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Importance: Poor retention may be associated with lack of faculty diversity in academic medicine., Objective: To examine differences in faculty retention by gender, degree type, and race and ethnicity using data from US medical schools., Design, Setting, and Participants: This cohort study analyzed data from 155 medical schools for 1978 to 2021, which were obtained from the Association of American Medical Colleges. Retention rates were calculated by gender, race and ethnicity, and degree type. Time to attrition was estimated using Kaplan-Meier curves and adjusted Cox proportional hazards models were used to examine the differences in retention by gender and race. Data were analyzed from March 2021 to November 2022., Main Outcomes and Measures: The duration of continuous employment in academic medicine and variations in retention based on gender, race, ethnicity, and terminal degree., Results: Among 390 766 faculty members (232 829 [59.6%] men; 1190 American Indian, Alaska Native, Native Hawaiian, or Pacific Islander [0.3%]; 72 490 Asian [18.6%]; 14 920 Black [3.8%]; 20 345 Hispanic, Latino, of Spanish origin, or multirace Hispanic [5.2%]; 251 670 non-Hispanic White [64.4%] participants; and 30 151 [7.7%] other race), 259 628 (66.4%) had MD or MD-equivalent terminal degrees. Women left academic medicine a median of 1 year earlier (median retention, 8.33 years; 95% CI, 8.18-8.41 years) than men (median retention, 9.35 years; 95% CI, 9.25-9.42 years). Compared with White faculty (median retention, 9.91 years; 95% CI, 9.83-9.92 years), multiracial and faculty of other races had the lowest retention (median retention, 5.42 years; 95% CI, 5.33-5.55 years), followed by Alaska Native, American Indian, Native Hawaiian, and Pacific Islander (median retention, 6.00 years; 95% CI, 5.62-6.62 years), Black (median retention, 7.78 years; 95% CI, 7.50-8.00 years), Asian (median retention, 8.00 years; 95% CI, 8.00-8.11 years) and Hispanic faculty (median retention, 9.00 years; 95% CI, 8.75-9.16 years). Women faculty in the 1970s were 20% more likely than men to leave academia, whereas women in the 2010s had no greater risk of leaving, mainly due to a decline in retention of men., Conclusions and Relevance: Gender differences in faculty retention have decreased in the most recent decade; however, men had lower retention compared with earlier cohorts. In this study, faculty who were underrepresented in medicine left academic medicine a median of 1 to 4 years earlier than White faculty. Greater attrition among men and women for recent cohorts suggests that enhanced retention efforts are imperative to maintain an experienced and diverse faculty.

Importance: The ranks of academic physicians do not reflect the diversity of the US population. To create a diverse and effective medical workforce, it is important to know the extent to which gender, race and ethnicity, and the intersection of these factors are associated with career advancement., Objective: To assess whether race and ethnicity and gender are associated with appointment to or promotion within academic medicine., Design, Setting, and Participants: This cohort study used Association of American Medical Colleges data on graduates of all US MD-granting medical schools from 1979 to 2019 merged with faculty appointment data since 2000. Data for this study are based on a February 19, 2021, snapshot. The analysis was performed from March 8, 2021, to May 5, 2023., Exposure: Gender and race and ethnicity among physician graduates., Main Outcomes and Measures: The main outcome was full-time faculty appointments and promotions to the ranks of instructor, assistant professor, associate professor, full professor, and department chair. Cox proportional hazards models were used to examine the differences in likelihood of appointment and promotion for racial and ethnic minority men and women compared with White men., Results: The analytic sample included 673 573 graduates (mean [SD] age at graduation, 28.1 [3.2] years; 59.7% male; and 15.2% identifying as Asian, 6.1% as Black, and 69.6% as White). White men accounted for the largest subgroup of graduates (43.8%). Asian men, Asian women, Black women, and White women were more likely than White men to be appointed to entry-level positions. Among physicians graduating both before and after 2000, White men were more likely to be promoted to upper ranks compared with physicians of nearly every other combination of gender and race and ethnicity. Among physicians graduating prior to 2000, Black women were 55% less likely (HR, 0.45; 95% CI, 0.41-0.49) to be promoted to associate professor (n = 131 457) and 41% less likely (HR, 0.59; 95% CI, 0.51-0.69) to be promoted to full professor (n = 43 677) compared with White men. Conversely, Black men (HR, 1.29; 95% CI, 1.03-1.61) were more likely to be appointed as department chair (n = 140 052) than White men., Conclusions and Relevance: These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.

Background: In 2000, a landmark study showed that women who graduated from U.S. medical schools from 1979 through 1997 were less likely than their male counterparts to be promoted to upper faculty ranks in academic medical centers. It is unclear whether these differences persist., Methods: We merged data from the Association of American Medical Colleges on all medical school graduates from 1979 through 2013 with faculty data through 2018, and we compared the percentages of women who would be expected to be promoted on the basis of the proportion of women in the graduating class with the actual percentages of women who were promoted. We calculated Kaplan-Meier curves and used adjusted Cox proportional-hazards models to examine the differences between the early cohorts (1979-1997) and the late cohorts (1998-2013)., Results: The sample included 559,098 graduates from 134 U.S. medical schools. In most of the cohorts, fewer women than expected were promoted to the rank of associate or full professor or appointed to the post of department chair. Findings were similar across basic science and clinical departments. In analyses that included all the cohorts, after adjustment for graduation year, race or ethnic group, and department type, women assistant professors were less likely than their male counterparts to be promoted to associate professor (hazard ratio, 0.76; 95% confidence interval [CI], 0.74 to 0.78). Similar sex disparities existed in promotions to full professor (hazard ratio, 0.77; 95% CI, 0.74 to 0.81) and appointments to department chair (hazard ratio, 0.46; 95% CI, 0.39 to 0.54). These sex differences in promotions and appointments did not diminish over time and were not smaller in the later cohorts than in the earlier cohorts. The sex differences were even larger in the later cohorts with respect to promotion to full professor., Conclusions: Over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to the rank of associate or full professor or to be appointed to department chair, and there was no apparent narrowing in the gap over time. (Funded by the University of Kansas Medical Center Joy McCann Professorship for Women in Medicine and the American Association of University Women.)., (Copyright © 2020 Massachusetts Medical Society.)

The emerging sciences of stem cell biology and cellular plasticity have led to the development of cell-based therapies for advanced human disease. Pre-clinical studies which defined the potential of bone marrow-derived mononuclear cells to repair damaged and dysfunctional myocardium led to the rapid advancement of these strategies to the clinic. Such rapid advancement has led to controversy regarding the appropriate conduct of such studies. In the United States, the National Heart, Lung, and Blood Institute established the Cardiovascular Cell Therapy Research Network (CCTRN) to facilitate the early translation of clinical trials of cell therapy for left ventricular dysfunction. The premise upon which the CCTRN was established was that multiple clinical trial sites would interact effectively with a Data Coordinating Center to perform early phase 1 and 2 clinical trials within a highly coordinated network structure. In order to develop this network, the unmet needs of the community needed to be defined, the clinical trials identified, and the structure to perform the studies needed to be established. This manuscript highlights the challenges in the development of the CCTRN and the approaches faced to define a network to perform clinical trials in human cell therapy of cardiovascular disease.

A realistic goal for cardiac cell therapy may be to attenuate left ventricular remodeling following acute myocardial infarction to prevent the development of congestive heart failure. Initial clinical trials of cell therapy have delivered cells 1 to 7 days after acute myocardial infarction. However, many patients at risk of developing congestive heart failure may not be ready for cell delivery at that time-point because of clinical instability or hospitalization at facilities without access to cell therapy. Experience with cell delivery 2 to 3 weeks after acute myocardial infarction has not to date been explored in a clinical trial. The objective of the LateTIME study is to evaluate by cardiac magnetic resonance the effect on global and regional left ventricular function, between baseline and 6 months, of a single intracoronary infusion of 150 × 106 autologous bone marrow mononuclear cells (compared with placebo) when that infusion is administered 2 to 3 weeks after moderate-to-large acute myocardial infarction. The 5 clinical sites of the Cardiovascular Cell Therapy Research Network (CCTRN) will enroll a total of 87 eligible patients in a 2:1 bone marrow mononuclear cells-to-placebo patient ratio; these 87 will have undergone successful percutaneous coronary intervention of a major coronary artery and have left ventricular ejection fractions ≤0.45 by echocardiography. When the results become available, this study should provide insight into the clinical feasibility and appropriate timing of autologous cell therapy in high-risk patients after acute myocardial infarction and percutaneous coronary intervention.