The employment-to-population ratio measures the share of a population that is working: the number of employed people is divided by the total population and multiplied by 100. For people with disabilities ages 16 to 64, the 1.5-percentage-point rise from July to August represented a 3.9% relative increase, the report said. By comparison, the rate for people without disabilities in the same age range fell by 0.4 percentage points, or 0.5% relative to the July level. The difference between the two employment rates narrowed from 36.7 percentage points in July, based on rates of 38.3% and 75.0%, to 34.8 percentage points in August, based on rates of 39.8% and 74.6%. Thus, the August data recorded a smaller gap even though substantial differences remained between the groups.

Labor force participation also increased among people with disabilities while declining slightly among those without disabilities. Among people with disabilities ages 16 to 64, the rate increased from 42.4% in July 2026 to 43.4% in August, a one-percentage-point rise and a 2.4% relative increase. Among people without disabilities, participation fell from 78.2% to 77.9%, a decrease of 0.3 percentage points, or 0.4% relative to July. The labor force participation rate includes people who were employed, actively looking for work during the previous four weeks, or temporarily laid off or on furlough, and expresses that labor force as a share of the total population. The August participation rate for people with disabilities surpassed the previous record of 42.8% set in November 2025.

John O’Neill, director of the Center for Employment and Disability Research at Kessler Foundation, said the rise in employment after a July increase in active job seeking “suggests that many of those job seekers found work.” He had reported in July that more people with disabilities were actively looking for work relative to people without disabilities. The August employment increase is consistent with that stated interpretation, although the nTIDE figures are population-level measures rather than a count of individual job seekers moving into employment. The reported result is therefore a 1.5-percentage-point monthly increase in the employment-to-population ratio for people with disabilities, accompanied by a one-percentage-point rise in their labor force participation rate.

The year-to-year comparison also showed higher employment and labor force participation for people with disabilities. Between August 2025 and August 2026, the employment-to-population ratio for people with disabilities ages 16 to 64 increased from 38.5% to 39.8%, a gain of 1.3 percentage points, or 3.4% relative to the 2025 level. The rate for people without disabilities edged up from 74.5% to 74.6% over the same period, an increase of 0.1 percentage points, or 0.1%. Disability labor force participation rose from 42.2% to 43.4% year over year, a gain of 1.2 percentage points, or 2.8%. For people without disabilities, the participation rate was unchanged at 77.9% in both August 2025 and August 2026. On both the monthly and annual comparisons, therefore, the disability employment-to-population and labor force participation measures rose, while the non-disability measures were flat or slightly lower.

Andrew Houtenville, a professor of economics and director of the UNH Institute on Disability, called the record participation rate a generally positive sign of greater engagement in the labor market. He also connected the increase to financial pressure, noting that prices continue to rise and that many people with disabilities live at or below the poverty line. His comments described a possible economic context for stronger labor force participation, including the need of people with disabilities and their families to cope with rising living costs. The nTIDE figures reported in the release do not quantify the contribution of financial necessity, and the data do not separate employment choices made for different reasons. The measured finding itself is that 43.4% of people with disabilities ages 16 to 64 were working or otherwise participating in the labor force in August, the highest rate in the nTIDE series.

Counts released with the report place the scale of disability employment within the overall U.S. workforce. In August, 6,788,000 workers ages 16 to 64 had disabilities, representing 4.5% of the total 150,913,000 workers in that age range. This share is a workforce composition measure, not an employment rate: it compares the number of workers with disabilities with the total number of workers and does not show the proportion of all people with disabilities who were employed. The 39.8% employment-to-population figure answers that separate question by using the population of people with disabilities ages 16 to 64 as its denominator. Likewise, the 43.4% labor force participation figure includes both people who were employed and those who were unemployed but actively seeking work or temporarily away from a job.

The nTIDE project is a joint effort of Kessler Foundation and the University of New Hampshire’s Institute on Disability. It issues monthly reports on employment and labor force trends for people with and without disabilities using data from the U.S. Bureau of Labor Statistics. The series customizes the underlying data to focus on working-age adults ages 16 to 64, and the September 2026 report draws on the Bureau’s August jobs data. Its two principal measures describe different aspects of the labor market. The employment-to-population ratio captures the share who are working, while the labor force participation rate combines people who are working with those who are actively looking for work or temporarily laid off or on furlough. Both are expressed relative to the relevant population rather than to the size of the labor force alone.

The August results show that the new disability labor force participation record did not erase the difference between people with and without disabilities. The employment gap was 34.8 percentage points, calculated from the 39.8% rate for people with disabilities and the 74.6% rate for those without disabilities. The labor force participation gap was 34.5 percentage points, based on rates of 43.4% and 77.9%, respectively. Those August gaps followed the July employment gap of 36.7 percentage points and July participation gap of 35.8 percentage points, calculated from rates of 42.4% and 78.2%. The month therefore coincided with movement in the same direction for both groups: employment and participation increased among people with disabilities and decreased modestly among people without disabilities. Year over year, however, the changes for people without disabilities were comparatively small, while both disability measures increased more clearly.

Taken together, the September nTIDE results document a combination of record monthly levels and positive annual changes. Employment among people with disabilities matched the 39.8% high previously reached in November 2025, while labor force participation reached a new high of 43.4%. The strongest immediate movement occurred between July and August, when disability employment increased by 1.5 percentage points and participation rose by one percentage point. The report also provides population totals showing that 6.788 million working-age workers with disabilities accounted for 4.5% of all workers in the age range. Taken together, the figures indicate greater employment and labor market engagement among working-age Americans with disabilities in August 2026, alongside persistent disparities in the measured rates of employment and participation between people with and without disabilities.

Subject of Research: Monthly U.S. disability employment and labor force participation trends

Article Title: Employment among people with disabilities ties all-time high

Article References: Employment among people with disabilities ties all-time high. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: disability employment, labor force participation, nTIDE, employment-to-population ratio, workforce disparities, working-age adults, Bureau of Labor Statistics, August 2026, Kessler Foundation, UNH Institute on Disability, Employment, people

The research team, led by Sohail Khan of Touro College of Osteopathic Medicine together with collaborators at George Mason University, Stony Brook Medicine, Columbia University and other institutions, constructed a cross-sectional cohort of 892 directors. It included 179 medical student clerkship directors, 366 general surgery residency program directors, and fellowship directors in complex general surgical oncology, surgical critical care, minimally invasive surgery and endocrine surgery. Leadership identities were compiled from publicly available sources and national accreditation databases, including the Liaison Committee on Medical Education, the Accreditation Council for Graduate Medical Education, the National Resident Matching Program and the American Medical Association’s FREIDA database, supplemented by the Fellowship Council and the American Association of Endocrine Surgeons.

Demographic characteristics were ascertained using automated facial analysis with investigator adjudication, an approach that has become increasingly common in workforce diversity research where self-reported race and gender data are unavailable for public-facing professionals. The team used the Betaface API, version 2.0, with human reviewers confirming classifications. Categorical comparisons relied on Pearson chi-squared and Fisher exact tests, while multivariable logistic regression identified factors independently associated with holding leadership roles. All analyses were performed in STATA version 18E. Because the study relied exclusively on publicly available, aggregated data with no patient-level or identifiable private information, institutional review board approval was deemed exempt.

The headline numbers are unambiguous. Among the 892 directors, White surgeons predominated at 67.8 percent, followed by Asian surgeons at 18.2 percent, Middle Eastern surgeons at 5.3 percent, Hispanic surgeons at 4.8 percent and Black surgeons at 3.9 percent. Female representation across the entire cohort stood at 34.5 percent, but the figure varied dramatically by subspecialty, a difference that reached statistical significance at P less than .001. Endocrine surgery led the way with 48.0 percent female fellowship directors, while minimally invasive surgery sat at the bottom with just 20.3 percent. Asian surgeons were most visible at the fellowship tier in complex general surgical oncology, at 31.4 percent, and endocrine surgery, at 24.0 percent, while international medical graduates were most prevalent among directors in complex general surgical oncology at 20.0 percent and minimally invasive surgery at 18.3 percent.

Perhaps the most revealing structural signal came from academic rank. Rank distribution differed markedly across leadership tiers, again with P less than .001. Assistant professors constituted the plurality of clerkship directors at 44.1 percent, suggesting that the entry point of the educational pipeline is staffed disproportionately by junior faculty. At the opposite end, full professors were most common among fellowship directors in complex general surgical oncology at 40.0 percent and minimally invasive surgery at 33.3 percent. Institutional setting followed a similar gradient: residency program directors were predominantly community-based at 58.8 percent, whereas fellowship directors were primarily university-based. In other words, as leadership roles become more senior and more concentrated in elite academic centers, they become demographically narrower.

The pipeline benchmarking makes the attrition vivid. Between 2022 and 2025, across 214,411 medical school applicants and 5,988 matched general surgery residents, women accounted for 56.8 percent of applicants and 55.1 percent of matched residents. Black trainees represented 9.4 percent of matriculants and 7.2 percent of matched residents, and Hispanic trainees 6.4 percent of matriculants and 12.0 percent of matched residents. Every one of those proportions exceeds the corresponding group’s share of surgical education leadership. Black surgeons, at 3.9 percent of directors, hold leadership roles at less than half their rate of residency entry. Hispanic surgeons, at 4.8 percent of directors, fare even worse against their 12.0 percent share of matched residents. Women, the statistical majority of incoming residents, remain a one-third minority of directors overall and barely one in five in minimally invasive surgery.

The authors frame this discordance as demographic consolidation within senior academic ranks and university-based institutions across the surgical training continuum. The mechanism is consistent with the well-documented leaky pipeline literature cited in the study, which traces how underrepresented-in-medicine trainees encounter compounding barriers from undergraduate education through faculty advancement. Prior work has shown that mentorship alone is insufficient without active sponsorship, that early-career scholarly productivity gaps set the stage for unequal academic advancement, and that leadership demographics of training programs are themselves associated with trainee diversity. A leadership tier that does not reflect the trainees beneath it risks perpetuating itself, since directors control recruitment, evaluation, promotion and the informal networks through which opportunities flow.

The timing of the study lends it particular urgency. The published literature it draws on includes recent warnings that health care has become a new battlefront for anti-diversity, equity and inclusion attacks, and that anti-DEI legislation threatens both equitable surgical care and workforce diversity. In that climate, the study’s demonstration that gains at the trainee level are not being converted into governance-level representation provides an empirical baseline against which any policy retreat or advance can be measured. It also matters for patients: prior research has linked surgeon sex to long-term postoperative outcomes for common operations, and a diverse physician workforce is associated with improved trust and communication among racially and ethnically diverse patient populations.

Methodologically, the continuum-wide design is what distinguishes this analysis from earlier single-tier studies. Previous investigations have examined gender gaps among residency program leadership, diversity within individual fellowship directorships, or racial trends in specific subspecialty pipelines, but few have connected clerkship, residency and fellowship leadership into a single cross-sectional frame and benchmarked each tier against national applicant and match data. That design exposes the gradient directly: diversity is highest where the pipeline is widest and lowest where the funnel is narrowest, with the fellowship director tier, the most university-concentrated and most senior, showing the greatest consolidation. The subspecialty contrasts are equally instructive, since endocrine surgery’s near-parity female leadership and complex surgical oncology’s relatively high Asian and international medical graduate representation demonstrate that different structural cultures within surgery produce different outcomes from the same national pipeline.

The study’s limitations are those inherent to its design. Facial analysis, even with investigator adjudication, is an imperfect proxy for self-identified race and gender, and the cross-sectional snapshot cannot establish causation or track individuals over time. The fellowship analysis covers four subspecialties rather than the full breadth of surgical fellowship training. Still, the data availability statement notes that all figures derive from publicly accessible sources and are included in the published article and its supplementary files, making the findings independently verifiable. What the analysis delivers is a precise, reproducible map of where the surgical education system loses its diversity, and the map points unambiguously to the terminal bottleneck: the senior, university-based directorships that shape who enters the profession, how they are trained, and who among them will one day hold the levers of surgical governance. Until representation at that tier reflects the majority-female, increasingly diverse residency cohorts now moving through the pipeline, the study suggests, the demographic gains of the past decade will remain stranded at the bottom of the ladder.

Subject of Research: Demographic and structural disparities in U.S. surgical education leadership across the training continuum

Article Title: The terminal bottleneck: a continuum-wide cross-sectional analysis of demographic and structural disparities in U.S. surgical education leadership (2025–2026)

Article References: Khan, S., Toro, D., Yu, Y., Cohen, H., Zuluaga, D., Betterbed, D., Luo, T., McAfee, G., Mahal, S., Yamada, A., Ojukwu, K., Ortiz, A. C., Koizumi, N., Wen, K., Parikh, A., Chijioke, W., Ijaz, S., Arrioja, L., Li, M.-H., & Ortiz, J. (2026). The terminal bottleneck: a continuum-wide cross-sectional analysis of demographic and structural disparities in U.S. surgical education leadership (2025–2026). Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 148. https://doi.org/10.1007/s44186-026-00548-w

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00548-w

Keywords: surgical education, leadership diversity, academic surgery, workforce disparities, gender equity, underrepresented in medicine, fellowship directors, residency program directors, clerkship directors, leaky pipeline, medical education, health equity