Representation Quotients to Examine Diversity in Ophthalmology Residency Applicants and Matriculants.

Importance: A diverse ophthalmic workforce is key to equitable care, and identifying areas of underrepresentation is important in tackling vision care disparities. Objective: To evaluate the diversity of applicants and matriculants in ophthalmology residency programs relative to medical school graduates and analyze the intersection of race and gender within this pathway. Design, Setting, and Participants: This retrospective cross-sectional study conducted from 2022 to 2024 used representation quotients (RQs) using reports from the Association of University Professors of Ophthalmology and San Francisco Match, along with demographic data from the Association of American Medical Colleges from 2008 to 2021. RQs measure equity by dividing a racial, ethnic, or gender group's proportion in a specific population by its proportion in a larger reference population. Individuals who graduated from US medical schools from 2008 to 2021 or who applied to or matriculated into US ophthalmology residency programs from 2015 to 2021 and from 2008 to 2021, respectively, were eligible for inclusion. Exposure: Applying to or matriculating into ophthalmology residency. Main Outcomes and Measures: The primary outcome was median RQs and trends among racial, ethnic, and gender groups for ophthalmology applicants (RQapp) and matriculants (RQmat), with RQ differences evaluated using Mann-Whitney U tests. Results: Among total applicants (n = 5304) and matriculants (n = 6139), 36% and 42% of applicants and matriculants, respectively, were female (applicants: 28% Asian, 4% Black, 7% Hispanic, and 47% White; matriculants: 31% Asian, 3% Black, 5% Hispanic, and 57% White). Self-identified Black individuals had the lowest median (IQR) RQs (RQapp, 0.604 [0.437-0.771]; RQmat, 0.469 [0.341-0.597]). Regression analysis revealed increased representation for male applicants (slope, 0.036; 95% CI, 0.015-0.057; P = .007) and matriculants (slope, 0.009; 95% CI, 0.002-0.016; P = .02), but decreased representation for female applicants (slope, -0.031; 95% CI, -0.010 to -0.102; P = .01) and matriculants (slope, -0.009; 95% CI, -0.016 to -0.002; P = .02). Black (RQapp, 0.604 vs RQmat, 0.469; P = .047) and Hispanic (RQapp, 1.46 vs RQmat, 1.04; P = .03) groups experienced a decrease between applicant and matriculants. Conclusions and Relevance: This cross-sectional retrospective study found persistent underrepresentation of Black and female individuals in ophthalmology residency programs, with increases in Black and Hispanic applicants failing to translate into higher matriculation rates. Barriers that female or Black medical students face when applying or matriculating into ophthalmology residency may contribute to their underrepresentation in the field.