Diversity in Emergency Medicine: Are We Supporting a Career Interest in Emergency Medicine for Everyone?

Study Objective: Women and students underrepresented in medicine are less likely to apply for residency in emergency medicine. The latter are from racial or ethnic populations that are underrepresented as physicians relative to the general population. The factors that result in lower application rates from women and groups underrepresented in medicine are inadequately described in the literature. This study's objective was to test whether female students and those underrepresented in medicine have lower interest in emergency medicine even after controlling for academic ability, student indebtedness, and common career values consistent with emergency medicine career interest.

Methods: Secondary data analyses were conducted on a cross section of all residency applicants from 2005 to 2010. Data sources included American Medical College Application Service, the Electronic Residency Application Service, and the Graduating Questionnaire. Data linkage was by the Association of American Medical Colleges and provided deidentified to the authors. A binary logistic regression model was fitted with the outcome variable planned career into emergency medicine versus another specialty on the Graduating Questionnaire. The binary logistic regression model independent variables included demographics, student attitudes, debt, grade point average, standardized tests, and medical school experiences.

Results: The binary logistic regression model included 17,067 individuals. Being a woman (odds ratio 0.75) and from a background underrepresented in medicine (odds ratio 0.68) independently correlated with lower emergency medicine interest. Age, medical debt, importance of work-life balance, confidence in specialty choice, and plan to care for underserved populations were positively associated with emergency medicine interest. Importance of specialty competitiveness and importance of mentorship advice were correlated with lower emergency medicine interest.

Conclusion: Female medical students and those underrepresented in medicine were less likely to plan for a career in emergency medicine. This correlation remained significant even when other previously identified factors that have predicted a career in emergency medicine were controlled for.