Abstract Body (Do not enter title and authors here): Introduction: Substantial evidence indicates that racial and ethnic diversity among the physician workforce bridges cultural gaps and improves patient care. Trends in racial diversity across the full training pipeline from undergraduate to practicing cardiologist are not yet well-characterized.

Aims: We analyze racial disparities at each stage of training towards becoming a practicing cardiologist, and identify changes in these disparities between 2012 and 2022.

Methods: We conducted a retrospective analysis of data specifying the racial composition of medical trainees acquired from the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and Electronic Residency Application Service. Population data was acquired from the US Census Bureau. We computed the representation quotient (RQ) for each racial group at each stage to compare representation among the trainees or physicians to age-matched segments of the US population.

Results: RQ decreases from undergraduate to active cardiologist for African Americans (0.719 to 0.314), Hispanics (0.660 to 0.359), American Indians (0.551 to 0.221), and Native Hawaiians (1.121 to 0.512). The lowest RQs of 0.133 and 0.137 were observed for American Indian active internal medicine residents and cardiology fellows, respectively. Racial disparities in medical education declined between 2012 and 2022, with RQs increasing from 0.541 to 0.735 for African American medical school matriculants and from 0.444 to 0.578 for Hispanic medical school matriculants. Similar increases were seen in the active cardiologist population for African Americans (2013 RQ: 0.227, 2022 RQ: 0.342) and Hispanics (2013 RQ: 0.283, 2022 RQ: 0.375).

Conclusion: While racial diversity in the cardiology training pipeline has increased over the last decade, significant disparities persist for under-represented minorities. Addressing these barriers will help achieve a cardiology workforce reflective of the diverse population it serves.