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Match rates in ophthalmology subspecialty fellowships were lower for applicants underrepresented in medicine, including Black and Hispanic candidates, according to a cohort study.

Using data from the 2021 San Francisco Match for 537 ophthalmology fellowship candidates, 55% of underrepresented applicants matched into programs compared with 72.2% of white and Asian applicants (P=0.007), reported Fasika Woreta, MD, MPH, of the Wilmer Eye Institute at Johns Hopkins University in Baltimore, and colleagues in .

A similar pattern was observed in application rates, with underrepresented applicants submitting a median of 10 compared with 21 for Asian applicants and 17 for white applicants (P=0.001). Likewise, underrepresented applicants had fewer interviews (median of 2) compared with 12 for Asian and 8 for white applicants (P=0.001), suggesting that "costs of applications and traveling for interviews may be a limiting factor for certain applicants," Woreta and team wrote.

Women and men had similar match rates (70.5% vs 69.2%, respectively, P=0.74). Of the subspecialties, men constituted the majority (68.9%) of applicants matched in retina, while women had the highest percentage of matches in pediatric ophthalmology (67.5%).

Meanwhile, underrepresented applicants made up 13.9% of the matched fellows in glaucoma, 10% in pediatric ophthalmology, 7.3% in cornea, and 6.6% in retina subspecialties.

"A diverse workforce has an impact on patient outcomes, as physicians from minoritized populations are more likely to care for minoritized, medically indigent, and sicker patients," the authors noted. "Moreover, physician-patient concordance in sex, gender, race, ethnicity, language, and culture has been shown to be associated with increased patient satisfaction and adherence to medical management."

Historically, ophthalmology has the second lowest number of , and the third-lowest proportion of underrepresented faculty at .

Furthermore, the proportion of female ophthalmology residents has been since 2011. "These trends are clearly discordant with the increasing proportion of females and [underrepresented] students graduating from U.S. medical schools and the changing racial and ethnic demographics of the U.S. population," Woreta and team pointed out.

In an , Jayanth Sridhar, MD, and Kara M. Cavuoto, MD, both of the Bascom Palmer Eye Institute in Miami, noted that although ophthalmology still has some catching up to do, representation of those underrepresented in medicine has improved, with the proportion matching into ophthalmology , when it reached 10.8%. However, increased practice consolidation and privatization may limit partnership opportunities for all young ophthalmologists, they added.

"The proverbial elephant in the room with the discussion surrounding diversity and inclusion in medicine is the recent " on June 29, to strike down affirmative action in the admissions process, which will have "upstream effects at the level of college and medical admissions," Sridhar and Cavuoto wrote.

For this study, Woreta and co-authors assessed data on 537 candidates who applied for an ophthalmology fellowship using the 2021 San Francisco Match; 42.6% were women, and 12.9% had an underrepresented status. Male and female applicants were comparable in terms of the country of medical school, Alpha Omega Alpha membership, median U.S. Medical Licensing Examination (USMLE) Step 1 score, median number of application submissions, and median interviews completed.

Women had a higher median USMLE Step 2 Clinical Knowledge score compared with men (248 vs 245, P=0.01), and underrepresented applicants -- also including Native Hawaiian, Native American, and multiracial individuals -- had lower median scores on the USMLE Step 1: 238 vs 246 for Asian applicants and 243 for white applicants (P=0.04).

Limitations acknowledged by the authors included the short-term, "snapshot in time" nature of the 1-year study, unavailability of data on oculoplastic and reconstructive surgery fellowships, and the lack of inclusion of some Asian groups in the definition of "underrepresented in medicine."

"These results may provide valuable information to fellowship programs and subspecialty societies that are striving to increase representation and diversity," Woreta and team concluded.

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