First-Generation Status as a Determinant of Career Advancement: A Cross-Sectional Analysis of Women of Color in Plastic Surgery

Background: Women of Color (WOC) are disproportionately underrepresented in Plastic and Reconstructive Surgery. Only 3.6% of all plastic surgery program directors identify as WOC. Several studies show that women and underrepresented individuals are less likely to receive grant funding, have fewer publication opportunities, and hold fewer leadership positions. This study aims to identify the multifactorial determinants contributing to this disparity, focusing on the influence of first-generation professional status. Methods: A cross-sectional survey involving 200 WOC in plastic surgery yielded 116 responses (58% response rate). Variables such as leadership role, race/ethnicity, first-generation status, practice duration, and location were analyzed. Results were compared to ACGME and AMA data using bivariate analysis. Results: Most respondents were Integrated PRS Residents (40.5%) or private practice surgeons (22.4%). Assistant professors constituted 8.6%, while associate and full professors comprised 1.7% and 2.6%, respectively. Black/African Descent/African American individuals comprised 37.1% of respondents. First-generation professionals accounted for 39.7% of the respondents. Bivariate analysis indicated significant associations between first-generation status and professional roles (p=0.031) and between years of practice and professional titles (p<0.001). Conclusion: WOC are underrepresented, particularly in leadership and academic roles. First-generation status is a significant variable in career progression, necessitating targeted interventions to remove career advancement barriers. Addressing these disparities has implications beyond equity; it promises to improve patient care quality through culturally competent and diverse medical leadership.