Sex Representation Among United States Residency Programs from 2011-2021

Abstract Background: Despite increased female representation in medicine, disparities persist. Female physicians face barriers including sex-based discrimination and wage gaps. It is unclear if efforts to recruit more female physicians into male-dominated specialties have been successful. Methods: This is an observational study to assess trends in female representation among United States allopathic residency programs from 2011–2021. Data were extracted from the American College of Graduate Medical Education database and subdivided into surgical and nonsurgical specialties. Trends in self-reported sex were analyzed. A representation quotient was calculated, reflecting the ratio of a subgroup of residents relative to the same subgroup in the United States population. Results: 1,174,615 residents completed the survey from 2011–2021. The proportion of female surgical residents increased (41.4% vs 46.4%, p < 0.0001), with a corollary uptrend in RQ (p < 0.0001). The proportion of female nonsurgical residents decreased (48.8% vs 47.7%, p = 0.0002), with a decrease in RQ (p = 0.015). Female surgical residents were underrepresented in 10 specialties and overrepresented in one (OBGYN). Female nonsurgical residents were underrepresented in eight specialties and overrepresented in six, with two specialties nearing equal representation. The proportion of female residents increased among ‘male-dominated’ surgical specialties, except for vascular surgery. Anesthesiology, a ‘male-dominated’ nonsurgical specialty, experienced decreased female representation. Conclusions: The proportion of female surgical residents increased from 2011–2021. Although female representation in male-dominated surgical specialties increased, discrepancies in representation among male-dominated nonsurgical specialties persist. Female residents remain underrepresented overall. It is paramount to advocate for women particularly in male-dominated specialties, as the future generation of physicians is majority-female.