BLOG: Being the change we want to see in ophthalmology

I am proud to be an ophthalmologist. We are fortunate to be in a field that is at the forefront of technological advancement, research development, and surgical innovation in medicine. 

However, though we lead in many aspects, ophthalmology has notoriously lagged behind other medical specialties with regards to diversity, equity, and inclusion.

The statistics on this are striking … and not in a flattering way for us.

A recent study showed that only 6% of practicing ophthalmologists in the US identify as an underrepresented minority (URM), with 3.3% identifying as Hispanic, 2.5% black, and 0.2% Native American. These percentages are drastically lower than in the general population (17.8% Hispanic, 12.1% black, and 0.8% Native American).¹

Although some progress has been made in recent years, unfortunately the immediate next generation does not look much different. For example, in 2021, out a total of 1,307 enrolled ophthalmology residents in the US, only 39 identified as black (3%).²

Of course, encouraging proportionate representation is about much more than just balancing the numbers. At the core of medicine is the doctor and patient relationship. Numerous studies have shown that physician diversity may decrease health care disparities by improving access to care. Similarly, shared primary language or racial background has been linked to improved patient satisfaction, compliance, and outcomes.³ Moreover, once fully trained, URMs are more likely to return and practice in underserved communities or minority populations of need.¹

So why does ophthalmology remain one of the least represented medical specialties? The reasons are multifactorial, including a tougher average starting point, particularly when URM’s come from disadvantaged backgrounds, and additional hurdles relative to others along the way.

For some, the barrier can be as simple (or as complex) as a number since even standardized testing performance is rooted in longstanding systemic inequities.⁴ In my own experience, I was told that medical school admission would be a challenge based solely on my MCAT score, not qualifications, ability, or experience. Unfortunately, I’m not alone – in a survey of medical school programs, MCAT scores were identified as the top barrier (90% of respondents) for recruiting URMs.⁴

Even simply matriculating into medical school does not guarantee a passing board score, residency position, or even graduation; in fact, studies have pointed to racial disparities in clinical grading even when adjusting for other factors.5 Beyond test scores and grades, limited personal connections may heavily impact entry or engagement in a specialty, with lack of mentors or faculty role models often cited as major barriers.⁴

So what can we do? Well, turns out a lot, both on a systemic and personal level. Some initial steps could include eliminating known simple systemic barriers (e.g., standardized testing score cutoffs for residency screening) and facilitating personal connections, which can be immensely empowering.

Ophthalmology is a relatively small and closeknit community compared to other specialties in medicine. As such, there is much potential for building personal relationships that will inspire the next generation for our field.

Pipeline programs that connect mentors and mentees for URM students can be particularly powerful because they draw support from established organizations and facilitate personal relationships. Not surprisingly, these programs are frequently cited as a key factor in improving representation.6 Examples of such programs in ophthalmology include the Minority Ophthalmology Mentorship (MOM) Program via the American Academy of Ophthalmology (AAO) or the Rabb-Venable Ophthalmology Research Program via the National Medical Association (NMA).

I am fortunate to be among the many URMs to be positively impacted by these pipeline programs, but we need many others to be invested through time, energy, and funds to help propagate their impact.

Another powerful avenue is mentorship. Although I’m originally from Los Angeles, I chose residency at Iowa (yes, in the middle of corn fields!) not just because of our residency program’s outstanding reputation for clinical training but also because of its firm commitment to mentorship. The impact of my mentors during my residency has been immeasurable, and in return, I do my best to invest in the next generation by serving as a mentor to other aspiring ophthalmologists.

You, too, can make an impact just by sharing your stories, experience, and opportunities. Get involved either informally or formally through organizational mentoring programs (e.g., MOM via the AAO).

Of course, mentorship is not limited to those from a similar racial or socioeconomic background. The power of personal relationships is immense, and even a few interactions to share experiences and insights can make a huge difference for aspiring ophthalmologists, including URMs, in our field.

Let us be the change we want to see for a brighter and more inclusive world of ophthalmology.

Aaron D. Dotson, MD, is a resident physician, PGY3, in the Department of Ophthalmology and Visual Sciences at the Carver College of Medicine, University of Iowa. He can be reached by email to aaron-dotson@uiowa.edu. His Twitter handle is @drdotson.