Association of demographic characteristics with evolution of interest in anesthesiology during medical school

BACKGROUND: Physician workforce diversity improves access to care, outcomes, and workforce productivity. Yet, women and sexual minorities remain underrepresented in anesthesiology, while representation for low-income trainees remains poorly characterized. How interest in anesthesiology evolves among these groups during medical school remains unclear. METHODS: This retrospective cohort study of U.S. MD-granting medical school matriculants from 2014-2017 used Association of American Medical Colleges data on self-reported sociodemographic characteristics and anesthesiology interest. Students were grouped by interest evolution from matriculation to graduation: never interested (no-no), cultivated (no-yes), lost (yes-no), sustained (yes-yes). Chi-square tests characterized sociodemographic differences across interest paths. Firth logistic regression models assessed odds of cultivated vs never interested and sustained vs lost paths across sociodemographic groups. RESULTS: Among 39,910 students in the cohort, 295 (0.7%) sustained, 2,007 (5.0%) cultivated, 494 (1.2%) lost interest, and 37,114 (93.0%) were never interested in anesthesiology. Women were less likely than men to have initial interest (1.5% vs 2.5%, p < .001), whereas initial interest among low-income (2.1% vs 1.9%, p = .087) and sexual minority (1.8% vs 2.0%, p = .505) students did not significantly differ from majority counterparts. Sustained interest did not differ significantly between women and men (OR: 0.85, 95% CI: 0.63-1.14), according to low-income (OR: 0.89, 95% CI: 0.65-1.22), or sexual minority status (OR: 0.77, 95% CI: 0.41-1.45). Women (OR: 0.50, 95% CI: 0.45-0.55) and sexual minority students (OR: 0.79, 95% CI: 0.65-0.96) were less likely to cultivate interest than men and heterosexual students, respectively. Low-income students had greater (OR: 1.27, 95% CI: 1.16-1.40) odds of cultivating interest compared to non-low-income peers. CONCLUSIONS: Women's underrepresentation in anesthesiology is associated with lower initial and cultivated interest. Sexual minority students also demonstrated lower cultivated interest. These disparities identify time points in training where interest diverges by demographic group and may help prioritize where future research - including studies of targeted interventions - is most needed.