Women Surgeons Research Articles

How Does Orthopaedic Surgeon Gender Representation Vary by Career Stage, Regional Distribution, and Practice Size? A Large-Database Medicare Study.

Orthopaedic surgery has the lowest proportion of women surgeons in practice of any specialty in the United States. Preliminary studies suggest that patients who are treated by physicians of the same race, ethnicity, cultural background, or gender feel more comfortable with their care and may have better outcomes. Therefore, understanding the discrepancies in the diversity of the orthopaedic surgeon workforce is crucial to addressing system-wide healthcare inequities. (1) Does a difference exist in gender representation among practicing orthopaedic surgeons across geographic distributions and years in practice? (2) Does a difference exist in gender representation among practicing orthopaedic surgeons with regard to rural-urban setting, group practice size, and years in practice? Orthopaedic surgeons serving Medicare patients in 2017 were identified in the Medicare Physician and Other Supplier Public Use File and Physician Compare national databases. This dataset encompasses more than 64% of practicing orthopaedic surgeons, providing a low proportion of missing data compared with other survey techniques. Group practice size, location, and Rural-urban Commuting Area scores were compared across physician gender and years in practice. Linear and logistic regressions modeled gender and outcomes relationships adjusted by years in practice. Least-square means estimates for outcomes were calculated by gender at the median years in practice (19 years) via regression models. According to the combined Medicare databases used, 5% (1019 of 19,221) of orthopaedic surgeons serving Medicare patients were women; this proportion increased with decreasing years in practice (R 2 0.97; p < 0.001). Compared by region, the West region demonstrated the highest proportion of women orthopaedic surgeons overall (7% [259 of 3811]). The Midwest and South regions were below the national mean for proportions of women orthopaedic surgeons, both overall (5% [305 of 6666] and 5% [209 of 4146], respectively) and in the first 5 years of practice (9% [54 of 574] and 9% [74 of 817], respectively). Women worked in larger group practices than men (median [interquartile range] 118 physicians [20 to 636] versus median 56 [12 to 338]; p < 0.001, respectively). Both genders were more likely to practice in an urban setting, and when controlling for years in practice, there was no difference between men and women orthopaedic surgeons practicing in rural or urban settings (respectively, R 2 = 0.0004 and 0.07; p = 0.89 and 0.09). Among orthopaedic surgeons, there is only one woman for every 20 men caring for Medicare patients in the United States. Although gender representation is increasing longitudinally for women, it trails behind other surgical subspecialties substantially. Longitudinal mentoring programs, among other evidenced initiatives, should focus on the more pronounced underrepresentation identified in Midwestern/Southern regions and smaller group practices. Gender-based equity, inclusion, and diversity efforts should focus on recruitment strategies, and further research is needed to study how inclusion and diversity efforts among orthopaedic surgeons improves patient-centered care. Level III, therapeutic study.

Gender disparity in academic orthopedic programs in Canada: a cross-sectional study.

Background:The majority of the literature on gender disparity in orthopedic surgery is from the United States; the Canadian perspective is lacking. The objective of this study was to determine the representation of women faculty members and the proportion of women faculty in published leadership positions in academic orthopedic divisions and departments across Canada.Methods:In this cross-sectional study, we used a Web-based search strategy to identify faculty listings for all 17 academic orthopedic programs affiliated with the Association of Faculties of Medicine of Canada for the 2018/19 academic year. For each faculty member identified, we determined gender (man or woman), professorial rank and leadership positions. We compared regional gender differences among 3 groups: schools in eastern Canada and Quebec (6), Ontario (6) and western Canada (5). Gender comparisons were made for all variables of interest.Results:We identified 809 orthopedic surgeons at the 17 Canadian academic institutions, of whom 96 (11.9%) were women. In eastern Canada and Quebec, 16.2% of the faculty were women, significantly above the national average (p = 0.03). The corresponding values for Ontario and western Canada were 8.9% (p = 0.1) and 11.4% (p = 0.7). There were no significant differences in the proportions of women and men at lower levels of promotion, but significantly more men than women had attained full professorship (65 [9%] v. 1 [1%], p = 0.002). Women surgeons were not represented in leadership roles or within faculty roles of distinction.Conclusion:In 2018/19, women orthopedic surgeons were underrepresented in faculty positions across academic orthopedic training programs in Canada, and were disproportionately underrepresented in promoted academic faculty roles and leadership positions. These data can be used to review and educate on equity in hiring and promotion, as well as to foster mentorship and transition planning.

Sex Differences in Commercial Patient Reviews of Women and Men Urogynecologic Surgeons

The objective of our study was to describe differences in commercial patient reviews of women and men urogynecologic surgeons.Reviews of surgeons on Healthgrades.com in 4 metropolitan areas were included. Based on the qualitative assessment using qualitative content analysis of major and minor elements, we defined 4 theme categories: global experience, social interaction, technical skills, and ancillary aspects, each embedded with discrete elements. Differences in proportions of mentioned themes as well as quantitative ratings were evaluated by sex with the appropriate statistical tests.Three hundred sixty-four patient reviews (51% for women surgeons and 49% for men surgeons) were identified for 141 gynecologic surgeons self-identifying as "urogynecologists." The majority of the cohort (77%) held subspecialty certification in female pelvic medicine and reconstructive surgery. Reviews of women demonstrated a lower mean quantitative "likelihood to recommend" score compared with men (4.0 vs 4.3, P = 0.002) on the 5-point scale. Women received more mention in comfort (52% vs 40%, P = 0.023) and professionalism (19% vs 9%, P = 0.007) themes and less mention with respect to surgical outcomes (28% vs 53%, P < 0.001) and technical skills (5% vs 15%, P = 0.011) compared with men.Commercial online patient reviews for urogynecologic surgeons reveal sex bias with women receiving lower scores overall and more comments related to social interaction and fewer comments related to surgical outcomes and technical skill compared with men.

Experiences in training and practice as a woman and orthopaedic surgeon

Experiences in training and practice as a woman and orthopaedic surgeon

Women Surgeons in Brazil: A Time Trend Analysis by Specialties in the Last Decade.

In surgery, there is a gender worldwide gap. In Brazil, we still do not have studies that describe this scenario. Based on this lack of research, we aim to assess the prevalence of women in surgical specialties, how it has changed over the years and how long it will take to achieve an equal distribution of men and women surgeons in Brazil. We conducted a retrospective review of the last five editions of the Brazilian Medical Demography (2011, 2013, 2015, 2018, and 2020). We analyzed the absolute and proportional (women/total) increase in women registered in 13 surgical specialties in Brazil. We performed a linear regression, and we estimated the expected year of equal distribution of women and men in each subspecialty, through the linear regression equation. In absolute numbers of women, all surgical specialties presented a linear increase over the years (p <.05). In proportional numbers of women, however, 10 specialties showed a significant linear increase (p <.05) except cardiovascular surgery, hand surgery, and neurosurgery. According to the equation that predicts equal distribution, pediatric surgery will be the first one to achieve equal distribution, in 2026, and other specialties are far from achieving it. For example, Urology will not achieve equal distribution until 2433. There are fewer women surgeons in Brazil than men. However, in general, there is an increase in women in the analyzed specialties over the years. With the proportional inclusion of women in the Brazilian surgical workforce, we hope that we can achieve sex equality in Brazil.

Blinded intraoperative skill evaluations avoid gender-based bias.

Gender bias has been identified consistently in written performance evaluations. Qualitative tools may provide a standardized way to evaluate surgical skill and minimize gender bias. We hypothesized that there is no difference in operative time or GEARS scores in robotic hysterectomy for men vs women surgeons. Patients undergoing robotic hysterectomies performed between June 2019 and March 2020 at 8 hospitals within the same hospital system were captured into a prospective database. GEARS scores were assigned by crowd-sourced evaluators by a third party blinded to any surgeon- or patient-identifying information. One-way ANOVA was used to compare the mean operative time and GEARS scores for each group, and significant variables were included in a one-way ANCOVA to control for confounders. Two-tailed p-value < 0.05 was considered significant. Seventeen women and 13 men performed a total of 188 hysterectomies; women performed 34 (18%) and men performed 153 (81%). Women surgeons had a higher mean operative time (133 ± 58 vs 86.3 ± 46min, p = 0.024); after adjustment, there were no significant differences in operative time (p = 0.607). There was no significant difference between the genders in total GEARS score (20.0 ± 0.77 vs 20.2 ± 0.70, p = 0.415) or GEARS subcomponent scores: bimanual dexterity (3.98 ± 0.03 vs 4.00 ± 0.03, p = 0.705); depth perception (4.04 ± 0.04 vs 4.05 ± 0.02, p = 0.799); efficiency (3.79 ± 0.02 vs 3.82 ± 0.02, p = 0.437); force sensitivity (4.01 ± 0.04 vs 4.05 ± 0.05, p = 0.533); or robotic control (4.16 ± 0.03 vs 4.26 ± 0.01, p = 0.079). There was no difference in GEARS score between men vs womensurgeons performing robotic hysterectomies. Video-based blinded assessment of skills may minimize gender biases when evaluating surgical skill for competency evaluation and credentialing.

Ergonomic simulation investigating the association between surgeon characteristics and laparoscopic device strain in gynecologic surgery

Laparoscopic instruments are known to contribute to the ergonomic injury of surgeons. Laparoscopic devices have largely been designed as one-size-fits-all, however women surgeons and surgeons of smaller glove size have reported increased odds of physical strain from use of these devices. Our objective was to perform an ergonomic simulation to assess whether surgeon characteristics, including sex and hand size, were associated with grip strength decline with use of 3 advanced energy laparoscopic devices (LigaSure, HALO PKS, and ENSEAL).

Sexual misconduct in medicine must end

In September, 2021 two UK surgical trainees called for more recognition and awareness of sexual harassment, sexual assault, and rape in the surgical profession.1 In response some women surgeons shared their own experiences of sexual harassment and assault.2 More than 3 months later, the Royal College of Surgeons of England apologised for what these women had experienced and stated it was “outraged and appalled”.3 The Times headlined the events a “Me Too moment for NHS as female surgeons speak out”.

Disparities in access to quality surgical care for women in resource-constrained settings: Bottlenecks and the way forward.

Women seeking surgical care are burdened with gender disparities, particularly in resource-limited settings. Such disparities can lead to women often presenting late with advanced disease and poor prognoses. The current narrative review was planned to find evidence for gender disparities, their implications, challenges faced by women seeking surgical care, and strategies to address them. Potentiating from interplay between various societal, sociocultural, and economic barriers, the main challenges included inadequate autonomy, financial constraints, transport and referral issues, lack of experienced women surgeons, privacy concerns, surgeon distrust, and higher thresholds for seeking care. While research revealed these underlying causes, much work remains for governmental healthcare bodies, the international community, surgical leadership, policymakers, surgeons, and family members of patients to act on the highlighted issues. Unrestricted access to quality surgical care for everyone is of vital importance, and can translate into a significant decrease in preventable disabilities and deaths among women in resource-constrained settings.

Analysis of authorship trends in vascular surgery demonstrates a sticky surgical floor for women.

Prior research in vascular surgery has identified significant gender disparities in leadership positions, but few data exist regarding gender disparities in vascular publications. This study aims to evaluate authorship trends by gender in the three highest impact factor vascular surgery journals. In this bibliometric analysis, PubMed was searched for articles published in the European Journal of Vascular and Endovascular Surgery, the Journal of Vascular Surgery, and Annals of Vascular Surgery from 2015 to 2019. The web-based application Genderize used predictive algorithms to classify names of first and last authors as male or female. Statistical analyses regarding trends in authorship were performed using Stata16. A total of 6457 articles were analyzed, with first author gender predicted with >90% confidence in 83% (4889/5796) and last author gender in 88% (5078/5796). Overall, 25% (1223/4889) of articles had women first authors, and 10% (501/5078) had women last authors. From 2015 to 2019, there was a slight increase in the proportion of articles written by women first authors (P= .001), but no increase in the proportion of articles written by women last authors (P= .204). The proportion of articles written by women last authors was lower than the proportion of active women vascular surgeons in 2015 (8% of articles vs 11% of surgeons; P= .015), 2017 (9% of articles vs 13% of surgeons; P< .001), and 2019 (11% of articles vs 15% of practicing surgeons; P< .001). The average number of last-author publications was higher for men (2.35± 3.76) than for women (1.62± 1.88, P= .001). The proportion of unique authors who were women was less than the proportion of active women vascular surgeons in 2017 (10% unique authors vs 13% surgeons; P= .047), but not in 2015 (9% unique authors vs 11% surgeons; P= .192) or 2019 (13% unique authors vs 15% surgeons; P= .345). Notably, a woman last author was associated with 1.45 higher odds of having a woman first author (95% confidence interval, 1.17-1.79; P= .001). Over the past 5years, there has been no significant increase in women last authors among top-tier journals in vascular surgery. Women remain under-represented as last authors in terms of proportion of published articles, but not in terms of proportion of unique authors. Nevertheless, women last authors are more likely to publish with women first authors, indicating the importance of women-led mentorship in achieving publication gender equity. Support for women surgeons through grants and promotions is essential not only for advancing last authorship gender equity, but for advancing junior faculty and trainee academic careers.

Women Representation in Surgical Specialties: Reflections about Gender Equity after the 34th Brazilian Surgical Conference.

In September 2021, the 34th Brazilian Surgical Conference hosted the "Panel: Women in Surgery" - the only session in the event solely composed of female speakers. Although gender inequities in surgery are well recognized in the international literature, the panel portrayed how distant we are from the desired equity in our country. In addition, the session emphasized the need to broaden the debate and identify the mechanisms for greater inclusion and maintenance of women in the surgical career. In this editorial, we provide a historical overview of gender disparities in the Brazilian surgical ecosystem, highlight the contributing factors to a reduced number of female surgeons, and how the structure of medical societies may influence the rise of women to leadership positions. Accordingly, we discuss the benefits of gender diversity for surgeons, patients, and institutions. Furthermore, we analyze the representation of women in the Brazilian College of Surgeons since its foundation and in the scientific sessions at the conference, demonstrating that more initiatives are required to encourage female representation in the college. Finally, we propose a series of recommendations to foster engagement and contribute to the prosperity of women surgeons in Brazil.

Marika Daniilidou, MD. The First Female Orthopaedic Surgeon in Greece.

Dr Marika Daniilidou was born in 1902 in Asia Minor. Her family was forced to immigrate to Greece, in 1922. Despite the horrendous difficulties of the era, she pursued undergraduate and postgraduate studies in the University of Berlin, Germany, and she specialized in orthopaedic surgery. In 1937, she became the first female certified orthopaedic surgeon in Greece. In 1947, she was the only female orthopaedic surgeon among the 22 founders of the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST). She became a true role model for the next generations of Greek women surgeons.

Gender-Related Trends in Publication Authorship: A 10-Year Analysis of a Brazilian Surgical Journal.

There is a gender gap in the representation of women in the authorship of surgical literature worldwide. In Brazil, data on the gender distribution of the authorship of articles are scarce; and hence, there is a lack of awareness about the contemporary situation of women surgeons within the academic surgery in the country. In light of this, we conducted this study with an aim to describe and evaluate the authorship trends in a Brazilian surgical journal over a period of 10 years (2010-2019). We included 4,301 authors from 792 articles extracted from 60 editions of this journal. We analyzed the female representation as authors in general, first and last authors, and the female surgeons' representation as first and last authors for 568 original articles. We found that, in general, women represented 27.8% of all authors. Regarding original articles, women surgeons represented 8.4% and 6.1% of first and last authors, respectively. The linear regression analysis demonstrated that there was an increase over the years in women authorship. However, despite this increase over the years, a gender gap still persists in terms of women's representation as authors in the Brazilian surgical literature.

Women Physicians Pay High Price—Again

Back to table of contents Previous article Next article ProfessionalFull AccessWomen Physicians Pay High Price—AgainMaureen Sayres Van Niel, M.D.Maureen Sayres Van NielSearch for more papers by this author, M.D.Published Online:1 Oct 2021https://doi.org/10.1176/appi.pn.2021.11.32AbstractWomen physicians have significantly higher rates of infertility, pregnancy loss, and pregnancy complications.Two recent New York Times articles on health documented the increased incidence of infertility, pregnancy loss, and pregnancy complications among studied groups of women physicians. Here is a small sample of the recent papers on this topic.In a study published in the October 2016 in the Journal of Women’s Health, a random sample of 327 women physicians, 24% (more than twice the rate of the general population) had been diagnosed with infertility at a mean age of 33.7 years. Among those with infertility, 29.3% reported diminished ovarian reserve, and 21.3% never conceived. Faced with this infertility, many respondents would have tried to conceive earlier, chosen a different specialty, or pursued oocyte cryopreservation.A study posted July 28 in JAMA Surgery surveyed 692 female surgeons and 158 nonphysician female partners of male surgeons, who were used as controls. Female surgeons had fewer children and delayed childbearing. Nearly 25% of women surgeons had infertility necessitating in vitro fertilization. The survey also found that 42% of women surgeons had experienced a pregnancy loss, more than twice the rate of the general population, following which most of them had taken no time off. Female surgeons had significantly higher rates of major pregnancy complications such as perinatal depression, hypertensive and placental disease, and intrauterine growth restriction. More than half (56%) of the pregnant women surgeons surveyed worked more than 60 hours a week, and those working 12 or more hours a week in the operating room (OR) during the last trimester were subject to a higher complication rate. A woman surgeon featured in one of the Times articles had a small stroke after developing severe preeclampsia at 34 weeks after working long hours in the OR.A January 2015 study in Journal of Obstetrics and Gynaecology Canada of 3,767 medical and surgical residents found that residents have higher rates of pregnancy loss and pregnancy complications than the general population and that the rate of pregnancy complications was five times higher for those working more than 8 hours a week in the OR.These are sobering findings despite the fact that we do not yet have a prospective, randomized, controlled study that would provide more accurate data. Women physicians can likely anticipate double the infertility and pregnancy loss of other women and will have significantly more pregnancy complications, especially when they work long hours. Authors of the articles cited have proposed solutions to these problems that include providing residents and medical students with more education on infertility and cryopreservation, offering built-in support for women who undergo a pregnancy loss, and anticipating that the problem will likely self-correct because the percentage of female medical students has now surpassed men, giving women more agency in the system.One cannot help but think when reading this: Have we in medicine lost our minds? Have the institutions of medicine become so intransigent that they would rather see their women physicians suffer infertility, pregnancy complications, and loss than recognize the fact that, for example, women surgeons who are in their third trimester should not be required to stand in surgery for more than 12 hours a week—period? And why can’t residency programs that train future heart transplant surgeons solve the logistics of creating a residency system with built-in redundancy to accommodate the predictable number of women who will become pregnant during residency?The same women physicians who have already possibly endured unequal pay and sexual harassment and who have hidden in bathrooms to pump their breast milk to conform to present expectations are now suffering painful intrusions into their ability to get pregnant, carry their baby to term, and have a pregnancy freer of complications. Academic medicine has not autocorrected over the years to accommodate the beautiful biology of so many of its contributing members. If we had not already reached the limit, we have reached it now. We don’t need small adjustments to the current system; we need a wholesale change. Medical institutions, all physicians, and especially we as psychiatrists must rise up immediately to enact solutions to this intolerable reality. ■“A Medical Career, at a Cost: Infertility” is posted at here.“Surgeons at Greater Risk of Pregnancy Loss, Study Finds” is posted here.“Fertility and Childbearing Among American Female Physicians” is posted here.“Incidence of Infertility and Pregnancy Complications in US Female Surgeons” is posted here.“Obstetrical Complications in Pregnant Medical and Surgical Residents” is posted here.Maureen Sayres Van Niel, M.D., is the immediate past president of the APA Caucus of Women Psychiatrists. She is a reproductive psychiatrist and private consultant in Cambridge, Mass. ISSUES NewArchived

Proceed, With Caution: Unconscious Bias in Technical Assessment.

Proceed, With Caution: Unconscious Bias in Technical Assessment.

A Preliminary Survey of Women Orthopaedic Surgeons on Awareness of Radiation Safety Practice and Breast Cancer Risk in India.

To assess women surgeons' awareness of radiation protection protocols, cumulative dose, safety measures, radiation exposure, and breast cancer risk in India. The data were acquired through a survey monkey questionnairecirculated to women orthopaedic surgeons across the country through the WOICE group, e-mails and phone. The questionnaire assessed the respondents' awareness of radiation protection measures and level of exposure. Medical history on breast cancer during their professional life, time of diagnosis, and radiation exposure were collected. Data were analysed and expressed as percentages. Fifty-one women orthopaedic surgeons responded. These were sub-grouped into early and late-career group based on whether they had worked in orthopaedics for less than 10years (n = 33) or 10 or more years (n = 18). The mean number of years of practice of the respondents was 8.1years, and for the group with 10 or more years was 18.7years. 90.2% reported compliance to the lead shield, while 9.8% (n = 5) were non-compliant because of the shield's weight. Of the included respondents, 88.8% are currently working. Among all the respondents, only 13.7% (n = 7) use a radiation dosimeter. Not surprisingly, 88.2% (n = 45) of all respondents were unaware of the total radiation exposure received. Two surgeons in the more than 10-year practice category reported a history of breast carcinoma. This preliminary report suggested a need for more awareness of radiation protection measures among women orthopaedic surgeons. Hence, along with the practice of wearing a lead gown, use of lightweight shield, awareness on exposure measure and use of radiation dosimeter should be encouraged.

Women treating lung cancer: a narrative review

: A lack of women in leadership positions is a common problem across medical specialties that treat lung cancer. Academic medicine appears to be falling behind science, technology, engineering, and mathematics in eliminating gender differences in promotion. Barriers to advancement in thoracic surgery, an essential specialty in the multidisciplinary team required to care for patients with lung cancer, include length of training, discrimination and harassment during training, difficulty balancing personal life and career, and a lack of role models. Fewer than 30% of section and division chiefs and <20% of department chairs are women. Very few women have achieved the position of full professor in a surgery department or department chairman. Addressing barriers to the academic advancement of female oncologists and thoracic surgeons may facilitate equity and improve collaborative research efforts, given the value that diversity brings to team endeavors. The quality of care and the clinical outcomes provided by women physicians are at least equivalent to those of men. There is a strong support from major international societies to increase the role of women in many specialties important to lung cancer treatment by promoting mentorship and equal career opportunities. Additionally, organizations, such as Women in Thoracic Surgery (WTS) and Women in Medicine and Science (WIMS) chapters, specifically focus their efforts on empowering women physicians and surgeons.

Gender imbalance amongst promotion and leadership in academic surgical programs in Canada: A cross-sectional Investigation.

Women are underrepresented at higher levels of promotion or leadership despite the increasing number of women physicians. In surgery, this has been compounded by historical underrepresentation. With a nation-wide focus on the importance of diversity, our aim was to provide a current snapshot of gender representation in Canadian universities. This cross-sectional online website review assessed the current faculty listings for 17 university-affiliated academic surgical training departments across Canada in the 2019/2020 academic year. Gender diversity of academic surgical faculty was assessed across surgical disciplines. Additionally, gender diversity in career advancement, as described by published leadership roles, promotion and faculty appointment, was analyzed. Women surgeons are underrepresented across Canadian surgical specialties (totals: 2,689 men versus 531 women). There are significant differences in the gender representation of surgeons between specialties and between universities, regardless of specialty. Women surgeons had a much lower likelihood of being at the highest levels of promotion (OR: 0.269, 95% CI: 0.179-0.405). Men surgeons were statistically more likely to hold academic leadership positions than women (p = 0.0002). Women surgeons had a much lower likelihood of being at the highest levels of leadership (OR: 0.372, 95% CI: 0.216-0.641). This study demonstrates that women surgeons are significantly underrepresented at the highest levels of academic promotion and leadership in Canada. Our findings allow for a direct comparison between Canadian surgical subspecialties and universities. Individual institutions can use these data to critically appraise diversity policies already in place, assess their workforce and apply a metric from which change can be measured.

Women Representation in Academic Vascular Surgery: Leadership, Education, and Research

There has been an increase in the proportion of registered women vascular surgeons in the past 5 years. It is unclear whether these changes have been reflected within leadership positions within vascular surgery. The purpose of our study was to quantify and highlight women representation within academic vascular surgery, specifically among editorial boards, the Society for Vascular Surgery (SVS), and in training program directors. Data on program directors and department or division leadership was determined by visiting the individual websites of all active vascular surgery residencies (n = 63) and fellowships (n = 116). Data on committee involvement was obtained from the SVS website (https://vascular.org/about/councils-and-committees). Demographics on editorial boards was determined from the top three vascular surgery-specific journals with the highest impact factors: Journal of Vascular Surgery, Journal of Vascular and Endovascular Surgery, and Annals of Vascular Surgery. Gender was assumed from the use of pronouns in surgeon biographies. The proportion of women vascular surgeons in the above leadership positions was compared with the demographics of the 2019 active physician's data available through the Association of American Medical Colleges using χ2 tests. Our analysis revealed significant disparities between men and women in vascular surgery leadership. Among active vascular surgeons, women account for 14.6% (575/3941) of the total workforce. Among the three highest impact vascular surgery journals, women comprised only 8.6% (25/291) of the editorial board, which was significantly lower than the proportion of active women vascular surgeons (P = .006). In contrast, 45.16% (14/31) of the SVS committee leadership positions were held by women (14/31), which was significantly higher than the proportion of active women surgeons (P < .001). Within vascular surgery training programs, women account for 14.52% (9/62 positions) of program directors in the integrated residency programs and 12.07% (14/116 positions) of program directors in fellowship programs (P = 1.0 and P = .487, respectively). Among division chiefs in the same academic institutions, women comprised only 4.81% (5/104 positions; P = .007) (Fig). Our results suggest that women are well-represented among SVS committee leadership but underrepresented among journal editorial boards and division leadership. Of note, our analysis may over-represent women in leadership as some individuals held multiple positions both within their institution and nationally. Leadership positions should evolve with the changing demographics of vascular surgeons, and additional research is needed to understand attitudes and barriers to a more balanced representation. In addition, gender was assumed based off pronoun usage, and self-reported data is needed to capture gender identity more accurately.

Treatment Recommendations for Suspected Scapholunate Ligament Pathology.

Background The diagnosis and treatment of scapholunate interosseous ligament (SLIL) pathology is debated and notably variable. This study assessed the influence of diagnostic arthroscopy on treatment recommendations and the interobserver reliability of the arthroscopic classification of SLIL pathology. Methods The influence of diagnostic arthroscopy on treatment recommendations and the reliability of the arthroscopic classification of SLIL pathology were tested in a survey-based experiment. Seventy-seven surgeons evaluated 16 scenarios of people with wrist pain with variation in symptoms, scaphoid shift, time of symptom onset, and MRI appearance of the SLIL. Participants were randomized to view or not to view diagnostic wrist arthroscopy. Factors associated with recommendation for repair, capsulodesis, or tenodesis were analyzed. Results Viewing arthroscopic videos was associated with both offering surgery and a more reconstructive option. Other factors independently associated with recommendation for surgery included greater pain intensity and activity intolerance, women surgeons, an asymmetric scaphoid shift, and a recent onset of symptoms. The interobserver reliability of SLIL classification was slight. Conclusions Diagnostic arthroscopy leads to more surgery, and more invasive surgery, in spite of unreliable assessment of pathology. Clinical Relevance This points to the need to measure the potential benefits and harms of diagnostic wrist arthroscopy among people with wrist pain and no clear diagnosis on interview, examination, and radiographs. Level of Evidence Not applicable.