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Women in orthopedic surgery: Raise the bar, narrow the gap
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More women enter the profession of medicine every year. However, there has not been an equal increase in the number of women entering the field of orthopedic surgery. The same questions and concerns about the limiting factors of orthopedic surgery seem to come up every year as well.
According to 2013 National Resident Matching Program data, 1,038 applicants which included 833 seniors — applied for 693 spots in orthopedic surgery. Of these, 692 spots were filled indicating that orthopedic surgery remains one of the most desired fields among medical school seniors. Orthopedic applicants remain some of the most competitive applicants, with proportionally higher board scores, publication numbers and grades.
Even though there is a substantial applicant pool, we may still be missing some elite applicants. This is for no other reason than the fact that proportionally fewer female applicants apply to orthopedic surgery. As Jo A. Hannifan, MD, PhD, notes in this month’s Cover Story, it follows that half of the most qualified applicants for residency are female given that half the medical student population in most medical schools is female. Thus, ideally, half of the applicants to orthopedic surgery would also be women, thus providing an applicant pool that truly represents the best medical school students.
Barriers and stereotypes
The number of women entering orthopedic surgery from medical school remains unacceptably low — now surpassed by other historically male-dominated fields, such as neurosurgery, urology and general surgery. Even more concerning is that despite the increase of female orthopedic residents from 9% in 2001 to 14% in 2011, 4.8% of the practicing orthopedic surgeons in the United States in 2012 were women.
Anthony A. Romeo
Rachel M. Frank
Within the American Academy of Orthopaedic Surgeons (AAOS), Ruth Jackson Orthopaedic Society (RJOS) and the specialty societies of orthopedic surgery, women hold 23 of the 176 leadership positions for the current academic year. However, if one were to exclude the nine current leadership positions of the RJOS, which are all held by women, 14 women hold the remaining 167 leadership positions. Only the RJOS and the American Orthopaedic Society for Sports Medicine currently have female presidents.
There are multiple barriers to increasing the number of women in orthopedic surgery. As noted by several surgeons in this month’s Cover Story, stereotypes about orthopedic surgery as well as the prototypical physique and character traits of orthopedic surgeons still exist. These stereotypes and myths are not easily dispelled, especially with a relatively low volume of practicing female orthopedic surgeons able to serve as mentors.
Potentially more problematic than previously appreciated are the unspoken biases about closing the gender gap in orthopedic surgery. Some people may argue that the most qualified applicants get into the field regardless of gender, so there is no need for additional efforts to change this, even at the cost of a lack of diversification. In this argument, it is easier to maintain the status quo, and thus, true attempts to increase diversity are limited from within the field.
Increase awareness
The benefits of patient care brought about by narrowing the gender gap cannot be underestimated. Increasing diversity of the workforce, both within residency programs and faculty positions, allows for an improved understanding of patients’ needs and backgrounds, which are often times more complex than the orthopedic complaints with which patients originally presented.
Substantial efforts during the past 2 decades have helped to increase awareness of the need to further diversify orthopedic surgery. Organizations, such as the RJOS, AAOS Diversity Advisory Board, Perry Initiative and the Nth Dimensions, have taken the lead on education and awareness.
The RJOS is a professional group with a mission to promote the professional growth and leadership of female orthopedic surgeons as well as to advance the practice of orthopedic surgery among women. This society has increased in membership every year since its inception in the early 1980s, and actively promotes resident and medical student participation through workshops, research endeavors and mentorship. The society is open to membership from both men and women, and also supports the academic achievements of both genders.
The AAOS Diversity Advisory Board focuses on medical student outreach and recruitment, as well as culturally competent care education initiatives. In addition to advocating for the recruitment of women into orthopedic surgery, the board attempts to diversify orthopedic surgery as a whole.
The Perry Initiative aims to inspire women to become leaders in orthopedic surgery and engineering. Since its inception in 2009, the organization has grown tremendously and provides substantial outreach programs for high school, college and medical students. Programs offer young women the opportunity to get hands-on experience with orthopedic instruments and implants, and provide inspiration for future career decisions and mentorship.
Nth Dimensions was recently established to address health care disparities by encouraging medical students from both gender and ethnic minority groups into the field of orthopedic surgery. The organization provides education and mentorship for medical students interested in orthopedic surgery with workshops, leadership forums, residency match strategic planning and other educational programs.
Together, these programs have filled a much-needed void in the recruitment of women into orthopedic surgery. They provide mentorship, which can otherwise be difficult for medical students to obtain, especially early in training. Mentorship is critical to success to both genders. However, for aspiring female orthopedic surgeons, it is even more critical as they look to practicing female orthopedic surgeons to see that their career choice is possible.
Leadership positions
Narrowing the gender gap in orthopedic surgery is crucial for the advancement of orthopedics and patient care. The numbers are simple. If we want to continue to attract the best applicants, then we have to better advocate for women to enter orthopedics.
Increasing the number of female orthopedic surgery residents and attending orthopedic surgeons is likely to increase the number of women in positions of leadership. We need more women to hold faculty and leadership positions within orthopedic societies. Not only will their leadership and mentorship encourage female medical students to enter orthopedic surgery, it will also show current female orthopedic residents that they can achieve the same levels of success and promotion as their male counterparts. It becomes a self-sustaining mechanism that more women will enter orthopedics when other women advance into leadership positions.
We must also continue to promote the ongoing efforts of the organizations that work to increase diversity within orthopedic surgery. The opportunities for residents and faculty members to contribute to the organizations are abundant, but we must be actively involved in the efforts.
Mentorship alone cannot replace the discipline and sacrifice necessary to be a successful orthopedic surgeon. However, by demystifying stereotypes, breaking down barriers and fostering career development of young female orthopedic surgeons through mentorship we can truly make this field the best it can be. Together, our sustained efforts will encourage the best medical students, including the half who are women, to enter orthopedic surgery.
For more information:
Rachel M. Frank, MD, can be reached at 1611 W. Harrison St., Suite 300, Chicago, IL 60612; email: rmfrank3@gmail.com.
Disclosures: Romeo receives royalties, is on the speakers bureau and a consultant for Arthrex Inc.; does contracted research for Arthrex Inc. and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex Inc., Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed. Frank has no relevant financial disclosures.
Additional disclosure: Romeo is the proud father of five daughters.