Asian American Representation in Medicine by Career Stage and Residency Specialty.

Abstract

Importance: Asian American individuals are not underrepresented in medicine; however, aggregation in prior workforce analyses may mask underlying disparities.

Objective: To assess representation by Asian race and disaggregated subgroups in the US allopathic medical school workforce.

Design, setting, and participants: This cross-sectional study used Association of American Medical Colleges (AAMC) special reports, generated using the AAMC Applicant-Matriculant Data File, Student Records System, Graduate Medical Education Track Survey, and faculty roster. Participants included medical school applicants, matriculants, graduates, residents, and faculty enrolled or employed at US allopathic medical schools between 2013 and 2021. Data were analyzed between March and May 2024.

Exposure: Asian race or ethnic subgroup as per AAMC and US Census Bureau Office of Management and Budget criteria, including Bangladeshi American, Cambodian American, Chinese American, Filipino American, Indian American, Indonesian American, Japanese American, Korean American, Pakistani American, Taiwanese American, and Vietnamese American.

Main outcomes and measures: Representation quotients (RQ) were used to indicate representation that was equivalent (RQ of 1), higher (RQ greater than 1), or lower (RQ less than 1) than expected representation based on US population estimates. One-way analysis of variance and linear regression models assessed mean RQ differences by career stage and over time, with Bonferroni correction for multiple comparisons.

Results: In this study, Asian American individuals accounted for 94 934 of 385 775 applicants (23%), 39 849 of 158 468 matriculants (24%), 37 579 of 152 453 graduates (24%), 229 899 of 1 035 512 residents (22%), and 297 413 of 1 351 187 faculty members (26%). The mean (SD) RQ was significantly greater among Asian American residents (3.44 [0.15]) and faculty (3.54 [0.03]) compared with Asian applicants (3.3 [0.04]), matriculants (3.37 [0.03]), or graduates (3.31 [0.06]). Upon disaggregation, RQ was significantly lower among residents and faculty in 10 of 12 subgroups. Although subgroups, such as Taiwanese American, Indian American, and Chinese American, had RQs greater than 1 (eg, Chinese American graduates: mean [SD], RQ, 3.90 [0.21]), the RQs were less than 1 for Laotian, Cambodian, and Filipino American subgroups (eg, Filipino American graduates: mean [SD], RQ, 0.93 [0.06]) at almost every career stage. No significant RQ changes were observed over time for Laotian American and Cambodian American trainees, with a resident RQ of 0 in 8 of 25 and 4 of 25 specialties, respectively. Faculty RQ increased in 9 of 12 subgroups, but Cambodian American, Filipino American, Indonesian American, Laotian American, and Vietnamese American faculty (eg, Vietnamese American faculty: mean [SD], RQ, 0.59 [0.08]) had RQs less than 1.

Conclusions and relevance: In this cross-sectional study of Asian representation in US allopathic medical schools, Laotian American, Cambodian American, and Filipino American individuals were underrepresented at each stage of the physician workforce pathway. Efforts to promote diversity in medicine should account for these disparities to avoid perpetuating inequities.