Orthopedic Surgery Fellowship Directors: Trends in Demographics, Education, Employment, and Institutional Familiarity

Abstract

Background: Fellowship directors are assumed to be distinguished in orthopedics, but the traits and training that have enabled them to achieve their leadership positions have not been assessed. Purpose: We sought to identify common demographics, research output, and educational trends of fellowship directors in orthopedics, with an emphasis on racial, ethnic, and gender diversity. Methods: We conducted a literature review to identify published studies on fellowship directors in orthopedic surgery and found 4 cross-sectional studies of fellowship directors in spine, arthroplasty, pediatrics, and sports medicine subspecialties. Another 4 accredited orthopedic subspecialties and their fellowship directors were identified using the American College of Graduate Medical Education Public Accreditation Data System for 2020-2021 and national fellowship directories. Data endpoints included race/ethnicity, age, sex, residency and fellowship training institutions, year of fellowship completion, year of hire at current institution, year of fellowship directors appointment, and h-index. The demographics and educational backgrounds for listed fellowship directors were collected from curricula vitae (CVs). Results: Of the 537 fellowship directors identified among 8 orthopedic subspecialties, the average age was 52.9 ± 2.2 years, 5.6% (N = 30) were women, 79.1% (N = 406) were white, 12.5% (N = 64) were Asian American, 3.7% (N = 19) were African American, 2.9% (N = 15) were Middle Eastern, and 1.7% (N = 9) were Hispanic/Latino. Oncology 20% (N = 4) had the highest percentage of female fellowship directors; 37.6% (N = 202) of fellowship directors were at the same institution they trained at for residency or fellowship. Their average h-index was 18.6 ± 3.7. Conclusion: This study of fellowship directors in orthopedics found that they have a high research output and a high level of institutional familiarity. We identified a need for greater diversity in these leadership positions in both gender and race/ethnicity.

Gender Diversity in Orthopaedic Surgery Residencies Does Not Translate to Accreditation Council for Graduate Medical Education–Accredited Fellowships

“…Finally, our analysis showed that although holding fellowship and orthopaedic surgery residency constant, the odds of being male decreased by 3% (95% CI: 0.97-0.98) for each year. The increased recruitment of female orthopaedic residents has not distributed equally among ACGME-accredited fellowships, but our data are encouraging with suggestions that gender representation is normalizing [8][9][10] .…”

“…Shah et al investigated gender diversity at varying academic levels and found that although the amount of female orthopaedic surgeons in faculty positions increased from 9% in 1997 to 18% in 2017, these opportunities were considerably more likely for a junior rather than senior position (p < 0.001) 13 . A national review of diversity among subspecialty leadership similarly found that the highest rates of male-dominated fellowship directors were seen in adult reconstruction (100%), sports medicine (99%), and spine (96%) fellowships 8 . Increasing equitable gender representation among faculty leadership is a critical step in promoting a future generation of culturally competent, diverse orthopaedic surgeons 3 .…”

“…When accounting for females in both residency and fellowship positions during the same year, this proportion further drops to 13% 5 , 6 . However, the current literature evaluating the gender diversity between residency and fellowship positions is sparse 7 , 8 .…”

Demographics and Career Trends of Urology Fellowship Directors in the United States

“…Most FDs were in their fourth to fifth decades of life, which is consistent with other surgical subspecialties. 11 As a whole, FDs were productive with a median H-index of 23.5, yet specific differences in academic productivity were identified across subspecialties. These findings allow for unique analysis of these academic leaders, which may be valuable for trainees and practicing urologists considering similar career paths.…”