Underrepresented in Medicine and Gender Trends in Ophthalmology: A Retrospective Analysis.

Representation in the physician workforce is essential for equitable patient care, yet trends in underrepresented in medicine (URIM) and female representation in ophthalmology relative to other specialties remain unclear. We conducted a population-based retrospective cross-sectional analysis from 2011 to 2024 to evaluate trends in URIM and female representation in ophthalmology compared with other surgical and nonsurgical residency programs. We also compared these trends among applicants, matched participants, and active residents within ophthalmology. Participants included ophthalmology residents in ACGME-accredited programs (2011-2024) and applicants and matched participants in the San Francisco Match (2016-2024). Primary outcomes were the proportions of URIM and female applicants and residents and changes over time. Data included 5,664 ophthalmology applicants (3,734 matched) for race/ethnicity and 6,206 applicants (4,420 matched) for gender from 2016-2024, and more than 1.27 million residents for race/ethnicity and 1.4 million for gender from 2011-2024. URIM representation increased significantly among applicants from 8.75% to 24.3% (absolute increase 15.6 percentage points, 95% CI 12.06-19.08) and among matched participants from 6.61% to 30.26% (23.6 percentage points, 95% CI 19.1-28.2). Among residents, URIM representation rose from 7.3% to 13.4% (6.1 percentage points, 95% CI 3.92-8.28). Female applicants increased from 40.0% to 45.2%, and matched female participants from 41.4% to 47.9%. However, female representation among ophthalmology residents declined slightly from 42.4% to 40.6% (-1.8 percentage points, 95% CI -5.5 to -1.9), while increasing significantly in other surgical specialties (+8.6 percentage points, 95% CI 7.7-9.5). Trend analyses confirmed statistical significance (all p < 0.001). Ophthalmology has made meaningful gains in URIM representation across the training pipeline, but improvements in gender representation have not translated into sustained increases among active residents, underscoring the need for longitudinal, specialty-specific strategies beyond recruitment alone.