The finding:
This study evaluated changes in C-L fellows’ race and gender over time through an analysis of the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Books. Between 2007 and 2019, there were relative and absolute decreases in C-L fellows who did not report their gender, potentially resulting in simultaneous relative and absolute increases in male and female fellow representation. Between 2011 and 2019, there were relative and absolute increases in C-L fellows who identified as White, relative and absolute decreases in C-L fellows who identified as African American/Black, Asian/Pacific Islander, and Others. There was no increase or decrease in C-L fellows who identified as Hispanic nor Native American/Alaskan.

Strength and weaknesses:
While an important publication for psychiatry at large, and for C-L psychiatry in particular, the article suffers from minimal acknowledgment on the lack of data on gender diversity which significantly impairs the analysis on minority gender representation. The article insufficiently addresses the impacts of the “not reported” gender or the “unknown” race categories on analyses. Nor does the article report the total number of fellows year over year, which inhibits a more comprehensive understanding of the trends presented. Nonetheless, the article is unique in the data presented and provides an opportunity for action.

Relevance:
The decrease in minority and marginalized populations represented within C-L psychiatry fellowships through the 2010s provides an opening for C-L fellowship directors and the Academy of Consultation-Liaison Psychiatry (ACLP) to further assess and understand barriers for these populations entering C-L psychiatry. External partnerships (eg, with the American Psychiatric Associations’ Division for Diversity and Health Equity) may be one opportunity to improve diversity in C-L psychiatry. More generally, better data are needed to understand the state of diversity in C-L psychiatry: nuances of gender and racial diversity are oversimplified by ACGME’s currently broad categories.