1646 Background: Despite evidence that a diverse workforce may improve access to care for underserved patients, emerging policies threaten to limit diversity in the physician workforce. We assessed whether nonwhite and foreign-born physicians were more likely than White and US-born physicians to care for underserved (minority race, low-income, rural) Medicare beneficiaries with cancer. Methods: Using SEER-Medicare, we analyzed Medicare beneficiaries aged 18+ newly diagnosed with breast, colorectal, lung, or prostate cancer from 2015-2019. We linked patients to cancer physicians (medical, radiation, and surgical oncology) using claims in the 6 months after diagnosis. We assessed physician race/ethnicity (data from Association of American Medical Colleges) and country of birth (American Medical Association). For each physician race and foreign-born status, we calculated the standardized treatment ratio (STR) as the percent of that group's dyads with a given patient characteristic divided by the percent of all dyads with that patient characteristic. Thus, STR > 1 indicates physicians in that group are more likely than the average physician to treat patients with the given characteristic. Results: We linked 434,923 patients (30% breast, 16% colorectal, 29% lung, 25% prostate) to 35,257 physicians. The patient population (mean age 74.7) was 79% White, 8% Black, 7% Hispanic, 3% Asian, 17% Medicaid dual-eligible, and 16% rural. Black physicians were more likely than expected to care for Black patients (STR 2.55; 95% CI 2.48–2.63; Table) and dual-eligible patients (STR 1.26; 1.22–1.29). Hispanic physicians were more likely to care for Hispanic (1.97; 1.91–2.03) and dual-eligible (1.11; 1.08–1.14) patients. Asian physicians were more likely to care for Asian (1.93; 1.89–1.96) and Hispanic (1.18; 1.16–1.20) patients and less likely to care for rural (0.73; 0.72-0.74) patients. Foreign-born physicians (20.7% of physicians) were more likely to care for Asian (1.36; 1.33–1.39), Hispanic (1.25; 1.23–1.27), and dual-eligible (1.20; 1.18–1.21) patients and less likely to care for rural patients (0.90, 0.89-0.91). Conclusions: Nonwhite and foreign-born cancer physicians disproportionately care for nonwhite and low-income patients. Policies restricting entry of minority and foreign-born physicians into the oncology workforce may hinder access to care for underserved cancer patients. Standardized treatment ratios (STRs) by physician race, ethnicity and country of birth. Physician characteristic Patient Characteristic Asian Black Hispanic White Dual eligible Rural Race & ethnicity Asian 1.93 1.00* 1.17 0.95 1.09 0.73 Black 0.60 2.55 1.08 0.85 1.26 1.04 Hispanic 0.79 0.97* 1.97 0.94 1.11 1.01* White 0.68 0.92 0.81 1.04 0.88 1.09 Foreign born No 0.86 0.96 0.89 1.02 0.88 1.04 Yes 1.36 1.05 1.25 0.96 1.20 0.90 *Denotes STRs NOT significantly different from 1.0; all other values are significant (P<0.05).

This cross-sectional study assesses National Institutes of Health (NIH) data from fiscal years 2016-2025 comprising annual counts of principal investigators funded through research grants and fellowship grant recipients, stratified by self-reported sex, race, ethnicity, and disability status.

OBJECTIVES:Fentanyl test strips (FTS) have the potential to moderate drug use behavior amidst an unregulated drug supply, yet are underutilized in medical settings. We aimed to describe emergency department (ED) FTS distribution across a large NYC health system and examine characteristics associated with clinicians' ordering FTS compared with the current standard-of-care, take-home naloxone (THN), to identify opportunities to optimize FTS distribution. METHODS:We conducted a retrospective review of THN and FTS provision across a large urban health system in its first year of FTS distribution. We evaluated the demographic and clinical characteristics of visits in which clinicians ordered FTS, compared with THN only. RESULTS:From July 20, 2022 to July 20, 2023, 237 (of 423) clinicians ordered THN for 1279 unique individuals in 1376 eligible visits (436 with FTS, 940 without). In pairwise analysis, FTS receipt was associated with being male, younger, non-White, lacking commercial insurance; substance-related or overdose-related visit chief complaint or diagnosis, attending physician, and patient-directed discharge ( P <0.05 for each). In multivariable regression, higher odds of FTS receipt were associated with male gender (OR=2.4; 95% CI=1.8-3.5), a substance-related chief complaint (OR=2.0; 95% CI=1.2-3.2) or visit diagnosis (OR=5.5; 95% CI=3.8-8.0), and overdose visit diagnosis (OR=1.7; 95% CI=1.1-2.8). Lower odds of FTS receipt were associated with older age (OR=0.98; 95% CI=0.97-0.99), noncommunity hospital sites (OR=0.71; 95% CI=0.60-0.83), and non-attending clinicians (OR=0.83; 95% CI=0.69-0.98). CONCLUSIONS:Integrating FTS into an existing ED THN program was feasible without disrupting clinical workflow. ED encounters where FTS were dispensed differed significantly from THN-only, revealing opportunities to optimize FTS ordering.

This cohort study describes US matriculants' perceptions of the importance of student and faculty diversity in selecting a medical school.

OBJECTIVES:The 2024 Society for Academic Emergency Medicine Consensus Conference focused on developing a pathway to build and support a diverse and sustainable emergency medicine (EM) clinician-scientist workforce. The underlying premise is that the specialty of EM needs a robust clinician-scientist workforce to fulfill its research mission of creating new knowledge to improve patient care and outcomes. METHODS:Preconference workgroups assessed existing pathways to develop and support EM clinician-scientists and generated unranked lists of strategies to holistically and comprehensively grow the clinician-scientist workforce. These strategies were refined and prioritized during a one-day, in-person conference, which was followed by a virtual conference to reach consensus on metrics, goals, and timelines for implementation. RESULTS:Overarching strategies included fostering a departmental culture that values research, addressing barriers to recruiting and retaining a diverse research work force, and enhancing the national reputation of EM research. At the undergraduate and medical school stage, creating a portfolio of medium- and long-term research training opportunities with EM faculty mentors was the highest priority. At the resident and fellow stage, top priorities were dedicated research training built into EM residencies and clinical fellowships. Early-career faculty strategies prioritized departmental support for federally funded K awards. Mid-career faculty strategies prioritized securing federal support for research mentoring, leading institutional training grants, and building research teams that include PhD scientists. At all stages, we addressed recruitment and retention of trainees and faculty from disadvantaged and underserved groups. CONCLUSIONS:These prioritized strategies with respective metrics, goals, timelines, and responsible parties provide a roadmap for EM to build a broadly inclusive and sustainable clinician-scientist workforce, capable of creating the new knowledge needed to advance emergency medical care. Successful implementation will require substantial commitment and investment from national EM organizations and academic department chairs. The result will be improved care and outcomes for the patients and communities we serve.

With increasing efforts to cultivate and foster a diverse physician workforce to improve the delivery of culturally responsive care, the accurate representation of Asian medical students continues to be obscured by aggregation of over 40 ethnic groups that are categorized as Asian race. To describe representation of Asian ethnic groups among applicants and matriculants to US allopathic medical schools. Cross-sectional study of applicant and matriculant data from 2020 to 2023, provided by the Association of American Medical Colleges, on self-reported Asian ethnic group and sex of medical school applicants and matriculants, compared with the American Community Survey population estimates of the typical medical school-aged population. For each academic year, Asian ethnic group, and sex, the representation quotient (RQ), defined as the proportion of an ethnic group in the total population of medical school applicants or matriculants relative to the corresponding estimated proportion of that ethnic group in the US population, was calculated. We compared differences in applicant and matriculant RQs using t-tests for those with an RQ less than one. Cambodian, Filipino, Indonesian, and Laotian applicants and matriculants were underrepresented in medicine with an RQ less than one. The RQ of Filipino females was lower than Filipino males among applicants and matriculants (p = 0.04 and 0.04, respectively). The RQ of Laotian and Filipino matriculants were lower than their respective applicant representation (p = 0.01 and 0.02, respectively). With disaggregated race and ethnicity data, we found significant variation in representation of Asian ethnic groups among medical school applicants and matriculants relative to the US population. Aggregating Asians into a single racial group conceals a more nuanced picture of representation in medicine, hindering efforts for a diverse workforce and improved patient care.

This cross-sectional study examines the association between the Liaison Committee on Medical Education’s diversity standards and medical school attrition demographics.

Background:Despite prevalent gender discrimination in medical education, its influence on personal and professional development, foundational competencies in medical training per the Association of American Medical Colleges (AAMC), remains unclear. This retrospective cross-sectional study assesses how experiences of gender discrimination in medical school influence personal and professional identity formation (PPIF). Methods:Deidentified student-level data were procured from the AAMC data warehouse for 37,610 MD students who matriculated in 2014-2015 and took the Graduation Questionnaire (GQ) between 2016-2020. Gender discrimination frequency was categorized as 'Never', 'Isolated', and 'Recurrent' from GQ responses to questions about denial of opportunities, offensive remarks, and lower evaluations due to gender. Gender was binarized, due to dataset limitations. PPIF was assessed using two GQ metrics, personal and professional development, and dichotomized. Results:Female students experienced higher rates of isolated (12.6%) and recurrent (20.1%) gender discrimination than males (4.3% isolated, 6.2% recurrent). Females reported slightly lower personal (71.2%) but similar professional development (92.2%) rates compared to males (73.4% personal, 91.2% professional). Both genders experiencing gender discrimination had lower likelihoods of PPIF than their counterparts without these experiences. If recurrent discrimination occurred, the aRR (95%CI) of professional development was 0.89 (0.87-0.90) for females and 0.78 (0.74-0.81) for males, while for personal development, it was 0.69 (0.67-0.71) for females and 0.61 (0.58-0.66) for males. Compared to females, males showed sharper declines in professional development as discrimination frequency increased from never to isolated (exp(b)=0.93, 95% CI [0.92-0.94], p<0.001) and isolated to recurrent (exp(b)=0.95, 95% CI [0.93-0.97], p<0.001). Conclusions:Gender discrimination negatively influences PPIF for both female and male medical students. Efforts to combat discrimination in medical training and promote holistic student development should be considered. Future work is needed to understand the influence of gender discrimination on the comprehensive development of gender-diverse medical students.

PURPOSE:Racial and ethnic underrepresentation in medicine (URiM) threatens the capacity of the cancer physician workforce to provide accessible, culturally competent care. We projected racial and ethnic diversity of the workforce through 2060 under three scenarios. METHODS:We assessed workforce composition using data from the American Medical Association (physician specialty and age) and Association of American Medical Colleges (race/ethnicity) in 2020. We defined URiM as American Indian/Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; or Native-Hawaiian/Pacific-Islander. We used stock-and-flow models based on 2020 data to project the racial and ethnic distribution of the workforce by decade from 2030 to 2060 across three scenarios: baseline (URiM distribution remains at 2020 levels); trajectory (growth of URiM% physicians continues at current rates); and doubling (URiM growth is twice the rate of non-URiM growth). We calculated representation ratios (RR) by dividing workforce share by population share for each race group. Finally, we estimated growth in URiM physicians required for the workforce to reach parity with the 2060 US population. RESULTS:In 2020, there were 66,450 cancer physicians (11.3% URiM overall, radiation oncology 8.2%, medical oncology 9.9%, surgical oncology 10.2%, palliative care 11.8%, general surgery 13.6%) compared with 31% of the US population. Under baseline conditions, 12.5% of the workforce would be URiM in 2060, compared with 43.2% of the US population (RR, 0.29). Continuing 2010-2020 trends would raise 2060 URiM representation to 16.5% (RR, 0.38). Doubling URiM growth relative to non-URiM would raise 2060 URiM representation to 19.1% (RR, 0.44). Achieving parity would require increasing URiM physicians entering the workforce by 9.5% per decade. CONCLUSION:Across various scenarios of physician recruitment, URiM representation in the cancer physician workforce will remain below half the US population share by 2060.

273 Background: Racial and ethnic groups underrepresented in medicine (URiM) comprise 31% of the US population but 8% of oncologists. Although there have been initiatives to increase diversity of the oncology workforce, recent challenges have raised concerns over the degree to which the oncology workforce will be reflective of the broader population in the coming years. This has implications for patient access to concordant physicians and quality of cancer care. This modeling study projects the racial and ethnic diversity of the cancer physician workforce through 2060 under three distinct scenarios. Methods: We used data from the American Medical Association (physician specialty and age) linked to data from the Association of American Medical Colleges (physician self-reported race and ethnicity). We classified cancer oncology specialties as Medical, Radiation, and Surgical Oncology, General Surgery, and Palliative Care. URiM was defined as American Indian/Alaska Native (AIAN), Black, Hispanic, or Native Hawaiian/Pacific Islander (NHPI). We determined the URiM distribution of the oncology workforce in 2020 and created stock and flow models to project changes by decade from 2030 to 2060, factoring in inflows from graduating trainees and expanded training slots, and outflows due to retirement. We modeled three scenarios with varying trends in the growth rate of URiM trainees: Baseline (URiM distribution remains the same as 2020 levels); Trajectory (distribution changes each decade at the same rate of change observed from 2010-2020); and Doubling (URiM growth occurs at twice the rate of non-URiM). Results: In 2020, there were 66,450 practicing cancer care physicians. Of these, 11.3% identified as URiM (9.7% of medical oncologists, 8.8% of radiation oncologists, 8.3% of surgical oncologists, 12.3% of general surgeons, 11.5% of palliative care physicians). The trend sample from 2010-2020 of physicians within 5 years of training completion showed a +1.2% increase in URiM representation (11.7%–12.9%), +1.2% in Hispanic (6.2%–7.4%), and +0.05% in Black (4.95%–5.00%). In the baseline scenario (no change in the % URiM trainees), in 2060, an estimated 12.5% of the workforce would be URiM, compared to 43.2% of the US population (Table). Continuing 2010-2020 trends would raise URiM representation to 16.5% in 2060. Doubling URiM growth would reach 19.1%. Achieving census parity would require increasing URiM trainee representation by 8% per decade. Conclusions: Achieving oncology physician workforce alignment with U.S. demographics by 2060 will require deliberate, systemic action—not just incremental change. 2060 Oncology workforce composition by scenario. Baseline (%) Trajectory (%) Doubling (%) US 2060 Population (%) AIAN 0.5 0.2 0.8 0.7 Asian 27.5 31.4 25.4 9.6 Black 4.9 5.1 7.5 14.1 Hispanic 7.0 11.2 10.7 28.2 NHPI 0.12 0.00 0.19 0.27 White 60.0 52.1 55.5 47.2 URiM 12.5 16.5 19.1 43.2

Importance:Previous research has documented the prevalence of discrimination based on race, ethnicity, sex, and sexual orientation among medical students; however, discrimination experienced by medical students with disabilities, and the impact of intersecting identities on these experiences, remains underexplored. Objective:To examine the association of general, gender-based, and race-based discrimination with disability status, sex, race, and ethnicity during medical school. Design, Settings, and Participants:This cross-sectional study surveyed graduating medical students in US accredited MD-granting medical schools from 2020 to 2022. Analyses were conducted from October to November 2024. Main Outcomes and Measures:Modified Poisson regression was used to estimate the relative risk of disability status, sex, race, and ethnicity with self-reported experiences of general, gender-based, and race-based discrimination and the intersection of disability status, sex, race, and ethnicity. Results:Among 45 705 graduating medical students, 3863 (8.5%) reported having a disability; 24 163 (52.9%) identified as female; and 10 100 (22.1%) identified as Asian, 2661 (5.8%) as Black, 4524 (9.9%) as Hispanic, 25 154 (55.0%) as White, and 3266 (7.1%) as other race or ethnicity. Medical students with disability (MSWD) were more likely than their peers without disability to report general discrimination (relative risk [RR], 1.57; 95% CI, 1.50-1.65), gender-based discrimination (RR, 1.64; 95% CI, 1.57-1.72), race-based discrimination (RR, 1.55; 95% CI, 1.44-1.67), and multiple types of discrimination (RR, 1.82; 95% CI, 1.71-1.91). Asian, Black, and Hispanic female MSWD were more likely to report general and race-based discrimination than their White male peers without disability, with the prevalence of general, gender-based, and race-based discrimination among female Asian, Black, and Hispanic MSWD being greater than 25%. Compared with White male students without disability, Asian and Black female MSWD reported the highest risk of general discrimination (Asian: RR, 2.40; 95% CI, 2.09-2.77; Black: RR, 2.58; 95% CI, 2.17-3.06). White and Asian female MSWD reported the highest risk of gender-based discrimination (White: RR, 4.65; 95% CI, 4.30-5.04; Asian: RR, 4.41; 95% CI, 3.85-5.05). Asian and Black female MSWD reported the highest risk of race-based discrimination (Asian: RR, 8.53; 95% CI, 7.26-10.01; Black: RR, 12.48; 95% CI, 10.76-14.47). Finally, Asian and Black female MSWD reported the highest risk of multiple types of discrimination (Asian: RR, 6.50; 95% CI, 5.63-7.52; Black: RR, 7.21; 95% CI, 6.10-8.52). Conclusions:In this cross-sectional study of US medical students, Asian, Black, and Hispanic female MSWD were more likely to report general and race-based discrimination, whereas White and Asian female MSWD were more likely to report gender-based discrimination during medical school. These findings highlight the need to address intersecting forms of discrimination for medical students with disabilities.

This cohort study examines disability status and membership in medical honor societies among medical students in the US.

Diversity in the physician workforce is critical for quality patient care. Students from low-income backgrounds represent an increasing proportion of medical school matriculants, yet little research has addressed their medical school experiences. To explore the medical school experiences of students from low-income backgrounds using a modified version of Maslow’s Hierarchy of Needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a theoretical framework. We conducted an exploratory qualitative study through in-depth, semi-structured interviews. Forty-two low-income medical students attending US-based MD or DO degree-granting institutions. We conducted a content analysis of interview transcripts using deductive and inductive coding. We discussed our independent analyses to reach consensus and shared findings with a subgroup of participants for member checking. Participants described substantial challenges in meeting their basic needs. Unmet physiologic needs included food insecurity, lack of adequate sleep/rest, and poor mental health. Unmet safety needs included lack of reliable transportation and safe housing; threats to financial safety included debt and an inability to cover both medical education–related and non–medical education–related expenses. Unmet belonging needs included difficulty connecting with peers or participating in financially inaccessible social activities. Unmet respect/esteem needs stemmed from bias from peers, teachers, and institutions. Unmet self-actualization needs were uncommon. Participants felt pride in their medical journey; however, some perceived that their financial struggles hindered them from realizing their full potential. Previously reported attrition and adverse academic outcomes among low-income students may be linked to challenges they experience trying to more fully meet important human needs. This finding underscores the need to approach wellness holistically and ensure students do not exist in a prolonged state of unmet needs. Recommendations that accreditation bodies and medical schools could implement to promote tailored support for low-income and other marginalized learners are provided.

BACKGROUND:Endotracheal intubation in the emergency department (ED) is a critical and time-sensitive procedure requiring both technical skills and cognitive-based reasoning. Evidence on supervised resident-attending dyads with differing years of seniority on decision making during clinical encounters with endotracheal intubations is nascent. OBJECTIVE:To investigate the intersection of postgraduate years in clinical practice between resident and attending supervisor dyads and its associations for clinician choice of laryngoscopy technique and paralytic agent during ED intubations. METHODS:We conducted a retrospective analysis of intubations performed at a multi-site, urban, academic emergency medicine training program, analyzing institutional airway registry data from 2013 to 2023. Using a standardized predictor that accounted for similarity in years of clinical experience within a dyad between a resident and their supervising attending, we performed adjusted mixed-effects logistic regression examining the association of this dyad on two primary outcomes in endotracheal intubation decision making. Our primary outcome measures were the selection of a laryngoscopy technique (either DL or VL), and of a paralytic agent (either short-acting or long-acting) analyzed as categorical variables with a linear mixed effects model, using a binomial response distribution. RESULTS:We examined 2969 intubations for choice of laryngoscopy technique (n = 1117, 37.6 %) and paralytic agent (n = 967, 32.6 %). Higher adjusted odds (aOR) were associated with resident choice of DL over VL when years of experience between residents and supervising attendings were more concordant (aOR 3.05, 95 % CI: 1.1-8.2). Choice of paralytic agent was not associated with differing years of experience. CONCLUSION:Concordant years of experience between residents and their attendings were associated with technical skill-based laryngoscopy technique choice but not for cognitive-based reasoning in paralytic agent choice among ED intubations, suggesting supervising attending's years in clinical practice may influence decision making during time-sensitive procedures.

BACKGROUND:Recruitment of a more diverse obstetrics and gynecology workforce may help improve patient outcomes in the US, particularly among women of color. Visiting rotations play a role in competing for a position in an obstetrics and gynecology residency, however, not all students may be able to complete these expensive experiences. Our objective was to evaluate socioeconomic and other demographic differences among US obstetrics and gynecology-bound students who participate in visiting rotations versus those who do not. METHODS:We obtained de-identified data from the Association of American Medical Colleges for students graduating in US allopathic medical schools 2019 or 2020. We analyzed self-reported receipt of state and/or federal assistance to obtain postsecondary education, medical education debt, sex, and race and ethnicity data using chi-square and ANOVA analyses and logistic regression. RESULTS:Of 33,287 US graduating medical students, 1978 (5.9%) indicated "Obstetrics and Gynecology" as their intended practice and included socio-demographic data; 1110 (56.1%) of these completed at least one visiting rotation. In multivariable analysis controlling for medical education debt, race and ethnicity, and sex, students with moderate debt were less likely to complete any visiting rotation (aOR 0.68, 95% CI: 0.52, 0.89) and students with any debt were less likely to complete two or more visiting rotations than those without debt. However, Black students were significantly more likely to complete two or more rotations than white students when adjusted for debt and sex (aOR 1.48, 95% CI: 1.02, 2.11). CONCLUSIONS:Among US obstetrics and gynecology-bound medical students, moderate medical education debt was associated with lower odds of completing visiting rotations when adjusted for race and ethnicity and sex. Black students were more likely to complete two or more visiting rotations compared to their white counterparts when adjusted for levels of debt, perhaps to improve the likelihood of a successful match that is lower than that of their white colleagues despite the risk of worsening their debt. Providing more financial support or deemphasizing the visiting rotation as part of the application could help recruit a workforce that better reflects the diversity of the general population.

PURPOSE:Timely diagnosis of disability is essential to student success. This study assesses the association between disability type; first-generation college graduate status; and race, ethnicity, and gender and the timing of disability diagnosis among medical students, and whether the timing of diagnosis is associated with likelihood of receiving accommodations in the preclinical and clinical phases of medical training. METHOD:The authors conducted a retrospective cohort study between April 2023-April 2024 across 9 U.S. MD-granting programs. Data were obtained from individual student records in collaboration with administrators and designated staff who support students with disability-related concerns and accommodation requests. Modified Poisson regression was utilized to estimate the relative risk of diagnosis timing after matriculation and preclinical and clinical accommodations to account for potential variability across schools. RESULTS:Among the 362 medical students in the study, 167 (46.1%) were diagnosed after medical school matriculation. Compared to continuing-generation students, first-generation college graduates were significantly more likely to have a disability diagnosis after medical school matriculation (59.0% vs 43.2%; aIRR, 1.33; 95% CI, 1.01-1.77). Across all racial and ethnic groups, Black students were significantly more likely to be diagnosed after matriculation compared to their White peers (66.6% vs 41.5%; aIRR, 1.58; 95% CI, 1.21-2.06). Female students were less likely to be diagnosed with a disability after matriculation (aIRR, 0.85; 95% CI, 0.73-0.98). Overall, 232 (64.1%) and 284 (78.4%) participants received preclinical and clinical accommodations, respectively. Students who received a disability diagnosis before medical school matriculation were significantly more likely to receive preclinical accommodations (79.4%) compared to those diagnosed after matriculation (46.1%; aIRR, 0.60; 95% CI, 0.50-0.72). No significant association was found between timing of diagnosis and clinical accommodations. CONCLUSIONS:This study highlights the challenges medical students with disabilities face in requesting accommodation, particularly for those who are diagnosed after medical school matriculation.

PURPOSE:Food insecurity is negatively associated with college students' well-being and academic performance. Little is known about the prevalence of food insecurity among medical students. This study examined variations in food insecurity among medical students at 15 schools, analyzing differences by disability status, race, ethnicity, and financial background. METHOD:Between March-October 2024, 1,659 students across 15 MD-granting medical schools completed an online survey. Over the past 12 months, food insecurity was assessed using the 10-item U.S. Household Food Security Survey Module. Additional survey measures included age, gender identity, race, ethnicity, Pell Grant recipient status, disability status, and graduation year. Poisson regression models were utilized to estimate the relative risk of food insecurity based on self-reported disability, race, ethnicity, and financial background and their intersections. RESULTS:In the analytic sample, a higher proportion of students with disability (33.7% vs 21.8%, P <.001), from low-income backgrounds (34.9% vs 20.3%, P <.001), and those underrepresented in medicine (URiM) reported food insecurity (37.6% vs 19.7%, P <.001). Across intersectional groups, URiM low-income students with disability have the highest rate of food insecurity (62.5% vs 16.8% for nondisabled non-URiM non-low-income peers, P <.001). In the fully adjusted model, compared to nondisabled non-URiM non-low-income students, non-URiM and URiM low-income students with disability (non-URiM aRR: 2.44, 95% CI: 1.72-3.48; URiM aRR: 3.52, 95% CI: 2.79-4.45) had a higher relative risk of food insecurity. CONCLUSIONS:In this study, nearly 1 in 4 medical students were food insecure. URiM, low-income, and students with disabilities reported food insecurity at a significantly higher rate than their peers, with over half of URiM low-income students with disabilities reporting food insecurity. These findings suggest a promising yet underutilized avenue for approaches to enhancing well-being. Proactive efforts should prioritize supporting marginalized students by linking them to nutrition resources and advocating for policies that address their essential needs.

Despite institutional efforts to promote diversity and inclusion, medical education continues to marginalize students with disabilities through persistent structural, cultural, and procedural barriers. Inaccessible learning environments, inadequate accommodations, and entrenched ableist attitudes contribute to inequitable educational experiences and outcomes for disabled students. These barriers are further compounded for individuals who hold intersecting marginalized identities, particularly those who are racially and ethnically underrepresented in medicine. This commentary applies the disability justice framework-a praxis developed by disabled queer and trans activists of color-to critically examine the limitations of current inclusion efforts within academic medicine. By analyzing the framework's 10 guiding principles, the authors identify systemic gaps and propose concrete, equity-driven strategies for transforming medical education. Recommendations include integrating intersectionality into curricula, adopting universal design, revising technical standards, elevating the leadership of disabled individuals, and embedding structural accountability. Operationalizing disability justice enables medical institutions to move beyond performative inclusion, dismantle ableist norms, and foster educational environments in which all trainees-particularly those at the margins-can thrive.

This cross-sectional study examines the association of the intersectionality of sexual orientation, race, ethnicity, and sex with attrition rates of students from medical school using national cohort data.