Trends in Diversity among Medical Cancer Workforce Trainees in the United States over Fifteen years.
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PURPOSE: Diverse oncology workforces improve care quality, patient satisfaction, and outcomes, particularly among underserved populations. This study aimed to evaluate long-term demographic and educational trends among U.S. cancer-related medical trainees and examine how these trends have shifted across specialties over a 15-year period. MATERIALS AND METHODS: Publicly available data were sourced from the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Books. Gender and educational-background trends were evaluated from 2007-2023, while race/ethnicity trends were evaluated from 2011-2023 across cancer-related physician training programs, including hematology-medical oncology, medical oncology, radiation oncology, surgical oncology, pediatric hematology-oncology, medical genetics, pathology, diagnostic and interventional radiology, and nuclear medicine. Demographic variables included gender, race/ethnicity, and age; educational background was categorized as U.S. allopathic, U.S. osteopathic, or international medical graduate (IMG). Trends were assessed using the nonparametric Mann-Kendall test, with P<.05 indicating statistical significance. RESULTS: Between 2007 and 2023, female trainee representation rose significantly (47.0% to 51.5%; p<0.001), with notable gains in pediatric hematology-oncology and medical oncology. Hispanic/Latino representation increased significantly from 7.9% to 11.6% overall (p<0.001), while African American/Black representation remained unchanged (7.1% to 7.5%; p>0.05). Asian/Pacific Islander proportions rose in select specialties. The percentage of U.S. osteopathic graduates increased across most specialties (5.1% to 16.2%; p<0.001), whereas IMG representation declined slightly overall. U.S. allopathic representation decreased from 62.9% to 53.3% (p<0.001), with variation across specialties. CONCLUSION: While gains in gender and Hispanic/Latino representation are evident, African American/Black trainee representation remains stagnant, and changes in IMG participation vary across specialties. These diverging trends highlight persistent representation gaps within the U.S. cancer workforce training pipeline. Continued monitoring will be important to determine how evolving educational and accreditation policies influence these trends over time. POLICY SUMMARY: Based on these findings, program directors and professional societies should maintain inclusive recruitment practices and continue systematic monitoring of workforce diversity as accreditation policies evolve. Sustained institutional commitment may help preserve patient trust, address workforce needs, and support an oncology workforce that better reflects the populations it serves.