Ophthalmology has a long-documented diversity problem.
|Mildred M.G. Olivier, MD, (left) and Eydie Miller-Ellis, MD, are co-directors of the Rabb-Venable Excellence in Ophthalmology Program.|
While minorities make up one-third of the U.S. population, they only comprise 6 percent of practicing ophthalmologists.1 That underrepresentation carries over to medical schools, with minorities representing only 5.7 percent of ophthalmology faculty.1 A recent analysis of 2019 American Association of Medical Colleges Faculty Roster data found that ophthalmology ranks in the bottom three of 17 specialties in terms of minority representation among department faculty.2
Last month, as Medscape reported, a coalition of Black physicians met with the American Medical Association to press the case for antiracism initiatives in medicine.
The studies of the lack of diversity in ophthalmology defined minority groups traditionally underrepresented in medicine, known at URM. That includes Black, Hispanic, Native American, and Native Hawaiian or Pacific Islander. U.S. Census data shows these URM groups make up 33.4 percent of the population.
Two ophthalmologists trying to do something about the lack of diversity in their ranks are Mildred M.G. Olivier, MD, assistant dean for diversity and inclusion and global health chair for Chicago Medical School and a professor at Rosalind Franklin University of Medicine and Science/John H. Stroger Jr. Hospital of Cook County, and Eydie Miller-Ellis, MD, professor and director of the glaucoma service at the Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
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They’re co-directors of the Rabb-Venable Excellence in Ophthalmology Program (RVEOP), an organization whose mission is to entice minority medical students to pursue ophthalmology and to support those who want to work in underserved communities. RVEOP was established in 2000 by the National Medical Association, the oldest and largest organization of African-American physicians and healthcare professionals in the United States. RVEOP is named for two pioneering African-American ophthalmologists: Maurice F. Rabb Jr., MD, a retina specialist in Chicago who devoted his research to sickle cell disease; and Howard P. Venable, MD, the first African-American on faculty at Washington University, St. Louis. Dr. Rabb died in 2005; Dr. Venable died in 1998.
RVEOP’s offerings include an annual awards scholarship as well as mentoring, career development and volunteer opportunities. The program also gets support from the National Eye Institute.
Improving diversity in retina
“I think that all of our subspecialties can use some diversification in them,” Dr. Olivier says. She credits the American Academy of Ophthalmology’s Minority Ophthalmology Mentoring program, or MOM, with bringing “a lot of those subspecialties … on board.” Also, RVEOP fireside chats hosted by O’Rese Knight, MD, of the University of North Carolina, and Dolly Ann Padovani-Claudio, MD, PhD, of Vanderbilt University exposed 30 ophthalmology training programs to RVEOP mentors and volunteers.
In retina, RVEOP has worked with the Retina, Macula and Vit-Buckle societies and American Society of Retina Specialists to engage minority trainees.
Last year the program matched 28 candidates with ophthalmology programs, four times the usual six or seven in a typical year, she says. “I think everybody was making a concerted effort to try to increase diversity,” Dr. Olivier says.
Dr. Miller-Ellis says the underrepresentation of minority ophthalmology residents is even more acute, with only 2 to 3 percent in her experience. She notes ophthalmology has some built-in disadvantages in attracting these candidates. “Many schools don’t even require ophthalmology as a rotation, and before coming to medical school some students may not even have considered this as a career,” she says. “So, we’re starting off a little bit behind because ophthalmology has an early match; it’s very competitive. So you have to provide exposure and opportunities so that they would be competitive when it’s time to apply for the match.”
Even before medical school, even before college, would-be doctors of economically disadvantaged backgrounds face a multitude of hurdles getting to their match moment.
“One of the barriers is not having institutional support or support from advisers in school to pursue this particular field,” Dr. Miller-Ellis says. That gets to high school counselors discouraging minority students from pursuing a STEM (science, technology, engineering, math) curriculum, college advisers and peers directing them away from medicine, and, if they get into medical school, forces there directing them toward primary care and away from a specialty.
“We all need talented, dedicated, smart primary-care doctors, but so many of the subspecialties, particularly ophthalmology—it’s like doing primary care for the eye,” Dr. Miller-Ellis adds. “There is so much that goes on with eye disease that reflects systemic diseases, being advised that we’re a super specialty and that you’re somehow abandoning the people that need you by pursuing it, I think, is a real misconception.”
The COVID-19 pandemic exposed many of those barriers on a more pedestrian level, Dr. Olivier notes. “When we had to go virtual, sometimes the broadband at their houses wasn’t enough for them to do the medical training,” she says. “You can look at the Latinx community; oftentimes they’re very near family and they’re still expected to be very involved with the family and yet they’re going to medical school. I’ve had students who had to drive two hours because their husbands had a job somewhere and they were not willing to move.” RS
Richard Mark Kirkner
FOR THE RECORD
A reference in the article “Retina Rounds: A curious case of RAMA” (pages 16 to 19, March/April Retina Specialist) was incorrect. The correct reference 10 is:
Klatz R, Goldman R, Punchuk B, Nelson K, Tarr R. The effects of gravity inversion on systemis blood pressure, intraocular pressure, and central retinal arterial pressure. J Am Osteopath Assoc. 1983;82:111-115.
1. Xierali IM, Nivet MA, Wilson MR. Current and future status of diversity in ophthalmologist workforce. JAMA Ophthalmol. 2016;134:1016-1023.
2. Fairless EA, Nwanyanwu KH, Forster SH, Teng CC. Ophthalmology departments remain among the least diverse clinical department at United States Medical Schools. Ophthalmology. Published online January 10, 2021.