Pain medicine continues to be a competitive fellowship program in the United States (US), likely due to the broad pool of applicants and the unique multidisciplinary nature of the specialty. Historically, medicine has largely been a male-dominated field, and although females continue to gain increasing representation in the healthcare profession, this gender imbalance remains prevalent across most medical specialties. This study aims to determine whether the difference in female-to-male representation in pain medicine fellowship programs is associated with a difference in research output to compensate. Furthermore, it seeks to explore whether research output in different racial backgrounds differs in a similar manner amongst the class of 2024 pain medicine fellows.

IRB approval was not required as the study exclusively used publicly available data and involved no patient protected health information.

The pain medicine fellowship programs in the US were identified using the ASRA fellowship directory and the Association of Pain Program Directors directory. All pain fellows from the class of 2024 were identified from the respective program websites and social media platforms. Publication volume, encompassing first authorship or second authorship in pain publications, publications in specialty-related journals, and total publications, was recorded prior to the end of July in the application year for each fellow, utilizing PubMed and Google Scholar. Collectively, 331 fellows from the class of 2024 were sorted by gender and race for analysis, with Welch’s T-Test and ANOVA, respectively. 

Number of publications for 331 pain medicine fellows from the Class of 2024 were analyzed and compared by race and gender (Table 1). Among all pain medicine fellowship programs in the US, 260 (78.55%) fellows in the Class of 2024 were male, while 71 (21.45%) were female. There was no significant difference seen in the number of total publications (p = 0.73), specialty specific publications (p = 0.36), pain publications (p=0.64), first author pain publications (p = 0.31), or second author pain publications (p = 0.31) amongst male and female fellows. When comparing fellows by race, there was also no significant difference seen in the number of total publications (F = 0.72, p = 0.58), specialty specific publications (F = 0.14, p = 0.97), pain publications (F = 0.97, p = 0.43), first author pain publications (F = 0.37, p = 0.83), or second author pain publications (F = 0.55, p = 0.70).

In this study, we sought to investigate whether there would be any difference in publication output amongst the demographics that are underrepresented in the pain fellowship programs, i.e. applicants identified as female, black, hispanic, or other. Our results demonstrated that there was no significant difference in publication output amongst these demographics. Additionally, there was no compensatory increase in publications by female applicants to address the gender disparity. These findings suggest that there may be other variables contributing to disparities in representation. Additional studies should be conducted to further characterize these variables and help guide residents from underrepresented demographics to help secure a spot in a pain medicine fellowship.