowships declined.

Women's share of residency and fellowship populations

Women made up 43.2% of the internal medicine resident population in 2016, compared with 30.2% in 1991. Over that same time, however, the percentage of women in subspecialty fellowships dropped from 33.3% to 23.6%, Anna T. Stone, MD, and associates wrote in a research letter published in JAMA Internal Medicine.

“Many factors are associated with the decisions of medical students in choosing an internal medicine residency, including their sex, educational experience, views of patient care, and lifestyle perceptions. Similar considerations apply to subspecialty training,” wrote Dr. Stone of the department of cardiology at St. Vincent Hospital and Heart Center, Indianapolis, and associates.

When the investigators focused on a subset of nine internal medicine subspecialties, they saw growth: “The percentage of women entering each of the fields [residents plus fellows] increased over time, with variations between specialty and some year-to-year variations within a specialty.”

Although none of the nine subspecialties had been majority women in 1991, by 2016 women made up more than half of the residents and fellows in four: endocrinology (71.3%), geriatric medicine (67.9%), rheumatology (60.2%), and infectious disease (54.6%), according to data from the Accreditation Council for Graduate Medical Education.

And then there’s cardiology. Its low rate of participation among women – the only one of the nine subspecialties under 35% – “is an important issue that the cardiology profession should continue to address,” they wrote.

In a survey of internal medicine residents conducted by other researchers, women were more likely than men to report that they had never considered cardiology as a career choice, Dr. Stone and associates noted, and women in the survey “had different perceptions of cardiology than men.”

SOURCE: Stone AT et al. JAMA Intern Med. 2019 Sep 23. doi: 10.1001/jamainternmed.2019.3833.

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