Diversity in Medicine

Many medical associations have publicly announced their determination to help eliminate racial disparities – from health care outcomes, from the level and quality of patient treatment, from their own memberships. How have those pronouncements translated into programs that could have, or even have had, positive impacts?

For this article, this news organization asked several associations about tangible actions behind their vows to combat racism in health care. Meanwhile, a recent Medscape report focused on the degree to which physicians prioritize racial disparities as a leading social issue.
 

American Academy of Family Physicians

The American Academy of Family Physicians’ approach is to integrate diversity, equity, and inclusion (DEI) efforts into all existing and new projects rather than tackle racial disparities as a discrete problem.

“Our policies, our advocacy efforts, everything our commissions and staff do ... is through a lens of diversity, equity, and inclusiveness,” said AAFP Board Chair Ada D. Stewart, MD, FAAP.

That lens is ground by a DEI center the AAFP created in 2017. Run by AAFP staff, members, and chapters, the center focuses on five areas: policy, education and training, practice, diversifying the workplace, and strategic partnerships.

The center has established a special project called EveryONE to provide AAFP members with relevant research, policy templates, and other resources to address patient needs. One example is the Neighborhood Navigator, an online tool that shows food, housing, transportation, and other needs in a patient’s neighborhood.

Meanwhile, the DEI center has created training programs for AAFP members on topics like unconscious and implicit racial biases. And the AAFP has implemented several relevant governing policies regarding pushes to improve childbirth conditions and limit race-based treatment, among other areas.

In January, the AAFP established a new DEI commission for family medicine to set the academy’s agenda on racial issues moving forward. “We only had 10 physician positions available on the commission, and over 100 individuals applied, which gave us comfort that we were going in the right direction,” Dr. Stewart said.
 

Association of American Medical Colleges

The Association of American Medical Colleges, which represents nearly 600 U.S. and Canadian medical schools and teaching hospitals, has a “longstanding” focus on racial equity, said Philip Alberti, founder of the AAMC Center for Health Justice. However, in 2020 that focus became more detailed and layered.

Those layers include:

• Encouraging self-reflection by members on how personal racial biases and stereotypes can lead to systemic racism in health care.
• Working on the AAMC organizational structure. Priorities range from hiring a consultant to help guide antiracism efforts, to establishing a DEI council and advisors, to regularly seeking input from staff. In 2021, the AAMC launched a Center for Health Justice to work more closely with communities.
• Ramping up collaboration with national and local academic medicine organizations and partners. As one example, the AAMC and American Medical Association released a guide for physicians and health care professionals on language that could be interpreted as racist or disrespectful.
• Continuing to be outspoken about racial disparities in health care in society generally.

Meanwhile, the AAMC is supporting more specific, localized health equity efforts in cities such as Cincinnati and Boston.

Cincinnati Children’s Hospital research has found that children in poor neighborhoods are five times more likely to need hospital stays. AAMC members have helped identify “hot spots” for social needs among children and focused specifically on two neighborhoods in the city. The initiative has roped in partnerships with community and social service organizations as well as health care providers, and proponents say the number of child hospital stays in those neighborhoods has dropped by 20%.

Boston Medical Center researchers learned that Black and Latino patients experiencing problems with heart failure were less likely to be referred to a cardiologist. AAMC members assisted with a program to encourage physicians to make medically necessary referrals more often.
 

National Health Council

The National Health Council, an umbrella association of health organizations, similarly has made a “commitment, not just around policy work but anytime and anything the NHC is doing, to build around trying to identify and solve issues of health equity,” CEO Randall Rutta said.

The NHC has identified four strategic policy areas including race and in 2021 issued a statement signed by 45 other health care organizations vowing to take on systemic racism and advance equity, through public policy and law.

In relation to policy, Mr. Rutta said his organization is lobbying Congress and federal agencies to diversify clinical trials.

“We want to make sure that clinical trials are inclusive of people from different racial and ethnic groups, in order to understand how [they are] affected by a particular condition,” he said. “As you would imagine, some conditions hit certain groups harder than others for genetic or other reasons, or it may just be a reflection of other disparities that occur across health care.”

The organization has issued suggestions for policy change in the Food and Drug Administration’s clinical trial policy and separately targeted telemedicine policy to promote equity and greater patient access. For example, one initiative aims to ensure patients’ privacy and civil rights as telemedicine’s popularity grows after the COVID-19 pandemic. The NHC presented the initiative in a congressional briefing last year.
 

American Public Health Association

The American Public Health Association says it started focusing on racial disparities in health care in 2015, following a series of racially fueled violent acts. The APHA started with a four-part webinar series on racism in health (more than 10,000 live participants and 40,000 replays to date).

Shortly afterward, then-APHA President Camara Jones, MD, MPH, PhD, launched a national campaign encouraging APHA members, affiliates, and partners to name and address racism as a determinant of health.

More recently in 2021, the APHA adopted a “Truth, Racial Healing & Transformation” guiding framework and “Healing Through Policy” initiative that offer local leaders policy templates and best practices.

“We have identified a suite of policies that have actually been implemented successfully and are advancing racial equity,” said Regina Davis Moss, APHA’s associate executive director of health policy and practice. “You can’t advance health without having a policy that supports it.”

Montgomery County, Md., is one community that has used the framework (for racial equity training of county employees). Leaders in Evanston, Ill., also used it in crafting a resolution to end structural racism in the city.

A version of this article first appeared on Medscape.com.

Many medical associations have publicly announced their determination to help eliminate racial disparities – from health care outcomes, from the level and quality of patient treatment, from their own memberships. How have those pronouncements translated into programs that could have, or even have had, positive impacts?

For this article, this news organization asked several associations about tangible actions behind their vows to combat racism in health care. Meanwhile, a recent Medscape report focused on the degree to which physicians prioritize racial disparities as a leading social issue.
 

American Academy of Family Physicians

The American Academy of Family Physicians’ approach is to integrate diversity, equity, and inclusion (DEI) efforts into all existing and new projects rather than tackle racial disparities as a discrete problem.

“Our policies, our advocacy efforts, everything our commissions and staff do ... is through a lens of diversity, equity, and inclusiveness,” said AAFP Board Chair Ada D. Stewart, MD, FAAP.

That lens is ground by a DEI center the AAFP created in 2017. Run by AAFP staff, members, and chapters, the center focuses on five areas: policy, education and training, practice, diversifying the workplace, and strategic partnerships.

The center has established a special project called EveryONE to provide AAFP members with relevant research, policy templates, and other resources to address patient needs. One example is the Neighborhood Navigator, an online tool that shows food, housing, transportation, and other needs in a patient’s neighborhood.

Meanwhile, the DEI center has created training programs for AAFP members on topics like unconscious and implicit racial biases. And the AAFP has implemented several relevant governing policies regarding pushes to improve childbirth conditions and limit race-based treatment, among other areas.

In January, the AAFP established a new DEI commission for family medicine to set the academy’s agenda on racial issues moving forward. “We only had 10 physician positions available on the commission, and over 100 individuals applied, which gave us comfort that we were going in the right direction,” Dr. Stewart said.
 

Association of American Medical Colleges

The Association of American Medical Colleges, which represents nearly 600 U.S. and Canadian medical schools and teaching hospitals, has a “longstanding” focus on racial equity, said Philip Alberti, founder of the AAMC Center for Health Justice. However, in 2020 that focus became more detailed and layered.

Those layers include:

• Encouraging self-reflection by members on how personal racial biases and stereotypes can lead to systemic racism in health care.
• Working on the AAMC organizational structure. Priorities range from hiring a consultant to help guide antiracism efforts, to establishing a DEI council and advisors, to regularly seeking input from staff. In 2021, the AAMC launched a Center for Health Justice to work more closely with communities.
• Ramping up collaboration with national and local academic medicine organizations and partners. As one example, the AAMC and American Medical Association released a guide for physicians and health care professionals on language that could be interpreted as racist or disrespectful.
• Continuing to be outspoken about racial disparities in health care in society generally.

Meanwhile, the AAMC is supporting more specific, localized health equity efforts in cities such as Cincinnati and Boston.

Cincinnati Children’s Hospital research has found that children in poor neighborhoods are five times more likely to need hospital stays. AAMC members have helped identify “hot spots” for social needs among children and focused specifically on two neighborhoods in the city. The initiative has roped in partnerships with community and social service organizations as well as health care providers, and proponents say the number of child hospital stays in those neighborhoods has dropped by 20%.

Boston Medical Center researchers learned that Black and Latino patients experiencing problems with heart failure were less likely to be referred to a cardiologist. AAMC members assisted with a program to encourage physicians to make medically necessary referrals more often.
 

National Health Council

The National Health Council, an umbrella association of health organizations, similarly has made a “commitment, not just around policy work but anytime and anything the NHC is doing, to build around trying to identify and solve issues of health equity,” CEO Randall Rutta said.

The NHC has identified four strategic policy areas including race and in 2021 issued a statement signed by 45 other health care organizations vowing to take on systemic racism and advance equity, through public policy and law.

In relation to policy, Mr. Rutta said his organization is lobbying Congress and federal agencies to diversify clinical trials.

“We want to make sure that clinical trials are inclusive of people from different racial and ethnic groups, in order to understand how [they are] affected by a particular condition,” he said. “As you would imagine, some conditions hit certain groups harder than others for genetic or other reasons, or it may just be a reflection of other disparities that occur across health care.”

The organization has issued suggestions for policy change in the Food and Drug Administration’s clinical trial policy and separately targeted telemedicine policy to promote equity and greater patient access. For example, one initiative aims to ensure patients’ privacy and civil rights as telemedicine’s popularity grows after the COVID-19 pandemic. The NHC presented the initiative in a congressional briefing last year.
 

American Public Health Association

The American Public Health Association says it started focusing on racial disparities in health care in 2015, following a series of racially fueled violent acts. The APHA started with a four-part webinar series on racism in health (more than 10,000 live participants and 40,000 replays to date).

Shortly afterward, then-APHA President Camara Jones, MD, MPH, PhD, launched a national campaign encouraging APHA members, affiliates, and partners to name and address racism as a determinant of health.

More recently in 2021, the APHA adopted a “Truth, Racial Healing & Transformation” guiding framework and “Healing Through Policy” initiative that offer local leaders policy templates and best practices.

“We have identified a suite of policies that have actually been implemented successfully and are advancing racial equity,” said Regina Davis Moss, APHA’s associate executive director of health policy and practice. “You can’t advance health without having a policy that supports it.”

Montgomery County, Md., is one community that has used the framework (for racial equity training of county employees). Leaders in Evanston, Ill., also used it in crafting a resolution to end structural racism in the city.

A version of this article first appeared on Medscape.com.

Many medical associations have publicly announced their determination to help eliminate racial disparities – from health care outcomes, from the level and quality of patient treatment, from their own memberships. How have those pronouncements translated into programs that could have, or even have had, positive impacts?

For this article, this news organization asked several associations about tangible actions behind their vows to combat racism in health care. Meanwhile, a recent Medscape report focused on the degree to which physicians prioritize racial disparities as a leading social issue.
 

American Academy of Family Physicians

The American Academy of Family Physicians’ approach is to integrate diversity, equity, and inclusion (DEI) efforts into all existing and new projects rather than tackle racial disparities as a discrete problem.

“Our policies, our advocacy efforts, everything our commissions and staff do ... is through a lens of diversity, equity, and inclusiveness,” said AAFP Board Chair Ada D. Stewart, MD, FAAP.

That lens is ground by a DEI center the AAFP created in 2017. Run by AAFP staff, members, and chapters, the center focuses on five areas: policy, education and training, practice, diversifying the workplace, and strategic partnerships.

The center has established a special project called EveryONE to provide AAFP members with relevant research, policy templates, and other resources to address patient needs. One example is the Neighborhood Navigator, an online tool that shows food, housing, transportation, and other needs in a patient’s neighborhood.

Meanwhile, the DEI center has created training programs for AAFP members on topics like unconscious and implicit racial biases. And the AAFP has implemented several relevant governing policies regarding pushes to improve childbirth conditions and limit race-based treatment, among other areas.

In January, the AAFP established a new DEI commission for family medicine to set the academy’s agenda on racial issues moving forward. “We only had 10 physician positions available on the commission, and over 100 individuals applied, which gave us comfort that we were going in the right direction,” Dr. Stewart said.
 

Association of American Medical Colleges

The Association of American Medical Colleges, which represents nearly 600 U.S. and Canadian medical schools and teaching hospitals, has a “longstanding” focus on racial equity, said Philip Alberti, founder of the AAMC Center for Health Justice. However, in 2020 that focus became more detailed and layered.

Those layers include:

• Encouraging self-reflection by members on how personal racial biases and stereotypes can lead to systemic racism in health care.
• Working on the AAMC organizational structure. Priorities range from hiring a consultant to help guide antiracism efforts, to establishing a DEI council and advisors, to regularly seeking input from staff. In 2021, the AAMC launched a Center for Health Justice to work more closely with communities.
• Ramping up collaboration with national and local academic medicine organizations and partners. As one example, the AAMC and American Medical Association released a guide for physicians and health care professionals on language that could be interpreted as racist or disrespectful.
• Continuing to be outspoken about racial disparities in health care in society generally.

Meanwhile, the AAMC is supporting more specific, localized health equity efforts in cities such as Cincinnati and Boston.

Cincinnati Children’s Hospital research has found that children in poor neighborhoods are five times more likely to need hospital stays. AAMC members have helped identify “hot spots” for social needs among children and focused specifically on two neighborhoods in the city. The initiative has roped in partnerships with community and social service organizations as well as health care providers, and proponents say the number of child hospital stays in those neighborhoods has dropped by 20%.

Boston Medical Center researchers learned that Black and Latino patients experiencing problems with heart failure were less likely to be referred to a cardiologist. AAMC members assisted with a program to encourage physicians to make medically necessary referrals more often.
 

National Health Council

The National Health Council, an umbrella association of health organizations, similarly has made a “commitment, not just around policy work but anytime and anything the NHC is doing, to build around trying to identify and solve issues of health equity,” CEO Randall Rutta said.

The NHC has identified four strategic policy areas including race and in 2021 issued a statement signed by 45 other health care organizations vowing to take on systemic racism and advance equity, through public policy and law.

In relation to policy, Mr. Rutta said his organization is lobbying Congress and federal agencies to diversify clinical trials.

“We want to make sure that clinical trials are inclusive of people from different racial and ethnic groups, in order to understand how [they are] affected by a particular condition,” he said. “As you would imagine, some conditions hit certain groups harder than others for genetic or other reasons, or it may just be a reflection of other disparities that occur across health care.”

The organization has issued suggestions for policy change in the Food and Drug Administration’s clinical trial policy and separately targeted telemedicine policy to promote equity and greater patient access. For example, one initiative aims to ensure patients’ privacy and civil rights as telemedicine’s popularity grows after the COVID-19 pandemic. The NHC presented the initiative in a congressional briefing last year.
 

American Public Health Association

The American Public Health Association says it started focusing on racial disparities in health care in 2015, following a series of racially fueled violent acts. The APHA started with a four-part webinar series on racism in health (more than 10,000 live participants and 40,000 replays to date).

Shortly afterward, then-APHA President Camara Jones, MD, MPH, PhD, launched a national campaign encouraging APHA members, affiliates, and partners to name and address racism as a determinant of health.

More recently in 2021, the APHA adopted a “Truth, Racial Healing & Transformation” guiding framework and “Healing Through Policy” initiative that offer local leaders policy templates and best practices.

“We have identified a suite of policies that have actually been implemented successfully and are advancing racial equity,” said Regina Davis Moss, APHA’s associate executive director of health policy and practice. “You can’t advance health without having a policy that supports it.”

Montgomery County, Md., is one community that has used the framework (for racial equity training of county employees). Leaders in Evanston, Ill., also used it in crafting a resolution to end structural racism in the city.

A version of this article first appeared on Medscape.com.

Despite some gains, new research shows ongoing gender imbalances in hematology and oncology, as reflected in the predominantly male presenters at board review lecture series – where early career faculty are also underrepresented.

“Our study provides the first analysis of gender and early-career faculty disparities in speakers at hematology and medical oncology board review meetings,” the authors reported in research published in Blood Advances.

“We covered six major board reviews over the last 5 years that are either conducted yearly or every other year, [and] the general trend across all meetings showed skewness toward men speakers,” the authors reported.

Recent data from 2021 suggests a closing of the gender gap in oncology, with women making up 44.6% of oncologists in training. However, they still only represented 35.2% of practicing oncologists and are underrepresented in leadership positions in academic oncology, the authors reported.

With speaking roles at academic meetings potentially marking a key step in career advancement and improved opportunities, the authors sought to investigate the balance of gender, as well as early-career faculty among speakers at prominent hematology and/or oncology board review lecture series taking place in the United States between 2017 and 2021.

The five institutions and one society presenting the board review lecture series included Baylor College of Medicine/MD Anderson Cancer Center, both in Houston; Dana-Farber Brigham Cancer Center, Boston; George Washington University, Washington; Memorial Sloan Kettering Cancer Center, New York; Seattle Cancer Care Alliance; and the hematology board review series from the American Society of Hematology.

During the period in question, among 1,224 board review lectures presented, women constituted only 37.7% of the speakers. In lectures presented by American Board of Internal Medicine–certified speakers (n = 1,016, 83%), women were found to have made up fewer than 50% of speakers in five of six courses.

Men were also more likely to be recurrent speakers; across all courses, 13 men but only 2 women conducted 10 or more lectures. And while 35 men gave six or more lectures across all courses, only 12 women did so.

The lecture topics with the lowest rates of women presenters included malignant hematology (24.8%), solid tumors (38.9%), and benign hematology lectures (44.1%).

courtesy Dr. Al Hadidi

“We suspected [the imbalance in malignant hematology] since multiple recurrent roles were concentrated in the malignant hematology,” senior author Samer Al Hadidi, MD, of the Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AK, said in an interview.

He noted that “there are no regulations that such courses need to follow to ensure certain proportions of women and junior faculty are involved.”
 

Early-career faculty

In terms of early-career representation, more than 50% of lectures were given by faculty who had received their initial certifications more than 15 years earlier. The median time from initial certification was 12.5 years for hematology and 14 years for medical oncology.

The findings that more than half of the board review lectures were presented by faculty with more than 15 years’ experience since initial certification “reflects a lack of appropriate involvement of early-career faculty, who arguably may have more recent experience with board certification,” the authors wrote.

While being underrepresented in such roles is detrimental, there are no regulations that such courses follow to ensure certain proportions of women and junior faculty are involved, Dr. Al Hadidi noted.
 

Equal representation remains elusive

The study does suggest some notable gains. In a previous study of 181 academic conferences in the United States and Canada between 2007 and 2017, the rate of women speakers was only 15%, compared with 37.7% in the new study.

And an overall trend analysis in the study shows an approximately 10% increase in representation of women in all of the board reviews. However, only the ASH hematology board review achieved more than 50% women in their two courses.

“Overall, the proportion of women speakers is improving over the years, though it remains suboptimal,” Dr. Al Hadidi said.

The authors noted that oncology is clearly not the only specialty with gender disparities. They documented a lack of women speakers at conferences involving otolaryngology head and neck meetings, radiation oncology, emergency medicine, and research conferences.

They pointed to the work of ASH’s Women in Hematology Working Group as an important example of the needed effort to improve the balance of women hematologists.

courtesy Penn Medicine

Ariela Marshall, MD, director of women’s thrombosis and hemostasis at Penn Medicine in Philadelphia and a leader of ASH’s Women in Hematology Working Group, agreed that more efforts are needed to address both gender disparities as well as those of early career speakers. She asserted that the two disparities appear to be connected.

“If you broke down gender representation over time and the faculty/time since initial certification, the findings may mirror the percent of women in hematology-oncology at that given point in time,” Dr. Marshall said in an interview.

“If an institution is truly committed to taking action on gender equity, it needs to look at gender and experience equity of speakers,” she said. “Perhaps it’s the time to say ‘Dr. X has been doing this review course for 15 years. Let’s give someone else a chance.’

“This is not even just from a gender equity perspective but from a career development perspective overall,” she added. “Junior faculty need these speaking engagements a lot more than senior faculty.”

Meanwhile, the higher number of female trainees is a trend that ideally will be sustained as those trainees move into positions of leadership, Dr. Marshall noted.

“We do see that over time, we have achieved gender equity in the percent of women matriculating to medical school. And my hope is that, 20 years down the line, we will see the effects of this reflected in increased equity in leadership positions such as division/department chair, dean, and hospital CEO,” she said. “However, we have a lot of work to do because there are still huge inequities in the culture of medicine (institutional and more broadly), including gender-based discrimination, maternal discrimination, and high attrition rates for women physicians, compared to male physicians.

“It’s not enough to simply say ‘well, we have fixed the problem because our incoming medical student classes are now equitable in gender distribution,’ ”

The authors and Dr. Marshall had no disclosures to report.

Despite some gains, new research shows ongoing gender imbalances in hematology and oncology, as reflected in the predominantly male presenters at board review lecture series – where early career faculty are also underrepresented.

“Our study provides the first analysis of gender and early-career faculty disparities in speakers at hematology and medical oncology board review meetings,” the authors reported in research published in Blood Advances.

“We covered six major board reviews over the last 5 years that are either conducted yearly or every other year, [and] the general trend across all meetings showed skewness toward men speakers,” the authors reported.

Recent data from 2021 suggests a closing of the gender gap in oncology, with women making up 44.6% of oncologists in training. However, they still only represented 35.2% of practicing oncologists and are underrepresented in leadership positions in academic oncology, the authors reported.

With speaking roles at academic meetings potentially marking a key step in career advancement and improved opportunities, the authors sought to investigate the balance of gender, as well as early-career faculty among speakers at prominent hematology and/or oncology board review lecture series taking place in the United States between 2017 and 2021.

The five institutions and one society presenting the board review lecture series included Baylor College of Medicine/MD Anderson Cancer Center, both in Houston; Dana-Farber Brigham Cancer Center, Boston; George Washington University, Washington; Memorial Sloan Kettering Cancer Center, New York; Seattle Cancer Care Alliance; and the hematology board review series from the American Society of Hematology.

During the period in question, among 1,224 board review lectures presented, women constituted only 37.7% of the speakers. In lectures presented by American Board of Internal Medicine–certified speakers (n = 1,016, 83%), women were found to have made up fewer than 50% of speakers in five of six courses.

Men were also more likely to be recurrent speakers; across all courses, 13 men but only 2 women conducted 10 or more lectures. And while 35 men gave six or more lectures across all courses, only 12 women did so.

The lecture topics with the lowest rates of women presenters included malignant hematology (24.8%), solid tumors (38.9%), and benign hematology lectures (44.1%).

courtesy Dr. Al Hadidi

“We suspected [the imbalance in malignant hematology] since multiple recurrent roles were concentrated in the malignant hematology,” senior author Samer Al Hadidi, MD, of the Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AK, said in an interview.

He noted that “there are no regulations that such courses need to follow to ensure certain proportions of women and junior faculty are involved.”
 

Early-career faculty

In terms of early-career representation, more than 50% of lectures were given by faculty who had received their initial certifications more than 15 years earlier. The median time from initial certification was 12.5 years for hematology and 14 years for medical oncology.

The findings that more than half of the board review lectures were presented by faculty with more than 15 years’ experience since initial certification “reflects a lack of appropriate involvement of early-career faculty, who arguably may have more recent experience with board certification,” the authors wrote.

While being underrepresented in such roles is detrimental, there are no regulations that such courses follow to ensure certain proportions of women and junior faculty are involved, Dr. Al Hadidi noted.
 

Equal representation remains elusive

The study does suggest some notable gains. In a previous study of 181 academic conferences in the United States and Canada between 2007 and 2017, the rate of women speakers was only 15%, compared with 37.7% in the new study.

And an overall trend analysis in the study shows an approximately 10% increase in representation of women in all of the board reviews. However, only the ASH hematology board review achieved more than 50% women in their two courses.

“Overall, the proportion of women speakers is improving over the years, though it remains suboptimal,” Dr. Al Hadidi said.

The authors noted that oncology is clearly not the only specialty with gender disparities. They documented a lack of women speakers at conferences involving otolaryngology head and neck meetings, radiation oncology, emergency medicine, and research conferences.

They pointed to the work of ASH’s Women in Hematology Working Group as an important example of the needed effort to improve the balance of women hematologists.

courtesy Penn Medicine

Ariela Marshall, MD, director of women’s thrombosis and hemostasis at Penn Medicine in Philadelphia and a leader of ASH’s Women in Hematology Working Group, agreed that more efforts are needed to address both gender disparities as well as those of early career speakers. She asserted that the two disparities appear to be connected.

“If you broke down gender representation over time and the faculty/time since initial certification, the findings may mirror the percent of women in hematology-oncology at that given point in time,” Dr. Marshall said in an interview.

“If an institution is truly committed to taking action on gender equity, it needs to look at gender and experience equity of speakers,” she said. “Perhaps it’s the time to say ‘Dr. X has been doing this review course for 15 years. Let’s give someone else a chance.’

“This is not even just from a gender equity perspective but from a career development perspective overall,” she added. “Junior faculty need these speaking engagements a lot more than senior faculty.”

Meanwhile, the higher number of female trainees is a trend that ideally will be sustained as those trainees move into positions of leadership, Dr. Marshall noted.

“We do see that over time, we have achieved gender equity in the percent of women matriculating to medical school. And my hope is that, 20 years down the line, we will see the effects of this reflected in increased equity in leadership positions such as division/department chair, dean, and hospital CEO,” she said. “However, we have a lot of work to do because there are still huge inequities in the culture of medicine (institutional and more broadly), including gender-based discrimination, maternal discrimination, and high attrition rates for women physicians, compared to male physicians.

“It’s not enough to simply say ‘well, we have fixed the problem because our incoming medical student classes are now equitable in gender distribution,’ ”

The authors and Dr. Marshall had no disclosures to report.

Despite some gains, new research shows ongoing gender imbalances in hematology and oncology, as reflected in the predominantly male presenters at board review lecture series – where early career faculty are also underrepresented.

“Our study provides the first analysis of gender and early-career faculty disparities in speakers at hematology and medical oncology board review meetings,” the authors reported in research published in Blood Advances.

“We covered six major board reviews over the last 5 years that are either conducted yearly or every other year, [and] the general trend across all meetings showed skewness toward men speakers,” the authors reported.

Recent data from 2021 suggests a closing of the gender gap in oncology, with women making up 44.6% of oncologists in training. However, they still only represented 35.2% of practicing oncologists and are underrepresented in leadership positions in academic oncology, the authors reported.

With speaking roles at academic meetings potentially marking a key step in career advancement and improved opportunities, the authors sought to investigate the balance of gender, as well as early-career faculty among speakers at prominent hematology and/or oncology board review lecture series taking place in the United States between 2017 and 2021.

The five institutions and one society presenting the board review lecture series included Baylor College of Medicine/MD Anderson Cancer Center, both in Houston; Dana-Farber Brigham Cancer Center, Boston; George Washington University, Washington; Memorial Sloan Kettering Cancer Center, New York; Seattle Cancer Care Alliance; and the hematology board review series from the American Society of Hematology.

During the period in question, among 1,224 board review lectures presented, women constituted only 37.7% of the speakers. In lectures presented by American Board of Internal Medicine–certified speakers (n = 1,016, 83%), women were found to have made up fewer than 50% of speakers in five of six courses.

Men were also more likely to be recurrent speakers; across all courses, 13 men but only 2 women conducted 10 or more lectures. And while 35 men gave six or more lectures across all courses, only 12 women did so.

The lecture topics with the lowest rates of women presenters included malignant hematology (24.8%), solid tumors (38.9%), and benign hematology lectures (44.1%).

courtesy Dr. Al Hadidi

“We suspected [the imbalance in malignant hematology] since multiple recurrent roles were concentrated in the malignant hematology,” senior author Samer Al Hadidi, MD, of the Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AK, said in an interview.

He noted that “there are no regulations that such courses need to follow to ensure certain proportions of women and junior faculty are involved.”
 

Early-career faculty

In terms of early-career representation, more than 50% of lectures were given by faculty who had received their initial certifications more than 15 years earlier. The median time from initial certification was 12.5 years for hematology and 14 years for medical oncology.

The findings that more than half of the board review lectures were presented by faculty with more than 15 years’ experience since initial certification “reflects a lack of appropriate involvement of early-career faculty, who arguably may have more recent experience with board certification,” the authors wrote.

While being underrepresented in such roles is detrimental, there are no regulations that such courses follow to ensure certain proportions of women and junior faculty are involved, Dr. Al Hadidi noted.
 

Equal representation remains elusive

The study does suggest some notable gains. In a previous study of 181 academic conferences in the United States and Canada between 2007 and 2017, the rate of women speakers was only 15%, compared with 37.7% in the new study.

And an overall trend analysis in the study shows an approximately 10% increase in representation of women in all of the board reviews. However, only the ASH hematology board review achieved more than 50% women in their two courses.

“Overall, the proportion of women speakers is improving over the years, though it remains suboptimal,” Dr. Al Hadidi said.

The authors noted that oncology is clearly not the only specialty with gender disparities. They documented a lack of women speakers at conferences involving otolaryngology head and neck meetings, radiation oncology, emergency medicine, and research conferences.

They pointed to the work of ASH’s Women in Hematology Working Group as an important example of the needed effort to improve the balance of women hematologists.

courtesy Penn Medicine

Ariela Marshall, MD, director of women’s thrombosis and hemostasis at Penn Medicine in Philadelphia and a leader of ASH’s Women in Hematology Working Group, agreed that more efforts are needed to address both gender disparities as well as those of early career speakers. She asserted that the two disparities appear to be connected.

“If you broke down gender representation over time and the faculty/time since initial certification, the findings may mirror the percent of women in hematology-oncology at that given point in time,” Dr. Marshall said in an interview.

“If an institution is truly committed to taking action on gender equity, it needs to look at gender and experience equity of speakers,” she said. “Perhaps it’s the time to say ‘Dr. X has been doing this review course for 15 years. Let’s give someone else a chance.’

“This is not even just from a gender equity perspective but from a career development perspective overall,” she added. “Junior faculty need these speaking engagements a lot more than senior faculty.”

Meanwhile, the higher number of female trainees is a trend that ideally will be sustained as those trainees move into positions of leadership, Dr. Marshall noted.

“We do see that over time, we have achieved gender equity in the percent of women matriculating to medical school. And my hope is that, 20 years down the line, we will see the effects of this reflected in increased equity in leadership positions such as division/department chair, dean, and hospital CEO,” she said. “However, we have a lot of work to do because there are still huge inequities in the culture of medicine (institutional and more broadly), including gender-based discrimination, maternal discrimination, and high attrition rates for women physicians, compared to male physicians.

“It’s not enough to simply say ‘well, we have fixed the problem because our incoming medical student classes are now equitable in gender distribution,’ ”

The authors and Dr. Marshall had no disclosures to report.

PORTLAND, ORE. – If you’re uncomfortable asking new dermatology patients about their sexual orientation and gender identity, they’re likely to sense your unease.

“From the patient perspective, there’s nothing more awkward than having an awkward provider asking awkward questions,” Howa Yeung, MD, MSc, assistant professor of dermatology at Emory University, Atlanta, said at the annual meeting of the Pacific Dermatologic Association.

In 2014, Sean Cahill, PhD, and Harvey Makadon, MD, published an article recommending the inclusion of sexual orientation and gender identity questions in electronic medical records, a practice that Dr. Yeung characterized as “the most patient-centered way to collect sexual orientation and gender identity information. The most important thing is to ask routinely on an intake form where they fill it out themselves. All electronic medical records have the capacity to do so.”

On the other hand, when asking new patients about their sexual orientation and gender identity in person, it’s important to normalize the discussion and ask in an inclusive way, said Dr. Yeung, who was the lead author on published recommendations on dermatologic care for LGBTQ persons published in the Journal of the American Academy of Dermatology. “For example, I always say, ‘I’m Howa Yeung. I use him pronouns,’ ” he said. “ ‘How should I address you?’ Then they will tell you. Allow people to lead the way.”

Other suggested tips in the JAAD article include to avoid using terms such as “sir” or “miss” until the patient’s gender identify is ascertained. Instead, use gender-neutral terms such as “they” or “the patient” when referring to new patients. Do not use the pronoun “it.” If a patient’s name does not match a name in the medical record, ask, “What is the name on your insurance/records?” and avoid assuming gender(s) of a patient’s partner or parents. Instead, consider asking, “Who did you bring with you today?” “Are you in a relationship?” “What are the names of your parents?”

Normalizing questions about the patient’s sexual history is also key. “I tell patients that I routinely ask about sexual history for patients with similar skin issues because it helps me provide the best care for them,” Dr. Yeung said. “I also discuss confidentiality and documentation.”

Dr. Yeung reported having no relevant disclosures.

PORTLAND, ORE. – If you’re uncomfortable asking new dermatology patients about their sexual orientation and gender identity, they’re likely to sense your unease.

“From the patient perspective, there’s nothing more awkward than having an awkward provider asking awkward questions,” Howa Yeung, MD, MSc, assistant professor of dermatology at Emory University, Atlanta, said at the annual meeting of the Pacific Dermatologic Association.

In 2014, Sean Cahill, PhD, and Harvey Makadon, MD, published an article recommending the inclusion of sexual orientation and gender identity questions in electronic medical records, a practice that Dr. Yeung characterized as “the most patient-centered way to collect sexual orientation and gender identity information. The most important thing is to ask routinely on an intake form where they fill it out themselves. All electronic medical records have the capacity to do so.”

On the other hand, when asking new patients about their sexual orientation and gender identity in person, it’s important to normalize the discussion and ask in an inclusive way, said Dr. Yeung, who was the lead author on published recommendations on dermatologic care for LGBTQ persons published in the Journal of the American Academy of Dermatology. “For example, I always say, ‘I’m Howa Yeung. I use him pronouns,’ ” he said. “ ‘How should I address you?’ Then they will tell you. Allow people to lead the way.”

Other suggested tips in the JAAD article include to avoid using terms such as “sir” or “miss” until the patient’s gender identify is ascertained. Instead, use gender-neutral terms such as “they” or “the patient” when referring to new patients. Do not use the pronoun “it.” If a patient’s name does not match a name in the medical record, ask, “What is the name on your insurance/records?” and avoid assuming gender(s) of a patient’s partner or parents. Instead, consider asking, “Who did you bring with you today?” “Are you in a relationship?” “What are the names of your parents?”

Normalizing questions about the patient’s sexual history is also key. “I tell patients that I routinely ask about sexual history for patients with similar skin issues because it helps me provide the best care for them,” Dr. Yeung said. “I also discuss confidentiality and documentation.”

Dr. Yeung reported having no relevant disclosures.

PORTLAND, ORE. – If you’re uncomfortable asking new dermatology patients about their sexual orientation and gender identity, they’re likely to sense your unease.

“From the patient perspective, there’s nothing more awkward than having an awkward provider asking awkward questions,” Howa Yeung, MD, MSc, assistant professor of dermatology at Emory University, Atlanta, said at the annual meeting of the Pacific Dermatologic Association.

In 2014, Sean Cahill, PhD, and Harvey Makadon, MD, published an article recommending the inclusion of sexual orientation and gender identity questions in electronic medical records, a practice that Dr. Yeung characterized as “the most patient-centered way to collect sexual orientation and gender identity information. The most important thing is to ask routinely on an intake form where they fill it out themselves. All electronic medical records have the capacity to do so.”

On the other hand, when asking new patients about their sexual orientation and gender identity in person, it’s important to normalize the discussion and ask in an inclusive way, said Dr. Yeung, who was the lead author on published recommendations on dermatologic care for LGBTQ persons published in the Journal of the American Academy of Dermatology. “For example, I always say, ‘I’m Howa Yeung. I use him pronouns,’ ” he said. “ ‘How should I address you?’ Then they will tell you. Allow people to lead the way.”

Other suggested tips in the JAAD article include to avoid using terms such as “sir” or “miss” until the patient’s gender identify is ascertained. Instead, use gender-neutral terms such as “they” or “the patient” when referring to new patients. Do not use the pronoun “it.” If a patient’s name does not match a name in the medical record, ask, “What is the name on your insurance/records?” and avoid assuming gender(s) of a patient’s partner or parents. Instead, consider asking, “Who did you bring with you today?” “Are you in a relationship?” “What are the names of your parents?”

Normalizing questions about the patient’s sexual history is also key. “I tell patients that I routinely ask about sexual history for patients with similar skin issues because it helps me provide the best care for them,” Dr. Yeung said. “I also discuss confidentiality and documentation.”

Dr. Yeung reported having no relevant disclosures.

Some members of the American Academy of Pediatrics say its association leadership is blocking discussion about a resolution asking for a “rigorous systematic review” of gender-affirming care guidelines.

At issue is 2018 guidance that states children can undergo hormonal therapy after they are deemed appropriate candidates following a thorough mental health evaluation.

Critics say minors under age 18 may be getting “fast-tracked” to hormonal treatment too quickly or inappropriately and can end up regretting the decision and facing medical conditions like sterility.

Five AAP members, which has a total membership of around 67,000 pediatricians in the United States and Canada, this year penned Resolution 27, calling for a possible update of the guidelines following consultation with stakeholders that include mental health and medical clinicians, parents, and patients “with diverse views and experiences.”

Those members and others in written comments on a members-only website accuse the AAP of deliberately silencing debate on the issue and changing resolution rules. Any AAP member can submit a resolution for consideration by the group’s leadership at its annual policy meeting.

This year, the AAP sent an email to members stating it would not allow comments on resolutions that had not been “sponsored” by one of the group’s 66 chapters or 88 internal committees, councils, or sections.

That’s why comments were not allowed on Resolution 27, said Mark Del Monte, the AAP’s CEO. A second attempt to get sponsorship during the annual leadership forum, held earlier this month in Chicago, also failed, he noted. Mr. Del Monte told this news organization that changes to the resolution process are made every year and that no rule changes were directly associated with Resolution 27.

But one of the resolution’s authors said there was sponsorship when members first drafted the suggestion. Julia Mason, MD, a board member for the Society for Evidence-based Gender Medicine and a pediatrician in private practice in Gresham, Ore., says an AAP chapter president agreed to second Resolution 27 but backed off after attending a different AAP meeting. Dr. Mason did not name the member.

On Aug. 10, AAP President Moira Szilagyi, MD, PhD, wrote in a blog on the AAP website – after the AAP leadership meeting in Chicago – that the lack of sponsorship “meant no one was willing to support their proposal.”

The AAP Leadership Council’s 154 voting entities approved 48 resolutions at the meeting, all of which will be referred to the AAP Board of Directors for potential, but not definite, action as the Board only takes resolutions under advisement, Mr. Del Monte notes.

In an email allowing members to comment on a resolution (number 28) regarding education support for caring for transgender patients, 23 chose to support Resolution 27 instead.

“I am wholeheartedly in support of Resolution 27, which interestingly has been removed from the list of resolutions for member comment,” one comment read. “I can no longer trust the AAP to provide medical evidence-based education with regard to care for transgender individuals.” 

“We don’t need a formal resolution to look at the evidence around the care of transgender young people. Evaluating the evidence behind our recommendations, which the unsponsored resolution called for, is a routine part of the Academy’s policy-writing process,” wrote Dr. Szilagyi in her blog.

Mr. Del Monte says that “the 2018 policy is under review now.”

So far, “the evidence that we have seen reinforces our policy that gender-affirming care is the correct approach,” Mr. Del Monte stresses. “It is supported by every mainstream medical society in the world and is the standard of care,” he maintains.

Among those societies is the World Professional Association for Transgender Health, which in the draft of its latest Standards of Care (SOC8) – the first new guidance on the issue for 10 years – reportedly lowers the age for “top surgery” to 15 years.

The final SOC8 will most likely be published to coincide with WPATH’s annual meeting in September in Montreal.

Opponents plan to protest outside the AAP’s annual meeting, in Anaheim in October, Dr. Mason says.

“I’m concerned that kids with a transient gender identity are being funneled into medicalization that does not serve them,” Dr. Mason says. “I am worried that the trans identity is valued over the possibility of desistance,” she adds, admitting that her goal is to have fewer children transition gender.

Last summer, AAP found itself in hot water on the same topic when it barred SEGM from having a booth at the AAP annual meeting in 2021, as reported by this news organization.

A version of this article first appeared on Medscape.com.

Some members of the American Academy of Pediatrics say its association leadership is blocking discussion about a resolution asking for a “rigorous systematic review” of gender-affirming care guidelines.

At issue is 2018 guidance that states children can undergo hormonal therapy after they are deemed appropriate candidates following a thorough mental health evaluation.

Critics say minors under age 18 may be getting “fast-tracked” to hormonal treatment too quickly or inappropriately and can end up regretting the decision and facing medical conditions like sterility.

Five AAP members, which has a total membership of around 67,000 pediatricians in the United States and Canada, this year penned Resolution 27, calling for a possible update of the guidelines following consultation with stakeholders that include mental health and medical clinicians, parents, and patients “with diverse views and experiences.”

Those members and others in written comments on a members-only website accuse the AAP of deliberately silencing debate on the issue and changing resolution rules. Any AAP member can submit a resolution for consideration by the group’s leadership at its annual policy meeting.

This year, the AAP sent an email to members stating it would not allow comments on resolutions that had not been “sponsored” by one of the group’s 66 chapters or 88 internal committees, councils, or sections.

That’s why comments were not allowed on Resolution 27, said Mark Del Monte, the AAP’s CEO. A second attempt to get sponsorship during the annual leadership forum, held earlier this month in Chicago, also failed, he noted. Mr. Del Monte told this news organization that changes to the resolution process are made every year and that no rule changes were directly associated with Resolution 27.

But one of the resolution’s authors said there was sponsorship when members first drafted the suggestion. Julia Mason, MD, a board member for the Society for Evidence-based Gender Medicine and a pediatrician in private practice in Gresham, Ore., says an AAP chapter president agreed to second Resolution 27 but backed off after attending a different AAP meeting. Dr. Mason did not name the member.

On Aug. 10, AAP President Moira Szilagyi, MD, PhD, wrote in a blog on the AAP website – after the AAP leadership meeting in Chicago – that the lack of sponsorship “meant no one was willing to support their proposal.”

The AAP Leadership Council’s 154 voting entities approved 48 resolutions at the meeting, all of which will be referred to the AAP Board of Directors for potential, but not definite, action as the Board only takes resolutions under advisement, Mr. Del Monte notes.

In an email allowing members to comment on a resolution (number 28) regarding education support for caring for transgender patients, 23 chose to support Resolution 27 instead.

“I am wholeheartedly in support of Resolution 27, which interestingly has been removed from the list of resolutions for member comment,” one comment read. “I can no longer trust the AAP to provide medical evidence-based education with regard to care for transgender individuals.” 

“We don’t need a formal resolution to look at the evidence around the care of transgender young people. Evaluating the evidence behind our recommendations, which the unsponsored resolution called for, is a routine part of the Academy’s policy-writing process,” wrote Dr. Szilagyi in her blog.

Mr. Del Monte says that “the 2018 policy is under review now.”

So far, “the evidence that we have seen reinforces our policy that gender-affirming care is the correct approach,” Mr. Del Monte stresses. “It is supported by every mainstream medical society in the world and is the standard of care,” he maintains.

Among those societies is the World Professional Association for Transgender Health, which in the draft of its latest Standards of Care (SOC8) – the first new guidance on the issue for 10 years – reportedly lowers the age for “top surgery” to 15 years.

The final SOC8 will most likely be published to coincide with WPATH’s annual meeting in September in Montreal.

Opponents plan to protest outside the AAP’s annual meeting, in Anaheim in October, Dr. Mason says.

“I’m concerned that kids with a transient gender identity are being funneled into medicalization that does not serve them,” Dr. Mason says. “I am worried that the trans identity is valued over the possibility of desistance,” she adds, admitting that her goal is to have fewer children transition gender.

Last summer, AAP found itself in hot water on the same topic when it barred SEGM from having a booth at the AAP annual meeting in 2021, as reported by this news organization.

A version of this article first appeared on Medscape.com.

Some members of the American Academy of Pediatrics say its association leadership is blocking discussion about a resolution asking for a “rigorous systematic review” of gender-affirming care guidelines.

At issue is 2018 guidance that states children can undergo hormonal therapy after they are deemed appropriate candidates following a thorough mental health evaluation.

Critics say minors under age 18 may be getting “fast-tracked” to hormonal treatment too quickly or inappropriately and can end up regretting the decision and facing medical conditions like sterility.

Five AAP members, which has a total membership of around 67,000 pediatricians in the United States and Canada, this year penned Resolution 27, calling for a possible update of the guidelines following consultation with stakeholders that include mental health and medical clinicians, parents, and patients “with diverse views and experiences.”

Those members and others in written comments on a members-only website accuse the AAP of deliberately silencing debate on the issue and changing resolution rules. Any AAP member can submit a resolution for consideration by the group’s leadership at its annual policy meeting.

This year, the AAP sent an email to members stating it would not allow comments on resolutions that had not been “sponsored” by one of the group’s 66 chapters or 88 internal committees, councils, or sections.

That’s why comments were not allowed on Resolution 27, said Mark Del Monte, the AAP’s CEO. A second attempt to get sponsorship during the annual leadership forum, held earlier this month in Chicago, also failed, he noted. Mr. Del Monte told this news organization that changes to the resolution process are made every year and that no rule changes were directly associated with Resolution 27.

But one of the resolution’s authors said there was sponsorship when members first drafted the suggestion. Julia Mason, MD, a board member for the Society for Evidence-based Gender Medicine and a pediatrician in private practice in Gresham, Ore., says an AAP chapter president agreed to second Resolution 27 but backed off after attending a different AAP meeting. Dr. Mason did not name the member.

On Aug. 10, AAP President Moira Szilagyi, MD, PhD, wrote in a blog on the AAP website – after the AAP leadership meeting in Chicago – that the lack of sponsorship “meant no one was willing to support their proposal.”

The AAP Leadership Council’s 154 voting entities approved 48 resolutions at the meeting, all of which will be referred to the AAP Board of Directors for potential, but not definite, action as the Board only takes resolutions under advisement, Mr. Del Monte notes.

In an email allowing members to comment on a resolution (number 28) regarding education support for caring for transgender patients, 23 chose to support Resolution 27 instead.

“I am wholeheartedly in support of Resolution 27, which interestingly has been removed from the list of resolutions for member comment,” one comment read. “I can no longer trust the AAP to provide medical evidence-based education with regard to care for transgender individuals.” 

“We don’t need a formal resolution to look at the evidence around the care of transgender young people. Evaluating the evidence behind our recommendations, which the unsponsored resolution called for, is a routine part of the Academy’s policy-writing process,” wrote Dr. Szilagyi in her blog.

Mr. Del Monte says that “the 2018 policy is under review now.”

So far, “the evidence that we have seen reinforces our policy that gender-affirming care is the correct approach,” Mr. Del Monte stresses. “It is supported by every mainstream medical society in the world and is the standard of care,” he maintains.

Among those societies is the World Professional Association for Transgender Health, which in the draft of its latest Standards of Care (SOC8) – the first new guidance on the issue for 10 years – reportedly lowers the age for “top surgery” to 15 years.

The final SOC8 will most likely be published to coincide with WPATH’s annual meeting in September in Montreal.

Opponents plan to protest outside the AAP’s annual meeting, in Anaheim in October, Dr. Mason says.

“I’m concerned that kids with a transient gender identity are being funneled into medicalization that does not serve them,” Dr. Mason says. “I am worried that the trans identity is valued over the possibility of desistance,” she adds, admitting that her goal is to have fewer children transition gender.

Last summer, AAP found itself in hot water on the same topic when it barred SEGM from having a booth at the AAP annual meeting in 2021, as reported by this news organization.

A version of this article first appeared on Medscape.com.

Only 21% of rheumatology journals showed gender-balanced editorial boards, defined as 40%-60% women members, based on data from 34 publications.

Women remain underrepresented on the editorial boards of medical journals in general, and rheumatology journals are no exception, according to Pavel V. Ovseiko, DPhil, of the University of Oxford (England) and colleagues.

“Gender representation on editorial boards matters because editorships-in-chief and editorial board memberships are prestigious roles that increase the visibility of role-holders and provide opportunities to influence research and practice through agenda setting, editorial decision making, and peer review,” the researchers wrote.

In a study published in The Lancet Rheumatology, the researchers examined the websites of 34 rheumatology publications in December 2021. The gender of the board members was estimated using a name-to-gender inference platform and checked against personal pronouns and photos used online.

Overall, six journals (15%) had female editors-in-chief or the equivalent, and 27% of the total editorial board members were women.

Occupation had a significant impact on gender representation. Gender was equally balanced (50%) for the four journals in which a publishing professional served as editor-in-chief, and women comprised 74% of the editorial board memberships held by publishing professionals.

However, women comprised only 11% of editorships and 26% of editorial board memberships held by academics or clinicians.

“Although academic rheumatology is male-dominated, academic publishing is female-dominated,” the researchers wrote.

Gender equity is important for rheumatology in part because most rheumatology patients are women, and the proportion of women in rheumatology is increasing in many countries, the researchers noted.

“Greater diversity on editorial boards is likely to have a positive effect on the quality of science through adequate consideration and reporting of sex-related and gender-related variables,” they said.

The seven journals with gender-balanced editorial boards were Acta Reumatologica Portuguesa, Arthritis & Rheumatology, Arthritis Care & Research, The Lancet Rheumatology, Lupus Science & Medicine, Nature Reviews Rheumatology, and Seminars in Arthritis and Rheumatism.

To achieve gender balance and diversity on editorial boards, the researchers offered strategies including advertising openings through open calls, establishing and monitoring gender diversity targets, and limiting editorial board appointments to fixed terms.

The study received no outside funding. The researchers had no financial conflicts to disclose, but several serve on the editorial boards of various rheumatology journals.

Only 21% of rheumatology journals showed gender-balanced editorial boards, defined as 40%-60% women members, based on data from 34 publications.

Women remain underrepresented on the editorial boards of medical journals in general, and rheumatology journals are no exception, according to Pavel V. Ovseiko, DPhil, of the University of Oxford (England) and colleagues.

“Gender representation on editorial boards matters because editorships-in-chief and editorial board memberships are prestigious roles that increase the visibility of role-holders and provide opportunities to influence research and practice through agenda setting, editorial decision making, and peer review,” the researchers wrote.

In a study published in The Lancet Rheumatology, the researchers examined the websites of 34 rheumatology publications in December 2021. The gender of the board members was estimated using a name-to-gender inference platform and checked against personal pronouns and photos used online.

Overall, six journals (15%) had female editors-in-chief or the equivalent, and 27% of the total editorial board members were women.

Occupation had a significant impact on gender representation. Gender was equally balanced (50%) for the four journals in which a publishing professional served as editor-in-chief, and women comprised 74% of the editorial board memberships held by publishing professionals.

However, women comprised only 11% of editorships and 26% of editorial board memberships held by academics or clinicians.

“Although academic rheumatology is male-dominated, academic publishing is female-dominated,” the researchers wrote.

Gender equity is important for rheumatology in part because most rheumatology patients are women, and the proportion of women in rheumatology is increasing in many countries, the researchers noted.

“Greater diversity on editorial boards is likely to have a positive effect on the quality of science through adequate consideration and reporting of sex-related and gender-related variables,” they said.

The seven journals with gender-balanced editorial boards were Acta Reumatologica Portuguesa, Arthritis & Rheumatology, Arthritis Care & Research, The Lancet Rheumatology, Lupus Science & Medicine, Nature Reviews Rheumatology, and Seminars in Arthritis and Rheumatism.

To achieve gender balance and diversity on editorial boards, the researchers offered strategies including advertising openings through open calls, establishing and monitoring gender diversity targets, and limiting editorial board appointments to fixed terms.

The study received no outside funding. The researchers had no financial conflicts to disclose, but several serve on the editorial boards of various rheumatology journals.

Only 21% of rheumatology journals showed gender-balanced editorial boards, defined as 40%-60% women members, based on data from 34 publications.

Women remain underrepresented on the editorial boards of medical journals in general, and rheumatology journals are no exception, according to Pavel V. Ovseiko, DPhil, of the University of Oxford (England) and colleagues.

“Gender representation on editorial boards matters because editorships-in-chief and editorial board memberships are prestigious roles that increase the visibility of role-holders and provide opportunities to influence research and practice through agenda setting, editorial decision making, and peer review,” the researchers wrote.

In a study published in The Lancet Rheumatology, the researchers examined the websites of 34 rheumatology publications in December 2021. The gender of the board members was estimated using a name-to-gender inference platform and checked against personal pronouns and photos used online.

Overall, six journals (15%) had female editors-in-chief or the equivalent, and 27% of the total editorial board members were women.

Occupation had a significant impact on gender representation. Gender was equally balanced (50%) for the four journals in which a publishing professional served as editor-in-chief, and women comprised 74% of the editorial board memberships held by publishing professionals.

However, women comprised only 11% of editorships and 26% of editorial board memberships held by academics or clinicians.

“Although academic rheumatology is male-dominated, academic publishing is female-dominated,” the researchers wrote.

Gender equity is important for rheumatology in part because most rheumatology patients are women, and the proportion of women in rheumatology is increasing in many countries, the researchers noted.

“Greater diversity on editorial boards is likely to have a positive effect on the quality of science through adequate consideration and reporting of sex-related and gender-related variables,” they said.

The seven journals with gender-balanced editorial boards were Acta Reumatologica Portuguesa, Arthritis & Rheumatology, Arthritis Care & Research, The Lancet Rheumatology, Lupus Science & Medicine, Nature Reviews Rheumatology, and Seminars in Arthritis and Rheumatism.

To achieve gender balance and diversity on editorial boards, the researchers offered strategies including advertising openings through open calls, establishing and monitoring gender diversity targets, and limiting editorial board appointments to fixed terms.

The study received no outside funding. The researchers had no financial conflicts to disclose, but several serve on the editorial boards of various rheumatology journals.

A low-level light therapy cap may be a safe, convenient treatment for some patients with central centrifugal cicatricial alopecia, though the treatment effects from a small prospective trial appear to be subtle.

Central centrifugal cicatricial alopecia (CCCA) is a form of scarring hair loss with unknown etiology and no known cure that affects mainly women of African descent.

“The low-level light therapy (LLLT) cap does indeed seem to help with symptoms and mild regrowth in CCCA,” senior study author Amy J. McMichael, MD, told this news organization. “The dual-wavelength cap we used appears to have anti-inflammatory properties, and that makes sense for a primarily inflammatory scarring from of alopecia.

“Quality of life improved with the treatment and there were no reported side effects,” added Dr. McMichael, professor of dermatology at Wake Forest University, Winston-Salem, N.C.

The results of the study were presented in a poster at the annual meeting of the Society for Investigative Dermatology.

The REVIAN RED cap (REVIAN Inc.) used in the study contains 119 light-emitting diodes (LEDs) arrayed on the cap’s interior surface that emit orange (620 nm) and red (660 nm) light.

The hypothesis for how the dual-wavelength lights work is that light is absorbed by the chromophore cytochrome c oxidase in the mitochondrial membrane. This induces the release of nitric oxide and the production of adenosine triphosphate (ATP), which leads to vasodilation, cytokine regulation, and increased transcription and release of growth factors.

LLLT is approved to treat androgenetic alopecia, the authors wrote, but has not been studied as a treatment for CCCA.

To assess the effects of LLLT on CCCA, Dr. McMichael and her colleagues at Wake Forest followed the condition’s progress in five Black women over their 6-month course of treatment. Four participants completed the study.

At baseline, all participants had been on individual stable CCCA treatment regimens for at least 3 months. They continued those treatments along with LLLT therapy throughout the study. The women ranged in age from 38 to 69 years, had had CCCA for an average of 12 years, and their disease severity ranged from stage IIB to IVA.

They were instructed to wear the REVIAN RED cap with the LEDs activated for 10 minutes each day.

At 2, 4, and 6 months, participants self-assessed their symptoms, a clinician evaluated the condition’s severity, and digital photographs were taken.

At 6 months:

• Three patients showed improved Dermatology Life Quality Index (DLQI).
• Three patients showed decreased loss of follicular openings and breakage.
• A dermoscopic image of the scalp of one patient revealed short, regrowing vellus hairs and minimal interfollicular and perifollicular scale.
• No patients reported side effects.

Small study raises big questions

“I hope this study will lead to a larger study that will look at the long-term outcomes of CCCA,” Dr. McMichael said. “This is a nice treatment that does not require application of something to the scalp that may affect hair styling, and it has no systemic side effects.”

Dr. McMichael acknowledges that the small sample size, participants continuing with their individual stable treatments while also undergoing light therapy, and the lack of patients with stage I disease, are weaknesses in the study.

“However, the strength is that none of the patients had side effects or stopped using the treatment due to difficulty with the system,” she added.

Dr. McMichael said she would like to investigate the effects of longer use of the cap and whether the cap can be used to prevent CCCA.

Chesahna Kindred, MD, assistant professor of dermatology at Howard University, Washington, D.C., and founder of Kindred Hair & Skin Center in Columbia, Md., told this news organization that she uses LLLT in her practice.

“I find that LLLT is mildly helpful, or at least does not worsen, androgenetic alopecia,” she said.

“Interestingly, while all four patients had stable disease upon initiating the study, it appears as though two of the four worsened after the use of LLLT, one improved, and one remained relatively stable,” noted Dr. Kindred, who was not involved in the study. “This is important because once there is complete destruction of the follicle, CCCA is difficult to improve.

“Given that there are several options to address inflammation and follicular damage in CCCA, more studies are needed before I would incorporate LLLT into my regular treatment algorithms,” she added.

“Studies like this are important and remind us to not lump all forms of hair loss together,” she said.

REVIAN Inc. provided the caps, but the study received no additional funding. Dr. McMichael and Dr. Kindred report relevant financial relationships with the pharmaceutical industry. Study coauthors have disclosed no relevant financial relationships.
 

A version of this article first appeared on Medscape.com.

A low-level light therapy cap may be a safe, convenient treatment for some patients with central centrifugal cicatricial alopecia, though the treatment effects from a small prospective trial appear to be subtle.

Central centrifugal cicatricial alopecia (CCCA) is a form of scarring hair loss with unknown etiology and no known cure that affects mainly women of African descent.

“The low-level light therapy (LLLT) cap does indeed seem to help with symptoms and mild regrowth in CCCA,” senior study author Amy J. McMichael, MD, told this news organization. “The dual-wavelength cap we used appears to have anti-inflammatory properties, and that makes sense for a primarily inflammatory scarring from of alopecia.

“Quality of life improved with the treatment and there were no reported side effects,” added Dr. McMichael, professor of dermatology at Wake Forest University, Winston-Salem, N.C.

The results of the study were presented in a poster at the annual meeting of the Society for Investigative Dermatology.

The REVIAN RED cap (REVIAN Inc.) used in the study contains 119 light-emitting diodes (LEDs) arrayed on the cap’s interior surface that emit orange (620 nm) and red (660 nm) light.

The hypothesis for how the dual-wavelength lights work is that light is absorbed by the chromophore cytochrome c oxidase in the mitochondrial membrane. This induces the release of nitric oxide and the production of adenosine triphosphate (ATP), which leads to vasodilation, cytokine regulation, and increased transcription and release of growth factors.

LLLT is approved to treat androgenetic alopecia, the authors wrote, but has not been studied as a treatment for CCCA.

To assess the effects of LLLT on CCCA, Dr. McMichael and her colleagues at Wake Forest followed the condition’s progress in five Black women over their 6-month course of treatment. Four participants completed the study.

At baseline, all participants had been on individual stable CCCA treatment regimens for at least 3 months. They continued those treatments along with LLLT therapy throughout the study. The women ranged in age from 38 to 69 years, had had CCCA for an average of 12 years, and their disease severity ranged from stage IIB to IVA.

They were instructed to wear the REVIAN RED cap with the LEDs activated for 10 minutes each day.

At 2, 4, and 6 months, participants self-assessed their symptoms, a clinician evaluated the condition’s severity, and digital photographs were taken.

At 6 months:

• Three patients showed improved Dermatology Life Quality Index (DLQI).
• Three patients showed decreased loss of follicular openings and breakage.
• A dermoscopic image of the scalp of one patient revealed short, regrowing vellus hairs and minimal interfollicular and perifollicular scale.
• No patients reported side effects.

Small study raises big questions

“I hope this study will lead to a larger study that will look at the long-term outcomes of CCCA,” Dr. McMichael said. “This is a nice treatment that does not require application of something to the scalp that may affect hair styling, and it has no systemic side effects.”

Dr. McMichael acknowledges that the small sample size, participants continuing with their individual stable treatments while also undergoing light therapy, and the lack of patients with stage I disease, are weaknesses in the study.

“However, the strength is that none of the patients had side effects or stopped using the treatment due to difficulty with the system,” she added.

Dr. McMichael said she would like to investigate the effects of longer use of the cap and whether the cap can be used to prevent CCCA.

Chesahna Kindred, MD, assistant professor of dermatology at Howard University, Washington, D.C., and founder of Kindred Hair & Skin Center in Columbia, Md., told this news organization that she uses LLLT in her practice.

“I find that LLLT is mildly helpful, or at least does not worsen, androgenetic alopecia,” she said.

“Interestingly, while all four patients had stable disease upon initiating the study, it appears as though two of the four worsened after the use of LLLT, one improved, and one remained relatively stable,” noted Dr. Kindred, who was not involved in the study. “This is important because once there is complete destruction of the follicle, CCCA is difficult to improve.

“Given that there are several options to address inflammation and follicular damage in CCCA, more studies are needed before I would incorporate LLLT into my regular treatment algorithms,” she added.

“Studies like this are important and remind us to not lump all forms of hair loss together,” she said.

REVIAN Inc. provided the caps, but the study received no additional funding. Dr. McMichael and Dr. Kindred report relevant financial relationships with the pharmaceutical industry. Study coauthors have disclosed no relevant financial relationships.
 

A version of this article first appeared on Medscape.com.

A low-level light therapy cap may be a safe, convenient treatment for some patients with central centrifugal cicatricial alopecia, though the treatment effects from a small prospective trial appear to be subtle.

Central centrifugal cicatricial alopecia (CCCA) is a form of scarring hair loss with unknown etiology and no known cure that affects mainly women of African descent.

“The low-level light therapy (LLLT) cap does indeed seem to help with symptoms and mild regrowth in CCCA,” senior study author Amy J. McMichael, MD, told this news organization. “The dual-wavelength cap we used appears to have anti-inflammatory properties, and that makes sense for a primarily inflammatory scarring from of alopecia.

“Quality of life improved with the treatment and there were no reported side effects,” added Dr. McMichael, professor of dermatology at Wake Forest University, Winston-Salem, N.C.

The results of the study were presented in a poster at the annual meeting of the Society for Investigative Dermatology.

The REVIAN RED cap (REVIAN Inc.) used in the study contains 119 light-emitting diodes (LEDs) arrayed on the cap’s interior surface that emit orange (620 nm) and red (660 nm) light.

The hypothesis for how the dual-wavelength lights work is that light is absorbed by the chromophore cytochrome c oxidase in the mitochondrial membrane. This induces the release of nitric oxide and the production of adenosine triphosphate (ATP), which leads to vasodilation, cytokine regulation, and increased transcription and release of growth factors.

LLLT is approved to treat androgenetic alopecia, the authors wrote, but has not been studied as a treatment for CCCA.

To assess the effects of LLLT on CCCA, Dr. McMichael and her colleagues at Wake Forest followed the condition’s progress in five Black women over their 6-month course of treatment. Four participants completed the study.

At baseline, all participants had been on individual stable CCCA treatment regimens for at least 3 months. They continued those treatments along with LLLT therapy throughout the study. The women ranged in age from 38 to 69 years, had had CCCA for an average of 12 years, and their disease severity ranged from stage IIB to IVA.

They were instructed to wear the REVIAN RED cap with the LEDs activated for 10 minutes each day.

At 2, 4, and 6 months, participants self-assessed their symptoms, a clinician evaluated the condition’s severity, and digital photographs were taken.

At 6 months:

• Three patients showed improved Dermatology Life Quality Index (DLQI).
• Three patients showed decreased loss of follicular openings and breakage.
• A dermoscopic image of the scalp of one patient revealed short, regrowing vellus hairs and minimal interfollicular and perifollicular scale.
• No patients reported side effects.

Small study raises big questions

“I hope this study will lead to a larger study that will look at the long-term outcomes of CCCA,” Dr. McMichael said. “This is a nice treatment that does not require application of something to the scalp that may affect hair styling, and it has no systemic side effects.”

Dr. McMichael acknowledges that the small sample size, participants continuing with their individual stable treatments while also undergoing light therapy, and the lack of patients with stage I disease, are weaknesses in the study.

“However, the strength is that none of the patients had side effects or stopped using the treatment due to difficulty with the system,” she added.

Dr. McMichael said she would like to investigate the effects of longer use of the cap and whether the cap can be used to prevent CCCA.

Chesahna Kindred, MD, assistant professor of dermatology at Howard University, Washington, D.C., and founder of Kindred Hair & Skin Center in Columbia, Md., told this news organization that she uses LLLT in her practice.

“I find that LLLT is mildly helpful, or at least does not worsen, androgenetic alopecia,” she said.

“Interestingly, while all four patients had stable disease upon initiating the study, it appears as though two of the four worsened after the use of LLLT, one improved, and one remained relatively stable,” noted Dr. Kindred, who was not involved in the study. “This is important because once there is complete destruction of the follicle, CCCA is difficult to improve.

“Given that there are several options to address inflammation and follicular damage in CCCA, more studies are needed before I would incorporate LLLT into my regular treatment algorithms,” she added.

“Studies like this are important and remind us to not lump all forms of hair loss together,” she said.

REVIAN Inc. provided the caps, but the study received no additional funding. Dr. McMichael and Dr. Kindred report relevant financial relationships with the pharmaceutical industry. Study coauthors have disclosed no relevant financial relationships.
 

A version of this article first appeared on Medscape.com.

To the Editor:

Psoriasis affects 2% to 3% of the US population and is one of the more commonly diagnosed dermatologic conditions.^1-3 Experts agree that common cutaneous diseases such as psoriasis present differently in patients with skin of color (SOC) compared to non-SOC patients.^3,4 Despite the prevalence of psoriasis, data on these morphologic differences are limited.^3-5 We performed a retrospective chart review comparing characteristics of psoriasis in SOC and non-SOC patients.

Through a search of electronic health records, we identified patients with an International Classification of Diseases, 10th Revision, diagnosis of psoriasis who were 18 years or older and were evaluated in the dermatology department between August 2015 and June 2020 at University Medical Center, an academic institution in New Orleans, Louisiana. Photographs and descriptions of lesions from these patients were reviewed. Patient data collected included age, sex, psoriasis classification, insurance status, self-identified race and ethnicity, location of lesion(s), biopsy, final diagnosis, and average number of visits or days required for accurate diagnosis. Self-identified SOC race and ethnicity categories included Black or African American, Hispanic, Asian, American Indian and Alaskan Native, Native Hawaiian and Other Pacific Islander, and “other.”

All analyses were conducted using R-4.0.1 statistics software. Categorical variables were compared in SOC and non-SOC groups using Fisher exact tests. Continuous covariates were conducted using a Wilcoxon rank sum test.

In total, we reviewed 557 charts. Four patients who declined to identify their race or ethnicity were excluded, yielding 286 SOC and 267 non-SOC patients (N=553). A total of 276 patients (131 SOC; 145 non-SOC) with a prior diagnosis of psoriasis were excluded in the days to diagnosis analysis. Twenty patients (15, SOC; 5, non-SOC) were given a diagnosis of a disease other than psoriasis when evaluated in the dermatology department.

Distributions between racial groups differed for insurance status, sex, psoriasis classification, biopsy status, and days between first dermatology visit and diagnosis. Skin of color patients had significantly longer days between initial presentation to dermatology and final diagnosis vs non-SOC patients (180.11 and 60.27 days, respectively; P=.001). Skin of color patients had a higher rate of palmoplantar psoriasis and severe plaque psoriasis (ie, >10% body surface area involvement) at presentation.

Several multivariable regression analyses were performed. Skin of color patients had significantly higher odds of biopsy compared to non-SOC patients (adjusted odds ratio [95% CI]=4 [2.05-7.82]; P<.001)(Figure 1). There were no significant predictors for severe plaque psoriasis involving more than 10% body surface area. Skin of color patients had a significantly longer time to diagnosis than non-SOC patients (P=.006)(Figure 2). On average, patients with SOC waited 3.23 times longer for a diagnosis than their non-SOC counterparts (95% CI, 1.42-7.36).

Our data reveal striking racial disparities in psoriasis care. Worse outcomes for patients with SOC compared to non-SOC patients may result from physicians’ inadequate familiarity with diverse presentations of psoriasis, including more frequent involvement of special body sites in SOC. Other likely contributing factors that we did not evaluate include socioeconomic barriers to health care, lack of physician diversity, missed appointments, and a paucity of literature on the topic of differentiating morphologies of psoriasis in SOC and non-SOC patients. Our study did not examine the effects of sex, tobacco use, or prior or current therapy, and it excluded pediatric patients.

To improve dermatologic outcomes for our increasingly diverse patient population, more studies must be undertaken to elucidate and document disparities in care for SOC populations.

To the Editor:

Psoriasis affects 2% to 3% of the US population and is one of the more commonly diagnosed dermatologic conditions.^1-3 Experts agree that common cutaneous diseases such as psoriasis present differently in patients with skin of color (SOC) compared to non-SOC patients.^3,4 Despite the prevalence of psoriasis, data on these morphologic differences are limited.^3-5 We performed a retrospective chart review comparing characteristics of psoriasis in SOC and non-SOC patients.

Through a search of electronic health records, we identified patients with an International Classification of Diseases, 10th Revision, diagnosis of psoriasis who were 18 years or older and were evaluated in the dermatology department between August 2015 and June 2020 at University Medical Center, an academic institution in New Orleans, Louisiana. Photographs and descriptions of lesions from these patients were reviewed. Patient data collected included age, sex, psoriasis classification, insurance status, self-identified race and ethnicity, location of lesion(s), biopsy, final diagnosis, and average number of visits or days required for accurate diagnosis. Self-identified SOC race and ethnicity categories included Black or African American, Hispanic, Asian, American Indian and Alaskan Native, Native Hawaiian and Other Pacific Islander, and “other.”

All analyses were conducted using R-4.0.1 statistics software. Categorical variables were compared in SOC and non-SOC groups using Fisher exact tests. Continuous covariates were conducted using a Wilcoxon rank sum test.

In total, we reviewed 557 charts. Four patients who declined to identify their race or ethnicity were excluded, yielding 286 SOC and 267 non-SOC patients (N=553). A total of 276 patients (131 SOC; 145 non-SOC) with a prior diagnosis of psoriasis were excluded in the days to diagnosis analysis. Twenty patients (15, SOC; 5, non-SOC) were given a diagnosis of a disease other than psoriasis when evaluated in the dermatology department.

Distributions between racial groups differed for insurance status, sex, psoriasis classification, biopsy status, and days between first dermatology visit and diagnosis. Skin of color patients had significantly longer days between initial presentation to dermatology and final diagnosis vs non-SOC patients (180.11 and 60.27 days, respectively; P=.001). Skin of color patients had a higher rate of palmoplantar psoriasis and severe plaque psoriasis (ie, >10% body surface area involvement) at presentation.

Several multivariable regression analyses were performed. Skin of color patients had significantly higher odds of biopsy compared to non-SOC patients (adjusted odds ratio [95% CI]=4 [2.05-7.82]; P<.001)(Figure 1). There were no significant predictors for severe plaque psoriasis involving more than 10% body surface area. Skin of color patients had a significantly longer time to diagnosis than non-SOC patients (P=.006)(Figure 2). On average, patients with SOC waited 3.23 times longer for a diagnosis than their non-SOC counterparts (95% CI, 1.42-7.36).

Our data reveal striking racial disparities in psoriasis care. Worse outcomes for patients with SOC compared to non-SOC patients may result from physicians’ inadequate familiarity with diverse presentations of psoriasis, including more frequent involvement of special body sites in SOC. Other likely contributing factors that we did not evaluate include socioeconomic barriers to health care, lack of physician diversity, missed appointments, and a paucity of literature on the topic of differentiating morphologies of psoriasis in SOC and non-SOC patients. Our study did not examine the effects of sex, tobacco use, or prior or current therapy, and it excluded pediatric patients.

To improve dermatologic outcomes for our increasingly diverse patient population, more studies must be undertaken to elucidate and document disparities in care for SOC populations.

To the Editor:

Psoriasis affects 2% to 3% of the US population and is one of the more commonly diagnosed dermatologic conditions.^1-3 Experts agree that common cutaneous diseases such as psoriasis present differently in patients with skin of color (SOC) compared to non-SOC patients.^3,4 Despite the prevalence of psoriasis, data on these morphologic differences are limited.^3-5 We performed a retrospective chart review comparing characteristics of psoriasis in SOC and non-SOC patients.

Through a search of electronic health records, we identified patients with an International Classification of Diseases, 10th Revision, diagnosis of psoriasis who were 18 years or older and were evaluated in the dermatology department between August 2015 and June 2020 at University Medical Center, an academic institution in New Orleans, Louisiana. Photographs and descriptions of lesions from these patients were reviewed. Patient data collected included age, sex, psoriasis classification, insurance status, self-identified race and ethnicity, location of lesion(s), biopsy, final diagnosis, and average number of visits or days required for accurate diagnosis. Self-identified SOC race and ethnicity categories included Black or African American, Hispanic, Asian, American Indian and Alaskan Native, Native Hawaiian and Other Pacific Islander, and “other.”

All analyses were conducted using R-4.0.1 statistics software. Categorical variables were compared in SOC and non-SOC groups using Fisher exact tests. Continuous covariates were conducted using a Wilcoxon rank sum test.

In total, we reviewed 557 charts. Four patients who declined to identify their race or ethnicity were excluded, yielding 286 SOC and 267 non-SOC patients (N=553). A total of 276 patients (131 SOC; 145 non-SOC) with a prior diagnosis of psoriasis were excluded in the days to diagnosis analysis. Twenty patients (15, SOC; 5, non-SOC) were given a diagnosis of a disease other than psoriasis when evaluated in the dermatology department.

Distributions between racial groups differed for insurance status, sex, psoriasis classification, biopsy status, and days between first dermatology visit and diagnosis. Skin of color patients had significantly longer days between initial presentation to dermatology and final diagnosis vs non-SOC patients (180.11 and 60.27 days, respectively; P=.001). Skin of color patients had a higher rate of palmoplantar psoriasis and severe plaque psoriasis (ie, >10% body surface area involvement) at presentation.

Several multivariable regression analyses were performed. Skin of color patients had significantly higher odds of biopsy compared to non-SOC patients (adjusted odds ratio [95% CI]=4 [2.05-7.82]; P<.001)(Figure 1). There were no significant predictors for severe plaque psoriasis involving more than 10% body surface area. Skin of color patients had a significantly longer time to diagnosis than non-SOC patients (P=.006)(Figure 2). On average, patients with SOC waited 3.23 times longer for a diagnosis than their non-SOC counterparts (95% CI, 1.42-7.36).

Our data reveal striking racial disparities in psoriasis care. Worse outcomes for patients with SOC compared to non-SOC patients may result from physicians’ inadequate familiarity with diverse presentations of psoriasis, including more frequent involvement of special body sites in SOC. Other likely contributing factors that we did not evaluate include socioeconomic barriers to health care, lack of physician diversity, missed appointments, and a paucity of literature on the topic of differentiating morphologies of psoriasis in SOC and non-SOC patients. Our study did not examine the effects of sex, tobacco use, or prior or current therapy, and it excluded pediatric patients.

To improve dermatologic outcomes for our increasingly diverse patient population, more studies must be undertaken to elucidate and document disparities in care for SOC populations.

Individuals of nonwhite race/ethnicity are underrepresented in cosmetic clinical trials. Individuals of nonwhite race/ethnicity are not underrepresented in cosmetic clinical trials, according to a recent literature review. The explanation for those contradictory conclusions comes down to money, or, more specifically, the source of the money.

Among the cosmetic studies funded by industry, non-Whites represented about 25% of the patient populations. That proportion, however, rose to 62% for studies that were funded by universities/governments or had no funding source reported, Lisa Akintilo, MD, and associates said in their review.

“Lack of inclusion of diverse patient populations is both a medical and moral issue as conclusions of such homogeneous studies may not be generalizable. In the realm of cosmetic dermatology, diverse research cohorts are needed to identify potential disparities in therapies for cosmetic concerns and fully investigate effective treatments for all,” wrote Dr. Akintilo of New York University and coauthors.

Data from the U.S. Census show that non-Hispanic Whites made up 60% of the population in 2019, with that proportion falling to about 50% by 2045, the investigators noted. A report from the American Society of Plastic Surgeons showed that about 34% of cosmetic patients identified as skin of color in 2020.

The availability of data was an issue in the review of the literature from 1990 to 2020, as 55% of the 318 randomized controlled trials that were reviewed did not include any information on racial/ethnic diversity and the other 143 studies offered only enough to determine White/non-White status, they explained.

That limitation meant that those 143 studies had to form the basis of the funding analysis, which also indicated that the studies with funding outside of industry were significantly more likely (odds ratio, 7.8) to have more than 50% non-White participants, compared with the industry-funded trials. The projects with industry backing, however, had a larger mean sample size than did those without: 139 vs. 81, Dr. Akintilo and associates said.

“The protocols of cosmetic trials should be questioned, as many target Caucasian‐centric treatment goals that may not be in alignment with the goals of skin of color patients,” they wrote. “It is important for cosmetic providers to recognize the well-established anatomical variations between different races and ethnicities and how they can inform desired cosmetic procedures.”

The investigators said that they had no conflicts of interest.

[email protected]

Individuals of nonwhite race/ethnicity are underrepresented in cosmetic clinical trials. Individuals of nonwhite race/ethnicity are not underrepresented in cosmetic clinical trials, according to a recent literature review. The explanation for those contradictory conclusions comes down to money, or, more specifically, the source of the money.

Among the cosmetic studies funded by industry, non-Whites represented about 25% of the patient populations. That proportion, however, rose to 62% for studies that were funded by universities/governments or had no funding source reported, Lisa Akintilo, MD, and associates said in their review.

“Lack of inclusion of diverse patient populations is both a medical and moral issue as conclusions of such homogeneous studies may not be generalizable. In the realm of cosmetic dermatology, diverse research cohorts are needed to identify potential disparities in therapies for cosmetic concerns and fully investigate effective treatments for all,” wrote Dr. Akintilo of New York University and coauthors.

Data from the U.S. Census show that non-Hispanic Whites made up 60% of the population in 2019, with that proportion falling to about 50% by 2045, the investigators noted. A report from the American Society of Plastic Surgeons showed that about 34% of cosmetic patients identified as skin of color in 2020.

The availability of data was an issue in the review of the literature from 1990 to 2020, as 55% of the 318 randomized controlled trials that were reviewed did not include any information on racial/ethnic diversity and the other 143 studies offered only enough to determine White/non-White status, they explained.

That limitation meant that those 143 studies had to form the basis of the funding analysis, which also indicated that the studies with funding outside of industry were significantly more likely (odds ratio, 7.8) to have more than 50% non-White participants, compared with the industry-funded trials. The projects with industry backing, however, had a larger mean sample size than did those without: 139 vs. 81, Dr. Akintilo and associates said.

“The protocols of cosmetic trials should be questioned, as many target Caucasian‐centric treatment goals that may not be in alignment with the goals of skin of color patients,” they wrote. “It is important for cosmetic providers to recognize the well-established anatomical variations between different races and ethnicities and how they can inform desired cosmetic procedures.”

The investigators said that they had no conflicts of interest.

[email protected]

Individuals of nonwhite race/ethnicity are underrepresented in cosmetic clinical trials. Individuals of nonwhite race/ethnicity are not underrepresented in cosmetic clinical trials, according to a recent literature review. The explanation for those contradictory conclusions comes down to money, or, more specifically, the source of the money.

Among the cosmetic studies funded by industry, non-Whites represented about 25% of the patient populations. That proportion, however, rose to 62% for studies that were funded by universities/governments or had no funding source reported, Lisa Akintilo, MD, and associates said in their review.

“Lack of inclusion of diverse patient populations is both a medical and moral issue as conclusions of such homogeneous studies may not be generalizable. In the realm of cosmetic dermatology, diverse research cohorts are needed to identify potential disparities in therapies for cosmetic concerns and fully investigate effective treatments for all,” wrote Dr. Akintilo of New York University and coauthors.

Data from the U.S. Census show that non-Hispanic Whites made up 60% of the population in 2019, with that proportion falling to about 50% by 2045, the investigators noted. A report from the American Society of Plastic Surgeons showed that about 34% of cosmetic patients identified as skin of color in 2020.

The availability of data was an issue in the review of the literature from 1990 to 2020, as 55% of the 318 randomized controlled trials that were reviewed did not include any information on racial/ethnic diversity and the other 143 studies offered only enough to determine White/non-White status, they explained.

That limitation meant that those 143 studies had to form the basis of the funding analysis, which also indicated that the studies with funding outside of industry were significantly more likely (odds ratio, 7.8) to have more than 50% non-White participants, compared with the industry-funded trials. The projects with industry backing, however, had a larger mean sample size than did those without: 139 vs. 81, Dr. Akintilo and associates said.

“The protocols of cosmetic trials should be questioned, as many target Caucasian‐centric treatment goals that may not be in alignment with the goals of skin of color patients,” they wrote. “It is important for cosmetic providers to recognize the well-established anatomical variations between different races and ethnicities and how they can inform desired cosmetic procedures.”

The investigators said that they had no conflicts of interest.

[email protected]

Dermatology is one of the least diverse medical specialties with only 3% of dermatologists being Black and 4% Latinx.¹ Leading dermatology organizations have called for specialty-wide efforts to improve diversity, with a particular focus on the resident selection process.^2,3 Medical students who are underrepresented in medicine (UIM)(ie, those who identify as Black, Latinx, Native American, or Pacific Islander) face many potential barriers in applying to dermatology programs, including financial limitations, lack of support and mentorship, and less exposure to the specialty.^1,2,4 The COVID-19 pandemic introduced additional challenges in the residency application process with limitations on clinical, research, and volunteer experiences; decreased opportunities for in-person mentorship and away rotations; and a shift to virtual recruitment. Although there has been increased emphasis on recruiting diverse candidates to dermatology, the COVID-19 pandemic may have exacerbated existing barriers for UIM applicants.

We surveyed dermatology residency program directors (PDs) and applicants to evaluate how UIM students approach and fare in the dermatology residency application process as well as the effects of COVID-19 on the most recent application cycle. Herein, we report the results of our surveys with a focus on racial differences in the application process.

Methods

We administered 2 anonymous online surveys—one to 115 PDs through the Association of Professors of Dermatology (APD) email listserve and another to applicants who participated in the 2020-2021 dermatology residency application cycle through the Dermatology Interest Group Association (DIGA) listserve. The surveys were distributed from March 29 through May 23, 2021. There was no way to determine the number of dermatology applicants on the DIGA listserve. The surveys were reviewed and approved by the University of Southern California (Los Angeles, California) institutional review board (approval #UP-21-00118).

Participants were not required to answer every survey question; response rates varied by question. Survey responses with less than 10% completion were excluded from analysis. Data were collected, analyzed, and stored using Qualtrics, a secure online survey platform. The test of equal or given proportions in R studio was used to determine statistically significant differences between variables (P<.05 indicated statistical significance).

Results

The PD survey received 79 complete responses (83.5% complete responses, 73.8% response rate) and the applicant survey received 232 complete responses (83.6% complete responses).

Applicant Characteristics—Applicant characteristics are provided in the eTable; 13.2% and 8.4% of participants were Black and Latinx (including those who identify as Hispanic/Latino), respectively. Only 0.8% of respondents identified as American Indian or Alaskan Native and were excluded from the analysis due to the limited sample size. Those who identified as White, Asian, multiple races, or other and those who preferred not to answer were considered non-UIM participants.

Differences in family background were observed in our cohort, with UIM candidates more likely to have experienced disadvantages, defined as being the first in their family to attend college/graduate school, growing up in a rural area, being a first-generation immigrant, or qualifying as low income. Underrepresented in medicine applicants also were less likely to have a dermatology program at their medical school (both Black and Latinx) and to have been elected to honor societies such as Alpha Omega Alpha and the Gold Humanism Honor Society (Black only).

Underrepresented in medicine applicants were more likely to complete a research gap year (eTable). Most applicants who took research years did so to improve their chances of matching, regardless of their race/ethnicity. For those who did not complete a research year, Black applicants (46.7%) were more likely to base that decision on financial limitations compared to non-UIMs (18.6%, P<.0001). Interestingly, in the PD survey, only 4.5% of respondents considered completion of a research year extremely or very important when compiling rank lists.

Application Process and Match Outcomes—The Table highlights differences in how UIM applicants approached the application process. Black but not Latinx applicants were less likely to be first-time applicants to dermatology compared to non-UIM applicants. Black applicants (8.3%) were significantly less likely to apply to more than 100 programs compared to non-UIM applicants (29.5%, P=.0002). Underrepresented in medicine applicants received greater numbers of interviews despite applying to fewer programs overall.

There also were differences in how UIM candidates approached their rank lists, with Black and Latinx applicants prioritizing diversity of patient populations and program faculty as well as program missions and values (Figure).

In our cohort, UIM candidates were more likely than non-UIM to match, and Black applicants were most likely to match at one of their top 3 choices (Table). In the PD survey, 77.6% of PDs considered contribution to diversity an important factor when compiling their rank lists.

Comment

Applicant Background—Dermatology is a competitive specialty with a challenging application process² that has been further complicated by the COVID-19 pandemic. Our study elucidated how the 2020-2021 application cycle affected UIM dermatology applicants. Prior studies have found that UIM medical students were more likely to come from lower socioeconomic backgrounds; financial constraints pose a major barrier for UIM and low-income students interested in dermatology.^4-6 We found this to be true in our cohort, as Black and Latinx applicants were significantly more likely to come from disadvantaged backgrounds (P<.000008 and P=.006, respectively). Additionally, we found that Black applicants were more likely than any other group to indicate financial concerns as their primary reason for not taking a research gap year. 

Although most applicants who completed a research year did so to increase their chances of matching, a higher percentage of UIMs took research years compared to non-UIM applicants. This finding could indicate greater anxiety about matching among UIM applicants vs their non-UIM counterparts. Black students have faced discrimination in clinical grading,⁷ have perceived racial discrimination in residency interviews,^8,9 and have shown to be less likely to be elected to medical school honor societies.¹⁰ We found that UIM applicants were more likely to pursue a research year compared to other applicants,¹¹ possibly because they felt additional pressure to enhance their applications or because UIM candidates were less likely to have a home dermatology program. Expansion of mentorship programs, visiting student electives, and grants for UIMs may alleviate the need for these candidates to complete a research year and reduce disparities in the application process.

Factors Influencing Rank Lists for Applicants—In our cohort, UIMs were significantly more likely to rank diversity of patients (P<.0001 for Black applicants and P=.04 for Latinx applicants) and faculty (P<.001 for Black applicants and P<.001 for Latinx applicants) as important factors in choosing a residency program. Historically, dermatology has been disproportionately White in its physician workforce and patient population.^1,12 Students with lower incomes or who identify as minorities cite the lack of diversity in dermatology as a considerable barrier to pursuing a career in the specialty.^4,5 Service learning, pipeline programs aimed at early exposure to dermatology, and increased access to care for diverse patient populations are important measures to improve diversity in the dermatology workforce.^13-15 Residency programs should consider how to incorporate these aspects into didactic and clinical curricula to better recruit diverse candidates to the field.

Equity in the Application Process—We found that Black applicants were more likely than non-UIM applicants to be reapplicants to dermatology; however, Black applicants in our study also were more likely to receive more interview invites, match into dermatology, and match into one of their top 3 programs. These findings are interesting, particularly given concerns about equity in the application process. It is possible that Black applicants who overcome barriers to applying to dermatology ultimately are more successful applicants. Recently, there has been an increased focus in the field on diversifying dermatology, which was further intensified last year.^2,3 Indicative of this shift, our PD survey showed that most programs reported that applicants’ contributions to diversity were important factors in the application process. Additionally, an emphasis by PDs on a holistic review of applications coupled with direct advocacy for increased representation may have contributed to the increased match rates for UIM applicants reported in our survey.

Latinx Applicants—Our study showed differences in how Latinx candidates fared in the application process; although Latinx applicants were more likely than their non-Latinx counterparts to match into dermatology, they were less likely than non-Latinx applicants to match into one of their top 3 programs. Given that Latinx encompasses ethnicity, not race, there may be a difference in how intentional focus on and advocacy for increasing diversity in dermatology affected different UIM applicant groups. Both race and ethnicity are social constructs rather than scientific categorizations; thus, it is difficult in survey studies such as ours to capture the intersectionality present across and between groups. Lastly, it is possible that the respondents to our applicant survey are not representative of the full cohort of UIM applicants.

Study Limitations—A major limitation of our study was that we did not have a method of reaching all dermatology applicants. Although our study shows promising results suggestive of increased diversity in the last application cycle, release of the National Resident Matching Program results from 2020-2021 with racially stratified data will be imperative to assess equity in the match process for all specialties and to confirm the generalizability of our results.

Dermatology is one of the least diverse medical specialties with only 3% of dermatologists being Black and 4% Latinx.¹ Leading dermatology organizations have called for specialty-wide efforts to improve diversity, with a particular focus on the resident selection process.^2,3 Medical students who are underrepresented in medicine (UIM)(ie, those who identify as Black, Latinx, Native American, or Pacific Islander) face many potential barriers in applying to dermatology programs, including financial limitations, lack of support and mentorship, and less exposure to the specialty.^1,2,4 The COVID-19 pandemic introduced additional challenges in the residency application process with limitations on clinical, research, and volunteer experiences; decreased opportunities for in-person mentorship and away rotations; and a shift to virtual recruitment. Although there has been increased emphasis on recruiting diverse candidates to dermatology, the COVID-19 pandemic may have exacerbated existing barriers for UIM applicants.

We surveyed dermatology residency program directors (PDs) and applicants to evaluate how UIM students approach and fare in the dermatology residency application process as well as the effects of COVID-19 on the most recent application cycle. Herein, we report the results of our surveys with a focus on racial differences in the application process.

Methods

We administered 2 anonymous online surveys—one to 115 PDs through the Association of Professors of Dermatology (APD) email listserve and another to applicants who participated in the 2020-2021 dermatology residency application cycle through the Dermatology Interest Group Association (DIGA) listserve. The surveys were distributed from March 29 through May 23, 2021. There was no way to determine the number of dermatology applicants on the DIGA listserve. The surveys were reviewed and approved by the University of Southern California (Los Angeles, California) institutional review board (approval #UP-21-00118).

Participants were not required to answer every survey question; response rates varied by question. Survey responses with less than 10% completion were excluded from analysis. Data were collected, analyzed, and stored using Qualtrics, a secure online survey platform. The test of equal or given proportions in R studio was used to determine statistically significant differences between variables (P<.05 indicated statistical significance).

Results

The PD survey received 79 complete responses (83.5% complete responses, 73.8% response rate) and the applicant survey received 232 complete responses (83.6% complete responses).

Applicant Characteristics—Applicant characteristics are provided in the eTable; 13.2% and 8.4% of participants were Black and Latinx (including those who identify as Hispanic/Latino), respectively. Only 0.8% of respondents identified as American Indian or Alaskan Native and were excluded from the analysis due to the limited sample size. Those who identified as White, Asian, multiple races, or other and those who preferred not to answer were considered non-UIM participants.

Differences in family background were observed in our cohort, with UIM candidates more likely to have experienced disadvantages, defined as being the first in their family to attend college/graduate school, growing up in a rural area, being a first-generation immigrant, or qualifying as low income. Underrepresented in medicine applicants also were less likely to have a dermatology program at their medical school (both Black and Latinx) and to have been elected to honor societies such as Alpha Omega Alpha and the Gold Humanism Honor Society (Black only).

Underrepresented in medicine applicants were more likely to complete a research gap year (eTable). Most applicants who took research years did so to improve their chances of matching, regardless of their race/ethnicity. For those who did not complete a research year, Black applicants (46.7%) were more likely to base that decision on financial limitations compared to non-UIMs (18.6%, P<.0001). Interestingly, in the PD survey, only 4.5% of respondents considered completion of a research year extremely or very important when compiling rank lists.

Application Process and Match Outcomes—The Table highlights differences in how UIM applicants approached the application process. Black but not Latinx applicants were less likely to be first-time applicants to dermatology compared to non-UIM applicants. Black applicants (8.3%) were significantly less likely to apply to more than 100 programs compared to non-UIM applicants (29.5%, P=.0002). Underrepresented in medicine applicants received greater numbers of interviews despite applying to fewer programs overall.

There also were differences in how UIM candidates approached their rank lists, with Black and Latinx applicants prioritizing diversity of patient populations and program faculty as well as program missions and values (Figure).

In our cohort, UIM candidates were more likely than non-UIM to match, and Black applicants were most likely to match at one of their top 3 choices (Table). In the PD survey, 77.6% of PDs considered contribution to diversity an important factor when compiling their rank lists.

Comment

Applicant Background—Dermatology is a competitive specialty with a challenging application process² that has been further complicated by the COVID-19 pandemic. Our study elucidated how the 2020-2021 application cycle affected UIM dermatology applicants. Prior studies have found that UIM medical students were more likely to come from lower socioeconomic backgrounds; financial constraints pose a major barrier for UIM and low-income students interested in dermatology.^4-6 We found this to be true in our cohort, as Black and Latinx applicants were significantly more likely to come from disadvantaged backgrounds (P<.000008 and P=.006, respectively). Additionally, we found that Black applicants were more likely than any other group to indicate financial concerns as their primary reason for not taking a research gap year. 

Although most applicants who completed a research year did so to increase their chances of matching, a higher percentage of UIMs took research years compared to non-UIM applicants. This finding could indicate greater anxiety about matching among UIM applicants vs their non-UIM counterparts. Black students have faced discrimination in clinical grading,⁷ have perceived racial discrimination in residency interviews,^8,9 and have shown to be less likely to be elected to medical school honor societies.¹⁰ We found that UIM applicants were more likely to pursue a research year compared to other applicants,¹¹ possibly because they felt additional pressure to enhance their applications or because UIM candidates were less likely to have a home dermatology program. Expansion of mentorship programs, visiting student electives, and grants for UIMs may alleviate the need for these candidates to complete a research year and reduce disparities in the application process.

Factors Influencing Rank Lists for Applicants—In our cohort, UIMs were significantly more likely to rank diversity of patients (P<.0001 for Black applicants and P=.04 for Latinx applicants) and faculty (P<.001 for Black applicants and P<.001 for Latinx applicants) as important factors in choosing a residency program. Historically, dermatology has been disproportionately White in its physician workforce and patient population.^1,12 Students with lower incomes or who identify as minorities cite the lack of diversity in dermatology as a considerable barrier to pursuing a career in the specialty.^4,5 Service learning, pipeline programs aimed at early exposure to dermatology, and increased access to care for diverse patient populations are important measures to improve diversity in the dermatology workforce.^13-15 Residency programs should consider how to incorporate these aspects into didactic and clinical curricula to better recruit diverse candidates to the field.

Equity in the Application Process—We found that Black applicants were more likely than non-UIM applicants to be reapplicants to dermatology; however, Black applicants in our study also were more likely to receive more interview invites, match into dermatology, and match into one of their top 3 programs. These findings are interesting, particularly given concerns about equity in the application process. It is possible that Black applicants who overcome barriers to applying to dermatology ultimately are more successful applicants. Recently, there has been an increased focus in the field on diversifying dermatology, which was further intensified last year.^2,3 Indicative of this shift, our PD survey showed that most programs reported that applicants’ contributions to diversity were important factors in the application process. Additionally, an emphasis by PDs on a holistic review of applications coupled with direct advocacy for increased representation may have contributed to the increased match rates for UIM applicants reported in our survey.

Latinx Applicants—Our study showed differences in how Latinx candidates fared in the application process; although Latinx applicants were more likely than their non-Latinx counterparts to match into dermatology, they were less likely than non-Latinx applicants to match into one of their top 3 programs. Given that Latinx encompasses ethnicity, not race, there may be a difference in how intentional focus on and advocacy for increasing diversity in dermatology affected different UIM applicant groups. Both race and ethnicity are social constructs rather than scientific categorizations; thus, it is difficult in survey studies such as ours to capture the intersectionality present across and between groups. Lastly, it is possible that the respondents to our applicant survey are not representative of the full cohort of UIM applicants.

Study Limitations—A major limitation of our study was that we did not have a method of reaching all dermatology applicants. Although our study shows promising results suggestive of increased diversity in the last application cycle, release of the National Resident Matching Program results from 2020-2021 with racially stratified data will be imperative to assess equity in the match process for all specialties and to confirm the generalizability of our results.

Dermatology is one of the least diverse medical specialties with only 3% of dermatologists being Black and 4% Latinx.¹ Leading dermatology organizations have called for specialty-wide efforts to improve diversity, with a particular focus on the resident selection process.^2,3 Medical students who are underrepresented in medicine (UIM)(ie, those who identify as Black, Latinx, Native American, or Pacific Islander) face many potential barriers in applying to dermatology programs, including financial limitations, lack of support and mentorship, and less exposure to the specialty.^1,2,4 The COVID-19 pandemic introduced additional challenges in the residency application process with limitations on clinical, research, and volunteer experiences; decreased opportunities for in-person mentorship and away rotations; and a shift to virtual recruitment. Although there has been increased emphasis on recruiting diverse candidates to dermatology, the COVID-19 pandemic may have exacerbated existing barriers for UIM applicants.

We surveyed dermatology residency program directors (PDs) and applicants to evaluate how UIM students approach and fare in the dermatology residency application process as well as the effects of COVID-19 on the most recent application cycle. Herein, we report the results of our surveys with a focus on racial differences in the application process.

Methods

We administered 2 anonymous online surveys—one to 115 PDs through the Association of Professors of Dermatology (APD) email listserve and another to applicants who participated in the 2020-2021 dermatology residency application cycle through the Dermatology Interest Group Association (DIGA) listserve. The surveys were distributed from March 29 through May 23, 2021. There was no way to determine the number of dermatology applicants on the DIGA listserve. The surveys were reviewed and approved by the University of Southern California (Los Angeles, California) institutional review board (approval #UP-21-00118).

Participants were not required to answer every survey question; response rates varied by question. Survey responses with less than 10% completion were excluded from analysis. Data were collected, analyzed, and stored using Qualtrics, a secure online survey platform. The test of equal or given proportions in R studio was used to determine statistically significant differences between variables (P<.05 indicated statistical significance).

Results

The PD survey received 79 complete responses (83.5% complete responses, 73.8% response rate) and the applicant survey received 232 complete responses (83.6% complete responses).

Applicant Characteristics—Applicant characteristics are provided in the eTable; 13.2% and 8.4% of participants were Black and Latinx (including those who identify as Hispanic/Latino), respectively. Only 0.8% of respondents identified as American Indian or Alaskan Native and were excluded from the analysis due to the limited sample size. Those who identified as White, Asian, multiple races, or other and those who preferred not to answer were considered non-UIM participants.

Differences in family background were observed in our cohort, with UIM candidates more likely to have experienced disadvantages, defined as being the first in their family to attend college/graduate school, growing up in a rural area, being a first-generation immigrant, or qualifying as low income. Underrepresented in medicine applicants also were less likely to have a dermatology program at their medical school (both Black and Latinx) and to have been elected to honor societies such as Alpha Omega Alpha and the Gold Humanism Honor Society (Black only).

Underrepresented in medicine applicants were more likely to complete a research gap year (eTable). Most applicants who took research years did so to improve their chances of matching, regardless of their race/ethnicity. For those who did not complete a research year, Black applicants (46.7%) were more likely to base that decision on financial limitations compared to non-UIMs (18.6%, P<.0001). Interestingly, in the PD survey, only 4.5% of respondents considered completion of a research year extremely or very important when compiling rank lists.

Application Process and Match Outcomes—The Table highlights differences in how UIM applicants approached the application process. Black but not Latinx applicants were less likely to be first-time applicants to dermatology compared to non-UIM applicants. Black applicants (8.3%) were significantly less likely to apply to more than 100 programs compared to non-UIM applicants (29.5%, P=.0002). Underrepresented in medicine applicants received greater numbers of interviews despite applying to fewer programs overall.

There also were differences in how UIM candidates approached their rank lists, with Black and Latinx applicants prioritizing diversity of patient populations and program faculty as well as program missions and values (Figure).

In our cohort, UIM candidates were more likely than non-UIM to match, and Black applicants were most likely to match at one of their top 3 choices (Table). In the PD survey, 77.6% of PDs considered contribution to diversity an important factor when compiling their rank lists.

Comment

Applicant Background—Dermatology is a competitive specialty with a challenging application process² that has been further complicated by the COVID-19 pandemic. Our study elucidated how the 2020-2021 application cycle affected UIM dermatology applicants. Prior studies have found that UIM medical students were more likely to come from lower socioeconomic backgrounds; financial constraints pose a major barrier for UIM and low-income students interested in dermatology.^4-6 We found this to be true in our cohort, as Black and Latinx applicants were significantly more likely to come from disadvantaged backgrounds (P<.000008 and P=.006, respectively). Additionally, we found that Black applicants were more likely than any other group to indicate financial concerns as their primary reason for not taking a research gap year. 

Although most applicants who completed a research year did so to increase their chances of matching, a higher percentage of UIMs took research years compared to non-UIM applicants. This finding could indicate greater anxiety about matching among UIM applicants vs their non-UIM counterparts. Black students have faced discrimination in clinical grading,⁷ have perceived racial discrimination in residency interviews,^8,9 and have shown to be less likely to be elected to medical school honor societies.¹⁰ We found that UIM applicants were more likely to pursue a research year compared to other applicants,¹¹ possibly because they felt additional pressure to enhance their applications or because UIM candidates were less likely to have a home dermatology program. Expansion of mentorship programs, visiting student electives, and grants for UIMs may alleviate the need for these candidates to complete a research year and reduce disparities in the application process.

Factors Influencing Rank Lists for Applicants—In our cohort, UIMs were significantly more likely to rank diversity of patients (P<.0001 for Black applicants and P=.04 for Latinx applicants) and faculty (P<.001 for Black applicants and P<.001 for Latinx applicants) as important factors in choosing a residency program. Historically, dermatology has been disproportionately White in its physician workforce and patient population.^1,12 Students with lower incomes or who identify as minorities cite the lack of diversity in dermatology as a considerable barrier to pursuing a career in the specialty.^4,5 Service learning, pipeline programs aimed at early exposure to dermatology, and increased access to care for diverse patient populations are important measures to improve diversity in the dermatology workforce.^13-15 Residency programs should consider how to incorporate these aspects into didactic and clinical curricula to better recruit diverse candidates to the field.

Equity in the Application Process—We found that Black applicants were more likely than non-UIM applicants to be reapplicants to dermatology; however, Black applicants in our study also were more likely to receive more interview invites, match into dermatology, and match into one of their top 3 programs. These findings are interesting, particularly given concerns about equity in the application process. It is possible that Black applicants who overcome barriers to applying to dermatology ultimately are more successful applicants. Recently, there has been an increased focus in the field on diversifying dermatology, which was further intensified last year.^2,3 Indicative of this shift, our PD survey showed that most programs reported that applicants’ contributions to diversity were important factors in the application process. Additionally, an emphasis by PDs on a holistic review of applications coupled with direct advocacy for increased representation may have contributed to the increased match rates for UIM applicants reported in our survey.

Latinx Applicants—Our study showed differences in how Latinx candidates fared in the application process; although Latinx applicants were more likely than their non-Latinx counterparts to match into dermatology, they were less likely than non-Latinx applicants to match into one of their top 3 programs. Given that Latinx encompasses ethnicity, not race, there may be a difference in how intentional focus on and advocacy for increasing diversity in dermatology affected different UIM applicant groups. Both race and ethnicity are social constructs rather than scientific categorizations; thus, it is difficult in survey studies such as ours to capture the intersectionality present across and between groups. Lastly, it is possible that the respondents to our applicant survey are not representative of the full cohort of UIM applicants.

Study Limitations—A major limitation of our study was that we did not have a method of reaching all dermatology applicants. Although our study shows promising results suggestive of increased diversity in the last application cycle, release of the National Resident Matching Program results from 2020-2021 with racially stratified data will be imperative to assess equity in the match process for all specialties and to confirm the generalizability of our results.

The Diagnosis: Syringoma

Syringomas are benign adnexal tumors with distinct histopathologic features, including the characteristic comma- or tadpole-shaped tail comprised of dilated cystic eccrine ducts. Clinically, syringomas typically present predominantly in the periorbital region in adolescent girls. They may present as solitary or multiple lesions, and sites such as the genital area, palms, scalp, and chest rarely can be involved.¹ Eruptive syringoma is a clinical subtype of syringoma that is seen on the face, neck, chest, and axillae that predominantly occurs in females with skin of color in countries such as Asia and Africa before or during puberty.^2,3 Lesions appear as small, flesh-colored or slightly pigmented, flat-topped papules.³ The condition can be cosmetically disfiguring and difficult to treat, especially in patients with darker skin.

In our patient, dermoscopic evaluation revealed reticular light brown lines, structureless light brown areas, clustered brown dots, globules, and reticular vessels on a faint background (Figure 1A). Glittering yellow-whitish round structures over a fading pink-brown background also were seen at some sites (Figure 1B). Histologic examination of a neck lesion revealed an epidermis with focal acanthosis; the upper dermis had tumor islands and ducts with cells with round to vesicular nuclei and eosinophilic cytoplasm. A well-circumscribed tumor in the dermis composed of tubules of varying sizes lined by cuboidal cells was seen, consistent with syringoma (Figure 2).

Dermoscopic features of syringomas have not been widely studied. Hayashi et al⁴ reported the dermoscopic features of unilateral linear syringomas as a delicate and faint reticular pigmentation network and multiple hypopigmented areas. Sakiyama et al⁵ also defined an incomplete pigment network with faint erythema in 2 eruptive syringoma cases.

Treatment of this condition is for cosmetic reasons only, and there are no reports of long-term morbidity associated with the disease.^6,7 Multiple therapeutic options are available but are associated with complications such as hyperpigmentation and sclerosis in patients with skin of color due to the dermal location of these syringomas. Management of syringomas includes topical and surgical methods, including topical retinoids such as tretinoin and atropine solution 1%; surgical methods include dermabrasion, excision, cryotherapy, electrocautery, electrofulguration, laser therapy, and chemical cautery. However, there is a substantial risk for recurrence with these treatment options. In a case series of 5 patients with periorbital syringomas, treatment using radiofrequency and a CO₂ laser was performed with favorable outcomes, highlighting the use of combination therapies for treatment.8 Seo et al⁹ reported a retrospective case series of 92 patients with periorbital syringomas in which they treated one group with CO₂ laser and the other with botulinum toxin A injection; CO₂ laser combined with botulinum toxin A showed a greater effect than laser treatment alone. The differential diagnosis includes pigmented plane warts, sebaceous hyperplasia, eruptive xanthomas, and hidrocystomas. Pigmented plane warts characteristically present as flat-topped papules with small hemorrhagic dots or tiny pinpoint vessels on dermoscopy. In sebaceous hyperplasia, yellowish umbilicated papular lesions are seen with crown vessels on dermoscopy. Eruptive xanthomas usually are erythematous to yellow, dome-shaped papules that appear mainly over the extensor aspects of the extremities. Hidrocystoma presents as a solitary translucent larger syringomalike lesion commonly seen in the periorbital region and/or on the cheeks.

We report a case of widespread syringomas with multiple close mimickers such as pigmented plane warts; however, dermoscopy of the lesions helped to arrive at the diagnosis. Dermatologists should be aware of this condition and its benign nature to ensure correct diagnosis and appropriate treatment.

The Diagnosis: Syringoma

Syringomas are benign adnexal tumors with distinct histopathologic features, including the characteristic comma- or tadpole-shaped tail comprised of dilated cystic eccrine ducts. Clinically, syringomas typically present predominantly in the periorbital region in adolescent girls. They may present as solitary or multiple lesions, and sites such as the genital area, palms, scalp, and chest rarely can be involved.¹ Eruptive syringoma is a clinical subtype of syringoma that is seen on the face, neck, chest, and axillae that predominantly occurs in females with skin of color in countries such as Asia and Africa before or during puberty.^2,3 Lesions appear as small, flesh-colored or slightly pigmented, flat-topped papules.³ The condition can be cosmetically disfiguring and difficult to treat, especially in patients with darker skin.

In our patient, dermoscopic evaluation revealed reticular light brown lines, structureless light brown areas, clustered brown dots, globules, and reticular vessels on a faint background (Figure 1A). Glittering yellow-whitish round structures over a fading pink-brown background also were seen at some sites (Figure 1B). Histologic examination of a neck lesion revealed an epidermis with focal acanthosis; the upper dermis had tumor islands and ducts with cells with round to vesicular nuclei and eosinophilic cytoplasm. A well-circumscribed tumor in the dermis composed of tubules of varying sizes lined by cuboidal cells was seen, consistent with syringoma (Figure 2).

Dermoscopic features of syringomas have not been widely studied. Hayashi et al⁴ reported the dermoscopic features of unilateral linear syringomas as a delicate and faint reticular pigmentation network and multiple hypopigmented areas. Sakiyama et al⁵ also defined an incomplete pigment network with faint erythema in 2 eruptive syringoma cases.

Treatment of this condition is for cosmetic reasons only, and there are no reports of long-term morbidity associated with the disease.^6,7 Multiple therapeutic options are available but are associated with complications such as hyperpigmentation and sclerosis in patients with skin of color due to the dermal location of these syringomas. Management of syringomas includes topical and surgical methods, including topical retinoids such as tretinoin and atropine solution 1%; surgical methods include dermabrasion, excision, cryotherapy, electrocautery, electrofulguration, laser therapy, and chemical cautery. However, there is a substantial risk for recurrence with these treatment options. In a case series of 5 patients with periorbital syringomas, treatment using radiofrequency and a CO₂ laser was performed with favorable outcomes, highlighting the use of combination therapies for treatment.8 Seo et al⁹ reported a retrospective case series of 92 patients with periorbital syringomas in which they treated one group with CO₂ laser and the other with botulinum toxin A injection; CO₂ laser combined with botulinum toxin A showed a greater effect than laser treatment alone. The differential diagnosis includes pigmented plane warts, sebaceous hyperplasia, eruptive xanthomas, and hidrocystomas. Pigmented plane warts characteristically present as flat-topped papules with small hemorrhagic dots or tiny pinpoint vessels on dermoscopy. In sebaceous hyperplasia, yellowish umbilicated papular lesions are seen with crown vessels on dermoscopy. Eruptive xanthomas usually are erythematous to yellow, dome-shaped papules that appear mainly over the extensor aspects of the extremities. Hidrocystoma presents as a solitary translucent larger syringomalike lesion commonly seen in the periorbital region and/or on the cheeks.

We report a case of widespread syringomas with multiple close mimickers such as pigmented plane warts; however, dermoscopy of the lesions helped to arrive at the diagnosis. Dermatologists should be aware of this condition and its benign nature to ensure correct diagnosis and appropriate treatment.

The Diagnosis: Syringoma

Syringomas are benign adnexal tumors with distinct histopathologic features, including the characteristic comma- or tadpole-shaped tail comprised of dilated cystic eccrine ducts. Clinically, syringomas typically present predominantly in the periorbital region in adolescent girls. They may present as solitary or multiple lesions, and sites such as the genital area, palms, scalp, and chest rarely can be involved.¹ Eruptive syringoma is a clinical subtype of syringoma that is seen on the face, neck, chest, and axillae that predominantly occurs in females with skin of color in countries such as Asia and Africa before or during puberty.^2,3 Lesions appear as small, flesh-colored or slightly pigmented, flat-topped papules.³ The condition can be cosmetically disfiguring and difficult to treat, especially in patients with darker skin.

In our patient, dermoscopic evaluation revealed reticular light brown lines, structureless light brown areas, clustered brown dots, globules, and reticular vessels on a faint background (Figure 1A). Glittering yellow-whitish round structures over a fading pink-brown background also were seen at some sites (Figure 1B). Histologic examination of a neck lesion revealed an epidermis with focal acanthosis; the upper dermis had tumor islands and ducts with cells with round to vesicular nuclei and eosinophilic cytoplasm. A well-circumscribed tumor in the dermis composed of tubules of varying sizes lined by cuboidal cells was seen, consistent with syringoma (Figure 2).

Dermoscopic features of syringomas have not been widely studied. Hayashi et al⁴ reported the dermoscopic features of unilateral linear syringomas as a delicate and faint reticular pigmentation network and multiple hypopigmented areas. Sakiyama et al⁵ also defined an incomplete pigment network with faint erythema in 2 eruptive syringoma cases.

Treatment of this condition is for cosmetic reasons only, and there are no reports of long-term morbidity associated with the disease.^6,7 Multiple therapeutic options are available but are associated with complications such as hyperpigmentation and sclerosis in patients with skin of color due to the dermal location of these syringomas. Management of syringomas includes topical and surgical methods, including topical retinoids such as tretinoin and atropine solution 1%; surgical methods include dermabrasion, excision, cryotherapy, electrocautery, electrofulguration, laser therapy, and chemical cautery. However, there is a substantial risk for recurrence with these treatment options. In a case series of 5 patients with periorbital syringomas, treatment using radiofrequency and a CO₂ laser was performed with favorable outcomes, highlighting the use of combination therapies for treatment.8 Seo et al⁹ reported a retrospective case series of 92 patients with periorbital syringomas in which they treated one group with CO₂ laser and the other with botulinum toxin A injection; CO₂ laser combined with botulinum toxin A showed a greater effect than laser treatment alone. The differential diagnosis includes pigmented plane warts, sebaceous hyperplasia, eruptive xanthomas, and hidrocystomas. Pigmented plane warts characteristically present as flat-topped papules with small hemorrhagic dots or tiny pinpoint vessels on dermoscopy. In sebaceous hyperplasia, yellowish umbilicated papular lesions are seen with crown vessels on dermoscopy. Eruptive xanthomas usually are erythematous to yellow, dome-shaped papules that appear mainly over the extensor aspects of the extremities. Hidrocystoma presents as a solitary translucent larger syringomalike lesion commonly seen in the periorbital region and/or on the cheeks.

We report a case of widespread syringomas with multiple close mimickers such as pigmented plane warts; however, dermoscopy of the lesions helped to arrive at the diagnosis. Dermatologists should be aware of this condition and its benign nature to ensure correct diagnosis and appropriate treatment.