Letter to the Editor: How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States? An Analysis of the National Provider Identifier Registry.

Abstract

To the Editor, Orthopaedic surgery is a "boys’ club." Are you sure you want to pursue it? Women do not possess the brute strength required for orthopaedics! How about considering something less physically demanding? Any medical student who is a woman and who is interested in orthopaedics has probably heard some form of the statements above at some point. Still, these sentiments are not unique to orthopaedic surgery. Women currently comprise 14% of orthopaedic surgery residents and 7% of practicing orthopaedic surgeons [3]. Although the struggle to achieve gender parity is seen in many surgical specialties, orthopaedic surgery has not realized the same progress in diversity that has been achieved by other surgical subspecialties [1, 11]. In their recent analysis of the National Provider Identifier Registry, Acuña et al. [1] found that marked regional differences exist in the percentage of women orthopaedic faculty, with the lowest proportion in the South Atlantic division (8%). Changes over time differed by region, too, with the South and West experiencing the slowest growth rates (19% and 17%, respectively). The authors further state that “Based on its current growth rate, it will take 217 years for orthopaedic surgery to achieve gender parity” [1]. This projection is even more dire than noted in an earlier, thematically related study [1]. As Acuña et al. demonstrated, women medical students are more likely to positively perceive the field following exposure during clinical rotations than men, who tend to develop their interest before clerkships [10, 13]. This suggests that the more women orthopaedic faculty and residents in a program, the higher the residency application rate of women medical students [9]. In addition, effective mentorship, rotations, and increased clinical exposure can positively influence the perception of the field. Therefore, we echo Acuña et al.’s recommendations for orthopaedic program directors to consider setting a benchmark for the percentage of women orthopaedic surgeons hired and residents accepted into their departments. In your May 2021 “Take 5” interview [7] with the senior author of the paper Dr. Atul Kamath [1], Dr. Kamath points out that over 50% of current medical students are women. Why, then, is the field of orthopaedic surgery so slow to catch up? Dr. Kamath referenced a recent study that found that gender was not associated with decreased odds of acceptance into orthopaedic residency programs. Race, however, was [12]. According to Gerull et al. [5], in 2018, only 5.8% of practicing orthopaedic surgeons were women, and 89.3% of all practicing surgeons in the U.S. were white. In a field with such a highly uneven distribution of women and racial minorities [2, 15], we would be remiss to separate race from our discussion of gender disparity, as the intersectionality of the two poses a greater “risk” than does gender alone. When nearly every faculty member is a man, it is difficult to ignore the “boys’ club” element. It is harder, still, to feel a sense of belonging when one’s fellow students seemingly fit the typical orthopaedic profile: men, white, and former athletes, as another recent study found [4]. Microaggressions, unequal expectations compared to white counterparts, and feelings of isolation are all core issues voiced by Black orthopaedic residents and have detrimental effects on retention of a diverse workforce [8, 10]. It is no wonder that between 2006 and 2015, orthopaedic surgery saw a 3.85% drop in its average percentage of minority residents each year [11]. Such a decline has far-reaching effects; multiple studies have shown the impact of diversity in improving organizational and healthcare outcomes [6, 14]. Thus, if lasting change and improved patient care are what we desire, racial and gender disparities must be addressed. We need both individual and collective action—facilitating environments for uncomfortable yet meaningful conversations as a community and looking within as individuals. As a field, perhaps it is time to seek help from outside resources—adoption of department-wide scorecards may provide a good start for orthopaedic departments looking for ways to improve gender and racial equity [5]. Now is the time for innovative solutions, support for diversity initiatives, and mentorship experiences. It will most certainly take hard, concerted work at both the individual and community level, but none of us chose the field of orthopaedics because we shy away from a challenge, did we? We hope this article by Acuña et al. [1] can be a call to arms for us—we cannot afford to wait.