Racial, Ethnic, and Gender Diversity in Academic Orthopaedic Surgery Leadership

Abstract

Background:Multiple investigations in the past 50 years have documented a lack of racial/ethnic and gender diversity in the orthopaedic surgery workforce when compared with other specialties. Studies in other industries suggest that diversification of leadership can help diversify the underlying workforce. This study investigates changes in racial/ethnic and gender diversity of orthopaedic surgery leadership from 2007 to 2019 and compares leadership diversity to that of other surgical and nonsurgical specialties, specifically in terms of chairpersons and program directors.Methods:Demographic data were collected from The Journal of the American Medical Association and the Association of American Medical Colleges. Aggregate data were utilized to determine the racial, ethnic, and gender composition of academic leadership for 8 surgical and nonsurgical specialties in 2007 and 2019. Comparative analysis was conducted to identify changes in diversity among chairpersons between the 2 years. Furthermore, current levels of diversity in orthopaedic leadership were compared with those of other specialties.Results:A comparative analysis of diversity among program directors revealed that orthopaedic surgery had significantly lower minority representation (20.5%) when compared with the nonsurgical specialties (adjusted p < 0.01 for all) and, with the exception of neurological surgery, had the lowest proportion of female program directors overall, at 9.0% (adjusted p < 0.001 for all). From 2007 to 2019, orthopaedic surgery experienced no change in minority representation among chairpersons (adjusted p = 0.73) but a significant increase in female representation among chairpersons, from 0.0% (0 of 102) to 4.1% (5 of 122) (adjusted p = 0.04). Lastly, a significant decrease in minority and female representation was observed when comparing the diversity of 2019 orthopaedic faculty to orthopaedic leadership in 2019/2020 (p < 0.05 for all).Conclusions:Diversity in orthopaedic surgery leadership has improved on some key fronts, specifically in gender diversity among chairpersons. However, a significant decrease in minority and gender representation was observed between 2019 orthopaedic faculty and 2019/2020 orthopaedic leadership (p < 0.05), which was a trend shared by other specialties. These findings may suggest a more pervasive problem in diversity of medical leadership that is not only limited to orthopaedic surgery.

Benchmarking Accomplishments of Presidents Elected to Hand Surgery Societies in the United States

“…9 The high visibility of these positions may lead to increased recruitment of these minority groups into limited training positions. [20][21][22] Continued coordinated efforts are needed to increase the presence of women and underrepresented racial minorities in hand surgery. Importantly, results from this study can lead to meaningful discussions regarding the backgrounds and accomplishments of future hand surgery presidents.…”

AOA Critical Issues: Gender Justice in Academic Medicine

“…This paper presents solutions to assist in developing equitable work environments for all academic clinicians.In the 1990s, the Association of American Medical Colleges (AAMC) began publishing research that explored gender inequities in academic medicine [1][2][3][4][5][6][7][8][9][10][11][12][13] . Several related studies demonstrated a low number of women leaders in medicine despite the growing number of women physicians 3,11,14 . As a result of this information, programs were developed to increase the representation of women throughout medicine, especially in leadership positions.…”

“…Targeted initiatives resulted in women making up nearly 50% of those matriculating into U.S. medical schools in the early 2000s and >50% in the last few years; the percentage of clinical faculty who are women has also increased since these targeted initiatives began [1][2][3]15 . Despite these increases, women remain underrepresented in leadership positions throughout academic medicine 3,14,16 . More specifically, only 18% of department chairs are women, and women physicians are disproportionately con-fined to instructor, assistant professor, and associate professor ranks, with decreased advancement in comparison with their men counterparts 3,16 .…”

“…With regard to leadership in academic orthopaedics, only 3% of chairs, 8% of vice chairs, 11% of program directors, and 9% of division chiefs are women 39 . Despite representing half of all medical students and constituting 45.2% of academic residents across specialties, women make up only 15.4% of orthopaedic surgery residents 14 . Women's lack of representation in orthopaedic leadership can be attributed, at least in part, to some of the factors noted previously during the Flexibility in hours/time to promotion conferences held by the AAMC [41][42][43] .…”

“…Similar to academic medicine, orthopaedics has not been immune to the issue of gender injustice and inequities. In fact, orthopaedics lags behind all other medical specialties in the representation of women, particularly in women's representation in leadership positions 13,14,[37][38][39][40][41] . Orthopaedics has the lowest percentage and rate of increase of women faculty out of all academic medical specialties 14,39 .…”