The Latino Resident Physician Shortage: A Challenge and Opportunity for Equity, Diversity, and Inclusion.

PURPOSE: The purpose of this study is to examine the number of Latino physicians in residency training and Latino resident physician trends in the nation's 10 largest medical specialties in the United States and in the 4 states with the largest Latino populations: California, Florida, New York, and Texas. METHOD: The authors used data from the United States Census Bureau's American Community Survey to determine Latino populations and a special report from the Association of American Medical Colleges to determine rates of Latino resident physicians in the United States and in California, Florida, New York, and Texas from 2001 to 2017. Rates of Latino residents in the nation's 10 specialties with the largest number of residents were also determined. RESULTS: From 2001 to 2017, the United States had an average of 37 resident physicians per 100,000 population. At the national level, however, Latino residents were underrepresented, with only 14 per 100,000 Latino population. At the state level, California and Texas, the 2 states with the largest Latino populations (39.4% and 39.7% of their population, respectively), had 5 and 9 Latino residents per 100,000 Latino population, respectively. Latino residents in California, Texas, Florida, and New York were also very underrepresented in the primary care specialties examined. CONCLUSIONS: The findings show a severe shortage of Latino resident physicians. While a similar shortage also exists in primary care specialties, the majority of Latinos in states with large Latino populations are consistently choosing to train in primary care. Investment and greater improvement in the representation of certain population groups in medicine and for combating the inequities existing in the current educational system is needed. The authors offer recommendations to increase the number of Latinos in residency programs and for increasing the number of Spanish-speaking physicians and Latino international medical graduates in residency programs.

Gelatin-thrombin hemostatic matrix in the management of placental site postpartum hemorrhage: a case report.

BACKGROUND: Gelatin-thrombin matrix (FloSeal, Baxter Healthcare Corporation, Fremont, California), a biodegradable hemostatic sealant, has been shown to control bleeding in multiple intraoperative scenarios and surgical disciplines. However, limited data is available regarding its use in obstetrics. A case of placental-site obstetric hemorrhage controlled with gelatin-thrombin matrix at time of cesarean delivery is presented. CASE: A 28-year-old woman underwent a tertiary repeat cesarean delivery for complete placenta previa. The placenta was removed without evidence of placenta accreta. Profuse bleeding occurred over the placental implantation site, resulting in hemorrhage, uncontrolled by conservative uterine-sparing methods. Upon preparation for emergency hysterectomy, gelatin-thrombin matrix was applied, resulting in rapid control of hemorrhage. CONCLUSION: Abnormal placentation is a predisposing factor of postpartum hemorrhage. In the absence of placenta accreta, profuse hemorrhage can occur from large vascular sinuses associated with a denuded implantation site in the poorly contractile lower uterine segment. In the event of unsuccessful hemorrhage control with conservative techniques, emergency hysterectomy is performed as a life-saving procedure. Multiple unit blood transfusion is often encountered. In the case presented, the use of gelatin-thrombin matrix gel for placental site hemorrhage management at the time of cesarean delivery resulted in rapid control of hemorrhage, uterine preservation and avoidance of massive blood transfusion.