Changing Faces in Cardiothoracic Surgery: Match Rates and Demographic Shifts amongst Integrated and Traditional Training Programs

M. Burmistrova¹, A. Zhou², A. A. Rizaldi³, S. Yang⁴, J. Gammie⁵, H. Wang^6
1Albany Medical College, Albany, New York ²Divison of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Baltimore, Maryland ³Johns Hopkins University School of Medicine, Baltimore, Maryland ⁴The Johns Hopkins School of Medicine, Baltimore, Maryland ⁵Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Stevenson, Maryland ⁶Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

Purpose: The persistent imbalance of racial and gender diversity is a critical issue in cardiothoracic surgery. This study examines contemporary trends in the racial and gender compositions of Integrated (I6) and traditional fellowship programs, focusing on the impact of changes in match rates on demographic composition.

Methods: Data from the National Residency Matching Program (NRMP) and the Accreditation Council for Graduate Medical Education (ACGME) were analyzed to assess trends in match rates and demographic compositions of I6 and traditional fellowship programs from 2011 to 2022. Time series analyses using the Mann-Kendall test, Bayesian Estimation of Abrupt Changes in Trend, and AutoRegressive Integrated Moving Average models were conducted to evaluate shifts in racial and gender composition, identify change points, and forecast future trends. Dirichlet regression models were employed to analyze the impact of match rate changes on demographic composition.

Results: Racial composition trends in I6 programs showed significant increases in Asian/Pacific Islander trainees (7.5% in 2011; 20.7% in 2022), Hispanic trainees (0% in 2011; 7.8% in 2022), and Black trainees (0% in 2011; 5.9% in 2022). The proportion of white trainees decreased from 77.5% in 2011 to 44.9% in 2022 (Panel A). Traditional fellowships maintained a stable racial composition (Panel B). Gender composition trends indicated significant increases in female trainees in I6 and traditional fellowships (Panel C and D) with inflection points in 2015 and 2020, respectively. Female trainees are forecasted to reach 50% by 2035 in I6 and by 2046 in traditional fellowships. The number of I6 and traditional programs increased from 17 and 68 in 2011 to 34 and 76 in 2023, respectively. Overall match rates for traditional fellowships decreased from 98% to 63%, with notable declines in 2014 (92% to 73%) and 2021 (72% to 59%), while I6 match rates increased from 25% in 2011 to 42% in 2023. Female applicant percentages are lower for traditional fellowships compared to I6 programs (Table). The combined effect of increasing match rate and year was associated with greater racial diversity and more female trainees in I6 programs.

Conclusion: Over the last decade, I6 programs have become more racially diverse, while traditional fellowships have maintained stable racial compositions. Women are increasingly represented in both. Despite positive trends, significant disparities in application rates and representation of females and minority groups remain, highlighting the need for improved diversity in cardiothoracic surgery training.

Identify the source of the funding for this research project: N/A