The Long Road to Gender Parity in Orthopaedic Surgery
At the current rate of change, it will take more than 200 years for the proportion of women in orthopaedic surgery to reach parity with the overall medical profession, according to a study published online ahead of print by Clinical Orthopaedics and Related Research (CORR).
“Substantive changes must be made across all levels of orthopaedic education and leadership to steepen the current curve,” the study authors conclude. “Our findings support the need for changes in medical schools, orthopaedic residency programs, as well as at the level of professional specialty and subspecialty societies.”
The researchers queried the Centers for Medicare and Medicaid Services’ National Provider Identifier Registry, which requires clinicians to identify themselves as male or female. As of April 2020, the registry included data on 31,296 practicing orthopaedic surgeons, of whom only 8% were women. That’s far lower than the proportion of women in the medical profession overall: 36% in 2019.
Between 2010 and 2019, the compound annual growth rate of women orthopaedic surgeons was a meager 2% (20% over the decade). Assuming this rate were sustained after 2019, it would take 217 years – until 2236 – to achieve gender parity with the rest of the medical profession. Time to achieve parity with the US population – currently 51% female – would take 326 years, or until 2354.
The researchers also analyzed trends by orthopaedic subspecialty and by region. In 2019, women accounted for 26% of surgeons in pediatric orthopaedics and 14% in foot and ankle surgery, but only 3% in adult reconstructive surgery and 3% in spine surgery. After 2019, the gains in subspecialty representation are projected to be just 1% or 2%, with no growth in adult reconstructive surgery.
The Midwest had the greatest growth in proportion of women orthopaedic surgeons at 27%, followed by the Northeast at 20%. Rates in the West and South were 17% and 19%, respectively, which is less than the rate of national growth.
The researchers call for changes throughout orthopaedic education and leadership to increase the number of women in the profession:
- Offer an orthopaedic surgery rotation in all medical schools to foster interest among women students and to help curb concerns related to work-life balance and a culture dominated by men
- Establish benchmarks in orthopaedic surgery training programs, in consultation with the Accreditation Council for Graduate Medical Education, for the proportion of orthopaedic faculty, fellowship program directors, and incoming trainees who are women
- Recruit women for leadership positions in the American Academy of Orthopaedic Surgeons and the orthopaedic subspecialty societies, as well as establish programs to encourage academic development of women in orthopaedic surgery
- Investigate diversity programs in other surgical specialties that have had success in gender parity and determine how to implement relevant aspects of these programs in orthopaedics
In an accompanying Take 5 interview with senior author Atul F. Kamath, MD, of the Cleveland Clinic Foundation,  CORR’s Editor-in-Chief Seth S. Leopold, MD, said, “Literally every other medical and surgical specialty has overcome this problem to a greater degree than has orthopaedic surgery; we’re dead last in gender diversity.” He calls on his specialty to stop paying “lip service” to “the substantial absence of women from our specialty and the lack of progress towards remedying the disparity over time.”
“We applaud these authors for highlighting this critical issue,” said Julie Samora, MD, president of the Ruth Jackson Orthopaedic Society, a support and networking group for the growing number of women orthopaedic surgeons. “The projection of over 300 years to achieve gender parity with the US population is alarming.
“We are missing out on outstanding talent and doing a disservice to our patients. The time is now to commit to action, to have intentional efforts to increase the representation of women in orthopedics. Improving gender diversity will not only make our programs and profession better, but it will also improve the overall care of our patients.”
Acuña AJ, Sato EH, Jella TK, et al. How long will it take to reach gender parity in orthopaedic surgery in the United States? An analysis of the National Provider Identifier Registry. Clin Orthop Relat Res. 2021 Mar 19. doi: 10.1097/CORR.0000000000001724. Online ahead of print.
- Leopold SS. Editor’s Spotlight/Take 5: How long will it take to reach gender parity in orthopaedic surgery in the United States? An analysis of the National Provider Identifier Registry. Clin Orthop Relat Res. 2021 May 7. doi: 10.1097/CORR.0000000000001805. Online ahead of print.