International medical graduates (IMGs) in leadership roles within academic oncology in the United States (US).

9004 Background: Although IMGs comprise one-third of US oncologists, their leadership presence at academic centers with affiliated oncology fellowship training programs has not been studied. Methods: Using Electronic Residency Application Services website for training programs, and publicly available information on corresponding institutional websites, data were collected on leadership (cancer center director, division chair, fellowship program director (PD), subspecialty chiefs) and clinical faculty (August to December 2024). Leadership level data included whether the institution is NCI-designated, its geographic region, presumed gender, additional graduate degree (AD: Master’s, PhD), H-index and citations. Leaders and faculty were categorized into American Medical Graduate (AMG) and IMG, who completed medical school within and outside the US, respectively. Logistic regression was used to assess factors associated with leadership. Results: Leaders (n=1057) and faculty (n=4338) from 186 oncology fellowship programs (medical, radiation, surgical oncology) were included . Among 146 cancer center directors, 26% were IMGs. IMGs represented 30% of division chairs and 32% of fellowship PDs in medical oncology; however, their representation in surgical and radiation oncology leadership and faculty was more modest (Table). There was no difference in AD (30.8% vs 30.2%), H index (44.3 ± 39 vs 45.9 ± 34.5) or citations (13,133 ± 26,228 vs 14,151 ± 23,529) between IMG and AMG leaders, respectively. IMG leadership varied regionally (Midwest 30%, Northeast 26%, South 23%, Southwest 31%, West 16%, p=0.03) and was under-represented in NCI-centers (21.3% vs 33.3%, p<0.05) vs other centers. There was no difference in male AMG leaders (48.9% vs 47.1%, p=0.77), however, the proportion of female AMG leaders was higher in NCI- vs other centers (28.8% vs 19.7%, p<0.01). Female IMGs had lowest leadership representation (7.3% at NCI-centers, 9.2% at other centers), similar to their limited faculty presence (9.2%). Female IMGs were less likely to be leaders compared to male IMGs (odds ratio [OR] 0.66 [95% CI 0.49-0.89], p<0.01) and male AMGs (OR 0.71 [0.55-0.93], p<0.05). Conclusions: Despite similar academic productivity, IMGs are under-represented in leadership in NCI-cancer centers, and in the West with female IMGs having lowest representation. Our results highlight the need to address these regional, gender and institutional disparities to foster a more inclusive workforce. Leadership and faculty positions by IMG and AMG. Medical Oncology (n=183) Radiation oncology (n=88) Surgical oncology (n=39) AMG IMG AMG IMG AMG IMG Division chair N (%) 94 (70%) 41 (30%) 70 (90%) 8 (10%) 28 (82%) 6 (18%) Subspecialty chiefs N (%) 255 (71%) 106 (29%) 66 (76%) 21 (24%) 65 (82%) 14 (18%) Fellowship PD N (%) 116 (68%) 54 (32%) 69 (90%) 8 (10%) 24 (77%) 7 (23%) Faculty N (%) 1849 (69%) 848 (31%) 922 (90%) 107 (10%) 449 (86%) 75 (14%)