Diversifying the Surgical Workforce: Understanding Barriers to Inform Solutions

Objectives: Race and gender concordance between physicians and patients is associated with reductions in healthcare disparities. However, the diversity of the medical workforce does not mirror the population; some of the greatest deficiencies exist in the surgical workforce. We conducted a pilot study focused on early recruitment of diverse college students in our region, with a concurrent needs assessment of their specific barriers to entering the field of surgery.

Methods: Local college students who self-identified as underrepresented in medicine (URiM) were recruited to attend a symposium hosted by an academic surgery department. Events included a specialty discussion panel, live OR streaming, simulation lab, and breakout sessions covering various topics. The primary aims were to 1: increase interest in surgical careers and 2: conduct a needs assessment to optimize strategies for overcoming perceived barriers to entering surgery. A mixed methods analysis was conducted to assess cohort characteristics, changes in impressions of pursuing a surgical career, barriers to pursuing such careers across five domains, and overall perceptions of the symposium.

Results: Recruitment consisted of emails sent to local college pre-medical society advisors. Of 58 students who attended, 77% were from state universities or community colleges. There were 63.8% who identified as a racial/ethnic minority (38% Latino, 24% Black, 16% Asian, 14% Middle Eastern, 8% mixed), 34.5% as economically-disadvantaged, 34.5% as first-generation college, 25.9% as female, 12.1% as LGBTQ+, and 3.5% as other. Pre-symposium, 93% of attendees intended to apply to medical school, but only 25% had considered surgery as a profession. Post-symposium, this increased to 43% who indicated an intention to pursue surgery, with an additional 52% who were undecided but interested. Across all sections, the mean rating for attendees' knowledge regarding surgical training and careers pre- and post-symposium increased significantly. The most frequently cited barriers were the lack of mentors (50%), concerns about MCAT scores (50%), overall costs (48%), and work/life balance (47%). Thematic analysis identified gratitude for the event and for opportunities to meet surgeons; ongoing needs included shadowing and mentorship matching. The direct costs of the event were approximately $500.

Conclusion: This pilot study demonstrated the avidity of an audience with the potential to diversify the surgical workforce. Participant interest in pursuing surgical careers nearly doubled and clear unmet needs were identified to support this group towards this goal. Furthermore, these results were achieved with very little funding or advertising. Work is ongoing to upscale these efforts and determine impact on our surgical workforce.