Fellowship and future career plans for orthopedic trainees: gender-based differences in influencing factors

Orthopaedic Fellowship Match: How Do Degree and Gender Type Affect Match Success?

Introduction

Discrepancies have previously been identified in terms of gender and medical degree throughout orthopaedic education. The purpose of this study was to evaluate trends in the degree type and gender of applicants to orthopaedic trauma, sports medicine, adult reconstruction, foot and ankle, shoulder and elbow, and pediatric fellowships.

Methods

Official San Francisco match data from 2012 to 2023 were obtained. Data regarding the number of applicants, match rates, and rank list position based on applicant degree and gender were evaluated.

Results

The match rate for female applicants increased from a low of 81% (45/56) in 2013 to a high of 99% (94/95) in 2021 (mean 90% ± 6%), with a significant increase over the study period (r = 0.59, p = 0.02). For male applicants, the match rate ranged from a low of 85% (416/488) in 2013 to a high of 96% (515/536) in 2021 (mean 90% ± 4%), with a significant increase (r = 0.91, p = 0.000007). The match rate for osteopathic applicants increased from 63% (46/73) in 2013 to 94% (84/89) in 2021 (mean 82% ± 8%). There was a statistically significant increase in the match rate of osteopathic applicants over the study period (r = 0.75, p = 0.002). The match rate for allopathic applicants ranged from a low of 86% (405/471) in 2013 to a high of 96% (522/542) in 2021 (mean 91% ± 3%). There was a statistically significant increase in the match rate of allopathic applicants over the study period (r = 0.72, p = 0.003).

Conclusions

Overall, male and female applicants match at equal rates for the orthopaedic fellowship. Osteopathic graduates are less likely to match than allopathic graduates.

Orthopaedic Adult Reconstruction Fellowship Match Rates: How Do Degree and Sex Affect Match Success?

BACKGROUND

Discrepancies have previously been identified in terms of sex and medical degree throughout orthopaedic education. The purpose of this study was to evaluate trends in the degree type and sex of applicants to adult reconstruction fellowships.

METHODS

The San Francisco match data from 2012 to 2023 were analyzed. Data regarding the number of applicants and match rates based on applicant degree and sex were evaluated. Pearson's correlation test was used to evaluate trends for the number of applicants and match rates.

RESULTS

The number of applicants for both women (r = 0.64, P = 0.009) and men (r = 0.81, P = 0.0004) had a significant increase annually over the study period. Women applicants (r = 0.27, P = 0.19) did not have a significant change in match rate, while men candidates (r = 0.74, P = 0.002) experienced a significant increase over the study period. Although women applicants matched at a slightly higher rate than men applicants (87.6 versus 84.8%), this difference was not statistically significant (odds ratio (OR) = 1.14, confidence interval (CI) = 0.71 to 1.83, P = 0.64). Osteopathic applicants (r = 0.4, P = 0.09) did not experience a significant change in the number of applicants, while allopathic candidates (r = 0.8, P = 0.0006) did experience a significant increase. Both osteopathic candidates (r = 0.76, P = 0.001) and allopathic candidates (r = 0.62, P = 0.01) experienced a significant increase in match rate. From 2012 to 2023, allopathic applicants were more likely to match into an Adult Reconstruction fellowship than osteopathic applicants (OR = 2.47, CI = 1.86 to 3.26, P = 0.0001).

CONCLUSIONS

Men and women applicants match at equal rates for the adult reconstruction fellowship. Osteopathic graduates, regardless of sex, are consistently ranked lower by adult reconstruction fellowship programs in the fellowship match process and are less likely to match than allopathic graduates.

Sex, Race, and Ethnic Diversity of the Emerging U.S. Orthopaedic Sports Medicine Workforce Is Limited

PURPOSE

To analyze the demographics and trends of orthopaedic surgeons entering the U.S. orthopaedic sports medicine workforce over the past decade.

METHODS

This was a cross-sectional study of allopathic medical students, orthopaedic surgery residents, and orthopaedic sports medicine fellows in the United States (2013-2022) that leveraged data from the Accreditation Council for Graduate Medical Education and American Medical Association. Disparities in demographic representation between orthopaedic sports medicine fellows and the 2020 U.S. population census were quantified with participation-to-prevalence ratios (PPRs). A PPR between 0.8 and 1.2 was classified as equivalent representation and a PPR<0.8 was classified as under-representation, relative to the U.S.

POPULATION

RESULTS

The representation of female, Hispanic, Black, and Asian trainees decreased at each stage of the training pipeline to orthopaedic sports medicine fellowship training. In contrast, the representation of White trainees increased at each stage of the training pipeline. Over the study period, there were modest increases in female (9.9% to 12.6%) and Hispanic (1.2% to 1.7%) trainee representation in orthopaedic sports medicine. In contrast, Asian (16.6% to 5.6%) and Black (5.1% to 1.9%) trainee representation decreased. Relative to the US population, female (PPR = 0.22), Black (PPR = 0.30), Hispanic (PPR = 0.19), Native Hawaiian/Pacific Islander (PPR = 0.01), and Native American/Alaskan Native (PPR = 0.00) trainees were under-represented. In contrast, male (PPR = 1.79), Asian (PPR = 1.96), and White (PPR = 1.36) trainees were over-represented in orthopaedic sports medicine.

CONCLUSIONS

There is limited diversity in the emerging orthopaedic sports medicine workforce relative to the U.S.

POPULATION

Improvements in the representation of female, Black, and Hispanic trainees in orthopaedic sports medicine has been marginal relative to trends observed at U.S. allopathic medical schools.

CLINICAL RELEVANCE

Promoting diversity and inclusion in the orthopaedic sports medicine workforce can create more surgical provider options for diverse patient populations in the United States.

Finding Your Job in Orthopaedic Trauma: A Survey Revealing the Cold Hard Facts

OBJECTIVES

Finding a first job after fellowship can be stressful due to the uncertainty about which resources to use, including fellowship program directors, residency faculty, and other sources. There are more than 90 orthopaedic trauma fellows seeking jobs annually. We surveyed orthopaedic trauma fellows to determine the job search process.

METHODS

DESIGN

An anonymous 37-question survey.

SETTING

Online Survey.

PATIENT SELECTION CRITERIA

Orthopaedic trauma fellows from the 5 fellowship-cycle years of 2016-2021.

OUTCOME MEASURES AND COMPARISONS

The primary questions were related to the job search process, current job, and work details. The secondary questions addressed job satisfaction. Data analysis was performed using STATA 17.

RESULTS

There were 159 responses (40%). Most of the respondents completed a fellowship at an academic program (84%). Many (50%) took an academic job and 24% were hospital employed. Sixteen percent had a job secured before fellowship and 49% went on 2-3 interviews. Word of mouth was the top resource for finding a job (53%) compared with fellowship program director (46%) and residency faculty (33%). While 82% reported ending up in their first-choice job, 34% of respondents felt they "settled." The number of trauma cases was important (62%), ranked above compensation (52%) as a factor affecting job choice. Surgeons who needed to supplement their practice (46%) did so with primary and revision total joints (37%).

CONCLUSIONS

Jobs were most often found by word of mouth. Most fellows landed their first job choice, but still a third of respondents reporting settling on a job. Case volume played a significant role in factors affecting job choice.

Comparing characteristics and perspectives of U.S. anesthesiology fellows in training and anesthesiologists in their first year of practice

BACKGROUND

The purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency.

METHODS

Anesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016-2017, 2017-2018, and 2018-2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology.

RESULTS

A total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes - workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists' value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles.

CONCLUSIONS

Anesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences.

Gender gap-Gender-specific development in the field of obstetrics and gynecology in Germany in the last 20 years

Background

Gender Gap refers to differences between men and women in terms of access to medical education, career development, and leadership positions in medical practice and research. Although women now make up most medical school graduates in many countries, they are often underrepresented in higher positions.

Objective

The aim of this study is therefore to analyze the gender-specific development in the field of Obstetrics and Gynecology in Germany over the past 20 years and to survey the current status quo.

Materials and methods

An narrative review was carried out on the development of female graduates of human medicine, the proportion of women in contract medical care and clinical care, as well as the gender-specific evaluation of obtaining a gynecological/obstetric additional qualification. habilitation figures in the field of Obstetrics and Gynecology were evaluated about gender distribution. All data were received from federal institutes.

Results

A total of 46.7% (n = 95,234) of all inpatient doctors were female. A total of 46.7% (n = 95,234) of the physicians in hospitals were female. A total of 46% (1,832/3,958) were the portion of females as assistant physicians, 39.8% (n = 45.551) as specialists, 35.3% (n = 18789) as senior physicians, 25.1% (n = 2394) as first senior physicians and 25% (n = 10) as chief physicians in hospital. A total of 64.6% (n = 3958) of the physicians in Obstetrics and Gynecology were female. A total of 46% (1,832/3,958) were the portion of females as assistant physicians, 64.6% (n = 3958) as specialists, 65.0% (n = 1919) as senior physicians, 26.4% (n = 207) first senior physicians and 25% (n = 10) as chief physicians in Obstetrics and Gynecology.

Discussion

The problem with the gender gap in medicine, does not seem to be access to teaching or starting a residency. But in the functions with increasing responsibility and management functions, e.g., as senior physicians, women are already rarely seen. In Obstetrics and Gynecology, too, there is a shortage of women in leading positions, despite the relatively high numbers, for example as senior physicians. Factors like maternity and establishing a family are points mentioned therefore, but also stereotypes seem to be considerable facts.

Conclusion

However, it is important to recognize the need for more women in higher positions in medicine and actively work to encourage more women to choose a career in medicine.

Gender Diversity in Sports Medicine: Current Trends

As the sports medicine field has grown, the need for a more diverse workforce has become more evident. Given the growing athlete diversity that exists at all recreational and competitive levels of organized sports, it is important to better understand the current state of athletic health care diversity. This review assesses the current state of diversity in sports medicine from the perspective of the medical and athletic training professions. Men and women currently display nearly equivalent participation levels; however, the distribution of female team physicians and athletic trainers could better match the teams that they serve. Although progress has been made, much more needs to be done to bring more female athletic trainers and team physicians into athletic health care leadership roles. Early mentoring programs have shown efficacy for increasing the number of female candidates who might become the foundation of future athletic health care and academic program leaders.

Level of Evidence

V, expert opinion.