Understanding the Lack of Under-represented Racial and Ethnic Minorities in Ophthalmology.

To adequately address the racial and ethnic disparities in eye care for our increasingly diverse society there needs to be a significant increase in physicians from under-represented minority groups (URMs) who pursue careers in ophthalmology. Studies have shown that patient–physician racial congruence tends to improve patient satisfaction and medical compliance.1However, there are significant racial and ethnic disparities that exist within medicine as a whole and, more specifically, within the field of ophthalmology.2 One way to address this gap is to diversify the physician workforce by increasing the number of physicians from URMs.2 URM is defined bymembership in certain ethnic and racial minority groups (i.e., Black, Hispanic, American-Indian, Alaskan Native, Native Hawaiian, and Pacific Islander). These ethnic/ racial minority groups have been deemed underrepresented in medicine (URiM).3 According to recent United States (U.S.) Census data, URM groups comprise 30.7% of the American population.3 However, a study published in 2016 based on information from the U.S. Census, Association of American Medical Colleges (AAMC), and the American Medical Association (AMA), found that only 6% of practicing ophthalmologists were from URM minority groups (3.3% Hispanic, 2.5% Black, and 0.2% Native American).3 Fairless et al reviewed the medical school faculty demographic data from the 2019 American Association of Medical Colleges Faculty Roster and discovered that ophthalmology has the third lowest proportion of URM faculty within all clinical departments at U.S. medical schools.4 Similarly, URiM trainees comprise only 7.7% of ophthalmology residents across the country, a figure that has been essentially stagnant, despitewidespread efforts to increase URM matriculants in medical schools.3 A recent call to action highlighted the significant need to increase the number of URiMs within ophthalmology training programs, academic institutions, and private practices.2 Here, we explore potential explanations for the low numbers of URMs in ophthalmology, in an effort to provide insights to improve the diversity of the ophthalmology workforce. One proposed explanation for a lack of ophthalmologists in training programs, and ultimately practicing ophthalmologists, stems from a lack of role models and mentors within the field of ophthalmology. Studies have consistently demonstrated that role models have the capacity to significantly influence the specialty, or subspecialty, that their mentees ultimately choose.2 According to a published report on science, technology, engineering, and mathematics (STEM) program at University of North Carolina at Chapel Hill (UNCCH), URM students view “advisors,” as thosewho they sought out for advice but with whom they remained more distant and less involved.5 However, the URM students view “mentors” as those who help students not only in academics and research, but also who inspire them through their shared personal, such as ethnic or gender, identity.5 Given that URMs comprise only 6% of practicing ophthalmologists, it would bemuch less likely for a URMmentee to be exposed to a URM ophthalmologist at their medical schools and within their communities to serve as a potential race-concordant mentor.3,6 Concurrently, the proportion of URMs among ophthalmology faculty has decreased over the past decade (from 6.2 to 5.7%; p1⁄400.01).2,3 The lack of both early exposure and adequate mentorship within the field may further decrease one’s chance of choosing to pursue and successfully matching into an ophthalmology residency, which are notoriously competitive. More opportunities to exposeURMmedical students to ophthalmology at an earlier stage of their training are needed. This can be partially achieved by involvement of cross-cultural, or race-discordant mentors.6 Limited data exists about the benefit of raceconcordant versus race-discordant mentoring relationships.