Available online 17 January 2026, 103220

Author links open overlay panelBlair A. Streater MD, Med a b, Laura Chiel MD, MHPE b c d 1, Puja J. Umaretiya MD, MS e 2, Alan Schwartz PhD, JD f g 3, Richard Mink MD, MACM h i 4, Katie A. Greenzang MD, EdM b j k 5, Jennifer C. Kesselheim MD, EdM b j k 5Show moreAbstractBackground

The pediatric workforce has not achieved representation of diversity that reflects the general US population. Data confirm significant underrepresentation of underrepresented in medicine (URIM) trainees in pediatric subspecialty fellowship programs.

Objectives

We aimed to describe: (1) how program directors leverage data regarding applicants’ race and ethnicity in the recruitment process; (2) program strategies to recruit a diverse fellowship class; and (3) perceived barriers and facilitators to the recruitment of a diverse fellowship class.

Methods

In collaboration with the Association of Pediatric Program Directors Subspecialty Pediatrics Investigator Network (APPD SPIN), we conducted a national survey of pediatric subspecialty fellowship program directors (FPDs).

Results

With 516 respondents, FPDs overwhelmingly agreed that diversity in subspecialty trainees is important and that it improves patient care. However, race and ethnicity were identified as a top factor influencing the rank list for fewer than 24% of respondents. FPDs employed several strategies to prioritize diversity in recruitment, but none were perceived as effective by more than 40% of respondents. The most prevalent facilitators for recruiting a diverse fellowship class were institutional culture and addressing diversity with applicants. Key barriers included diversity of the applicant pool and institution faculty.

Conclusions

Diversity in pediatric subspecialty fellowship programs is important to FPDs and is thought to improve patient care. Although strategies are being utilized to recruit URIM fellows, FPDs give only modest ratings to their effectiveness.

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Access through your organizationSection snippetsBackground

Improving child health outcome disparities depends, in part, on increasing the diversity of the pediatric subspecialty workforce.1 Underrepresented in medicine (URIM) physicians are more likely to care for underserved communities2 and racial and ethnic minority patients3 and conduct health disparities research.4, 5 In addition, patients with race-concordant physicians may experience improved outcomes in care, including higher satisfaction with quality of care,6 more engagement with preventive

Methods

We conducted a national, cross-sectional survey of FPDs and program coordinators (PCs) of Accreditation Council of Graduate Medical Education (ACGME)-accredited pediatric subspecialty fellowship programs in the US through the Association of Pediatric Program Directors Subspecialty Pediatrics Investigator Network (APPD SPIN). We used the Association of American Colleges (AAMC) definition of URIM which refers to “any US citizen or permanent resident who self-identified as one or more of the

FPD Demographics

Five hundred and sixteen FPDs representing 15 pediatric subspecialties responded (58.3%), with a mean fellowship size of 6 (range 0-40) fellows (Table). Approximately 70% of FPDs identified their race and ethnicity as White. Using the APPD groupings,25 the majority of FPDs represented programs in the Southeast region.

Consideration of diversity during recruitment process

FPDs overwhelmingly agreed that diversity in pediatric subspecialty trainees is important (N= 492, 97.4%) and endorsed that diversity in the physician workforce improves patient

Discussion

We surveyed pediatric FPDs to understand how pediatric subspecialty FPDs prioritize applicants’ diversity in the fellowship recruitment process, describe what efforts pediatric subspecialty FPDs take towards recruiting a diverse class, and identify facilitators and barriers pediatric subspecialty FPDs face in these efforts. The data reveal that less than 1/3 of FPDs consider applicants’ race and ethnicity when drafting their final rank lists. Even when the recruitment of racially and ethnically

Conclusion

Our data show that fellowship program directors overwhelmingly agreed that diversity in pediatric subspecialty trainees is important and that diversity in the physician workforce improves patient care. The fellowship recruitment process commonly takes applicant race into account at several time points. Our study of FPDs further reveals several strategies to foster diversity in recruitment that are used frequently but also demonstrates that fellowship program directors do not perceive these

Funding/Support

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

none

Acknowledgements

We would like to thank the APPD SPIN Steering Committee and Anjana Gigi Radhakrishnan for their assistance in recruitment and survey distribution.

Conflict of Interest Disclosures (including financial disclosures)

None of the authors have conflicts of interest to disclose.

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Division of Pulmonary Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts, 02115;

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Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390

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Department of Medical Education, University of Illinois College of Medicine, 808 South Wood Street, Mail Code 591, Chicago, Illinois 60612;

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Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, California, 90502;

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Pediatric Hematology/Oncology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts, 02115;

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