Professional societies strive to bring diversity to orthopedics

Many medical students are not exposed to minority or female orthopedist role models; three orthopedic societies are working together to change that.

Issue: May 2003

Various professional societies have banded together to change perceptions of the specialty and increase the number of women and minorities entering orthopedics.

“There appears to be a myth that ‘brute’ strength and athletic experience are required to enter this specialty,” Claudia Thomas, MD, assistant professor of orthopedic surgery at Johns Hopkins University and the first U.S. African-American female orthopedic surgeon, told Orthopedics Today.

“Therefore, the American Academy of Orthopaedic Surgeons, the Ruth Jackson Orthopaedic Society, and the J. Robert Gladden Orthopedic Society are joining forces to get the word out that this specialty can be performed by either gender of any ethnicity.”

The 2002 Institute of Medicine report titled “Unequal Treatment: What Healthcare Providers Need to Know About Racial and Ethnic Disparities in Healthcare” highlighted the disparities between physicians and minorities, thus prompting the American Medical Association and many specialty associations to focus on ways to increase the number of minorities and women entering medicine. Minority Americans tend to be in poorer health and struggle with access to care more than white Americans. And research has shown that minority physicians often return to their communities to treat minority patients — a huge, underserved population.

Despite the rise in women (approximately 45%) and minorities (approximately 35%) entering medicine in general, there is still a big discrepancy seen in orthopedics. Statistics from an AAOS survey of program directors from 111 U.S. Residency Programs for the 2001/2002 academic year showed that orthopedics is still a white, male-dominated profession.

However, encouraging data can also be extrapolated from this survey The findings showed that regardless of ethnicity, the number of women enrolled as sixth year residents was 4.2%; the number of women in the second year of a program rose to 27.1%. Similarly, for male residents across ethnicity it has risen from 3.6% of sixth year residents to 24.7% second year residents.

Promoting diversity

Diversity is slowly emerging in orthopedics thanks, in part, to the efforts of the AAOS Diversity Committee, established in 1997. The committee recently debuted its Diversity in Orthopaedics Web site, which is targeted to three audiences — medical students, practicing orthopedists and orthopedic residency directors. Last year, the Diversity Committee introduced a new mentoring initiative, The Changing Face of Orthopaedics, and in February, it presented the first annual AAOS Diversity Award.

“Our goal is to plant the seed as early as possible that orthopedics is an excellent specialty for women and minorities to choose,” Thomas said. Many medical students are not even aware of orthopedics as a choice nor are they ever exposed to a minority or female orthopedic role model. Often, they are pushed into nonspecialty practices. To change this, the three societies have established mentoring programs. By linking volunteer, practicing orthopedists with first- or second-year medical students, the goal is to expose them to orthopedics and help them in the process of obtaining a competitive orthopedic residency.

The committee has also produced culturally sensitive recruitment materials for program directors to use and is encouraging them to be open-minded. Although the AAOS has increased its efforts to attract women and minorities, the “intent is not to lower the standards for those accepted into orthopedic training programs,” as stated by Vernon T. Tolo, MD, former AAOS president in a recent AAOS Online Bulletin. “Qualification and diversification can and should co-exist.”

A fear of isolation — being the only woman or minority in a program — has kept many qualified applicants from entering orthopedics. Needless to say, schools and training programs with women and minority students, faculty and staff tend to attract more of the same. Thomas, who trained under Wayne O. Southwick, MD, the first recipient of the Diversity Award, said that “Yale has a commitment to diversity as evident in Dr. Southwick’s equitable approach to recruitment — Choose the best horse to run the race!”

Slowly moving forward

Even with the increased awareness, disparities may still continue after residency, especially for women. “Many male orthopedists are still amazed and bewildered that women are doing the same thing they are,” Thomas said. “Women orthopedists who join an all-male practice are sometimes still discriminated against. They are still a novelty in some areas of the country. Therefore, they may decide to strike out on their own or go into academics, where there is not such a sharp disparity between the treatment of men and women.”

Even in academics, there is room for improvement and the need for more mentors. Although dated, statistics from a 1996 American Association of Medical Colleges Project Committee on Increasing Women’s Leadership in Academic Medicine reported that out of 119 women faculty or administrators in orthopedic surgery, only five were full professors, one a division chief and none a department chair. Women in orthopedics are not advancing in academic tenure positions at the same rate as men.

Although “bias is hard to change,” Thomas said, some areas are improving. “When I was in residency, marriage and family were not an option. Today, women are getting married and having children during residency. It takes support from colleagues and family, but it can be done. Subspecialties, such as hand surgery, which are not as physically demanding or require as much on-call, are attracting more women desiring a work/ life balance.