Study: Diversity in orthopedic leadership made minimal progress from 2007 to 2019
Although diversity in orthopedic surgery leadership has improved in some key areas, published results showed a decrease in representation of gender and underrepresented groups between orthopedic faculty and orthopedic leadership.
“While numerous other articles have discussed the lack of racial and gender diversity in our field at the resident/faculty level, this is the first article to discuss the further narrowing of current minority chairs of orthopedic surgery nationally as compared to the current minority orthopedic faculty representation,” Charles S. Day, MD, MBA, interim medical director and chair and professor of orthopedic surgery in the department of orthopedic surgery and service line at Wayne State University School of Medicine, Henry Ford Health, told Healio. “There has been no significant improvement in minority orthopedic chairs from 2007 to 2020 despite significant focus on this issue from both the American Academy of Orthopaedic Surgeons and American Orthopaedic Association leadership in this millennium.”
Day and colleagues collected demographic data from JAMA and the Association of American Medical Colleges and utilized aggregate data to determine the racial, ethnic and gender composition of academic leadership for eight surgical and nonsurgical specialties in 2007 and 2019. Researchers conducted a comparative analysis to identify changes in diversity among chairpersons between the 2 years. Researchers also compared current levels of diversity in orthopedic leadership with those of other specialties.
Compared with nonsurgical specialties, results showed orthopedic surgery had a significantly lower representation of underrepresented groups among program directors at 20.5% in 2020. Researchers also found that, with the exception of neurological surgery, orthopedic surgery had the lowest proportion of female program directors overall at 9%. Although orthopedic surgery had no change in representation of underrepresented groups among chairpersons from 2007 to 2019, researchers noted orthopedic surgery had a significant increase in female representation among chairpersons from 0% to 4.1%. When comparing the diversity of 2019 orthopedic faculty to orthopedic leadership in 2019/2020, researchers observed a significant decrease in representation of underrepresented groups and women.
“When compared to neurosurgery, [otolaryngology], surgery, OB/GYN, family medicine, internal medicine and pediatrics, orthopedics has the smallest representation of minority chairs,” Day said. “When comparing women chairs, orthopedics is similar to neurosurgery, [otolaryngology] and surgery. Perhaps the most important finding is that across all eight subspecialties analyzed, there was a similar decrease in minority chairs as compared to minority faculty representations in those fields. This suggests that the decrease in minority leadership from faculty representation may be a more pervasive issue across all of academic medicine.”
Perspective
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This paper represents a relatively recent phase of our collective journey building a diverse workforce and inclusive environment for our teams and patients. As the authors mention, for decades there has been a focus on pipeline programming to decrease disparities in medical school and graduate medical education. Upon completion of training, however, the intentional mentorship pipeline comes to a rather abrupt halt in many cases and pursuit of leadership careers in academic medicine becomes less of an inclusive endeavor. That is likely one of several contributors to the disparities this investigation found at the proportionate leadership level, otherwise termed a “sticky floor.”
In this study, leadership is identified by designation as chairperson or program director. Clearly, there are numerous other leadership positions that impact the delivery of care and the education of learners, such as medical directorships, division leadership and vice chair roles. In fact, it is often better to seek out a position of influence than a title, as the two are not necessarily synonymous. That said, there is no question that chairpersons and program directors stand in positions of power that can heavily dictate the environments in which we work, learn and care for our communities.
The authors’ recommendations for addressing this are intriguing, but there should also be attention to organizational psychology and dynamics of change. Broad-stroke solutions can backfire, and a clear understanding of change management is critical. In addition, leadership-focused organizations, such as the Orthopaedic Diversity Leadership Consortium (ODLC) and the American Orthopaedic Association (AOA), can be leveraged to bring expertise and context to these opportunities.
Moving forward, I challenge the readership to consider how mentorship and sponsorship manifests beyond training and when interacting with peers. In addition, it is important to consider the goal beyond quantitative diversity. How do we best create an environment of respect and belonging for all in orthopedics? Indeed, it starts at the top.
Perspective
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The recent well-done study by Austin M. Meadows, BS, and colleagues in the Journal of Bone and Joint Surgery July 2022 showcases the anemic effort to diversify leadership in academic orthopedic departments. In this study, recruitment of a diverse leadership has seemingly not moved for minority representation, while female representation, specifically among chairpersons, has notably improved. Still at 4% as of 2019 for women in chair roles, while higher than in 2007, might be seen as still too low. Only one time point was mentioned for program directors, and this clouds the paper to some degree as no inferences can be made for changes over time.
As a person of color, specifically Hispanic, I find that I take the most pride in achievements that are earned because of my skills and abilities. I also am appreciative of the efforts to increase residency and then faculty/leadership representation of people who look like me because of those persons’ quality skills and abilities. Growth of a more diverse, academic orthopedic leadership will be aided by this move to populate the lower ranks, as proven in many studies. To illustrate an exemplary take-home point, the number of Hispanic chairpersons was two in 2007 and two in 2019 (both rounded). I hope myself and others can help to change that paradigm with meritorious skills and abilities in the future.
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