Representation of South Asian physicians in dermatology training programs and academic leadership

Dear Editor,

Current research indicates that dermatology departments in the U.S. continue to have limited racially and culturally diverse representation among physicians, despite evidence that cultural competency improves dermatologic care and outcomes.^1,2 Over five million people living in the U.S. are of South Asian (SA) origin, yet very little is known about South Asian physician representation or training in academic dermatology. Most diversity studies categorise all Asian physicians together without distinguishing South Asian individuals.³ International medical graduates (IMGs) are also underrepresented in dermatology, comprising less than 5% of the workforce versus much higher percentages (23-37%) in primary care fields.^4,5 About 40% of IMG dermatologists are trained in Asia.⁵ In addition, while Asian physicians are well represented in entry-level academic roles, they remain underrepresented in leadership positions.⁶ Increasing South Asian representation in dermatology leadership may improve cultural understanding in education and patient care. This study is the first to analyse the representation of SA dermatology residents (DRs), program directors (PDs), and department chairs (DCs) in the U.S.

Data from 146 Accreditation Council for Graduate Medical Education (ACGME)-accredited U.S. dermatology residency programs were collected in March 2024 via the ACGME website. Public program websites were reviewed to identify the sex, race, and roles of DRs, PDs, and DCs using biographies, ethnic name origins, and photos. IMGs were defined as physicians who received a primary medical degree outside the U.S. and Canada. Sex and race were assessed subjectively according to the American Association of Medical Colleges (AAMC) guidelines. “South Asian” included origins from India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and Afghanistan. U.S. regions were classified by Census definitions: Northeast (NE), Midwest (MW), South (S), and West (W).

Of the 1556 DRs, 193 (12.4%) were identified as South Asian. Of these, 107 (55.4%) were female and 86 (44.6%) were male. A total of 15 South Asian DRs (7.7%) were enrolled in community-based dermatology residency programs (CBRs). Of the 193 South Asian DRs, 58 (30.0%), 53 (27.5%), 58 (30.0%), and 24 (12.4%) were in the NE, MW, South (S), and West (W) regions, respectively [Tables 1 and 2].

Of 146 PDs, 11 (7.5%) were identified as South Asian; five (45.5%) were male and six (54.5%) were female. Four (36.4%), four (36.4%), and three (27.2%) were in the MW, S, and W regions, respectively. There were no South Asian PDs leading community-based dermatology residency programs. Of 130 DCs, five (3.9%) were identified as South Asian. Three (60.0%) were in the NE and two (40.0%) in the S.

Of 16 South Asian DCs and PDs, three (18.8%) were IMGs. The percentages of South Asian DRs, PDs, and DCs were not consistent across levels of position (chi-squared statistic, p<0.01).

While the AAMC reports aggregated data for all Asian physicians, this is the first study to specifically examine South Asian representation in academic dermatology. Our findings show that South Asian individuals comprise 12.4% of DRs, 7.6% of PDs, and 3.9% of DCs. This stepwise decline suggests potential barriers to leadership advancement. Although South Asian women were well-represented among residents, none held DC roles.

U.S. dermatology residency programs often lack sufficient exposure to patients with skin of colour (SOC), contributing to disparities in clinical outcomes.³ Within this broader group, South Asian patients’ unique cultural and religious practices may further complicate care.⁷ Greater South Asian representation in academic dermatology may help raise awareness of these factors. However, ethnic identity alone does not equate to clinical knowledge or cultural fluency. Second- or third-generation South Asian physicians may have less familiarity with South Asian customs than first-generation immigrants or those trained abroad. Dermatology has among the lowest proportions of IMGs who comprise fewer than 5% of dermatologists.⁴

By 2044, over half of Americans are expected to belong to a non-White racial group, and by 2060, nearly one in five will be foreign-born. Despite considerable variation in skin types, dermatoses, and cultural practices across South Asia, education of these distinctions is not consistently reflected in the U.S. dermatology training curriculum.⁷ Skin of colour dermatology curricula tend to emphasise the Fitzpatrick scale. While culture-specific dermatoses are described in the literature, their integration into residency education remains unclear. For example, “saree cancer,” a form of squamous cell carcinoma occurring along the waistline in saree-wearing women, is covered in Indian dermatology training but rarely discussed in U.S. programs.

This study offers the first look at South Asian representation across dermatology training and leadership. While ethnicity is not a proxy for cultural competence, demographic analysis remains important. Future research should explore generational background, IMG status, and strategies to broaden dermatology education on the cultural and religious nuances that impact dermatologic care for South Asians. These efforts may ultimately enhance culturally informed care for SA patients in the U.S. and globally.