Racial and Gender Disparities among Nephrology Fellowship Trainees: Trends over a Decade and the Impact of COVID-19

Background: This study examines trends in racial and gender diversity among nephrology fellowship trainees from 2014 to 2023, evaluating representation and assessing the influence of the COVID-19 pandemic on the demographic composition of trainees. Methods: Data from the Accreditation Council for Graduate Medical Education (ACGME) were analyzed to identify nephrology fellows during the study period, categorized by self-reported race and gender. The pre-COVID era was defined as 2017-2020, and the post-COVID era as 2020-2023. Chi-square tests assessed differences between groups and longitudinal trends. Results: Female fellows (36.7%) were significantly underrepresented compared to males (62.9%) (p<0.05). Female representation remained relatively stagnant, ranging from 39.0% in 2014-2015 to 38.5% in 2022-2023, with a slight increase post-COVID (38.0%) versus pre-COVID (35.5%) (p=0.050). Black individuals (24.7%) were underrepresented compared to Whites and Asians (p<0.05). The percentage of Black fellows declined from 23.5% in 2014-2015 to 11.0% in 2022-2023, while Hispanics increased from 6.4% to 10.3%. Black fellow representation decreased significantly post-COVID (10.2%) compared to pre-COVID (23.7%) (p<0.05). Conclusion: Significant gender and racial disparities persist in ACGME-accredited nephrology fellowships. While a modest increase in female fellows post-COVID is encouraging, representation remains stagnant overall. Concerningly, Black fellow representation has declined substantially, despite the disproportionate burden of kidney disease in this population. Urgent action is needed to enhance diversity and address systemic barriers for racial minorities and women in nephrology training.