Have gender and ethnic disparities in ophthalmology disappeared? Insights from a workforce-based study in Israel (2006-2021)

Background: Workforce diversity in healthcare has been shown to improve the quality of patient care. A paucity of data exists globally on this subject in ophthalmology. The purpose of this study was to analyze nationwide trends in gender-, ethnic- and country of graduation disparities among ophthalmologists in Israel.

Methods: Cross-sectional, workforce-based study using data retrieved from the Israeli Ministry of Health. Data included gender, ethnicity, and medical graduation country. Proportions and trends among new residents and board-certified ophthalmologists (BCO) were assessed.

Results: During 2006-2021, 18,624 medical licenses were issued (41.7% Israeli Medical Graduates (IsrMGs), 42.2% female), average yearly increase (AYI) was 6.9%, females and IsrMGs had an average yearly decrease of 1% and 0.53%, respectively. 561 physicians began ophthalmology residency (57.5% male, 75% Jewish, 69.9% IsrMGs), reflecting a 6.2% total AYI, but 8.1% and 4.8% for female versus male residents, respectively. There were fewer female residents despite population and graduate pool adjustments (p = 0.002 and p = 0.002, respectively), but differences disappeared after 2015 (p = 0.52). Arab and Jewish residents AYIs were 6.4% and 5.7% respectively, with ethnic differences elucidated by adjusting for population sizes (p = 0.097). BCO densities in 2006 and 2021 were 7.5 and 9.06, respectively, with a 1.3% AYI (p < 0.001). Proportions of female and Arab BCO were lower than expected based on population proportions. (p < 0.001 and p < 0.001, respectively). Gender-differences remained after adjusting for population sizes (p < 0.001), but AYIs for female and male BCO were 1.38% and 1.15%, respectively. AYIs for Arab and Jewish BCO were 12% and 0.61%, respectively.

Conclusions: Jewish and male dominance was seen among Israeli BCOs and was unrelated to population size or graduate distribution. Among new ophthalmology residents, Arab representation was adequate to their population proportion. In early years, male predominance was noted, however this disparity was no longer evident after 2015. These trends are encouraging, and efforts should be made to ensure the field remains inclusive and representative of the broader population.