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Sue TC, Churchill IF, Mallity C, Lau R, Peters DA, Lampron J, Phan P, Stratton A, Wai EK, Tsai EC. Gender and racial diversity in leadership roles within academic surgery internationally: a retrospective cross-sectional study pre-COVID-19. Am J Surg 2025:116394. [PMID: 40374419 DOI: 10.1016/j.amjsurg.2025.116394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 04/07/2025] [Accepted: 05/06/2025] [Indexed: 05/17/2025]
Abstract
OBJECTIVE Journal editorial and society executive boards have widespread impacts, however, the associated leadership diversity remains underexplored. Our study evaluated such diversity across four surgical specialties before the influences of COVID-19. METHODS This retrospective, cross-sectional study obtained perceived gender and race of identified leaders from publicly available websites. Leadership of the top three journals and journal-affiliated societies based on the 2021 Journal Citation Reports journal impact factor was evaluated for subspecialties within neurosurgery, orthopaedic, general, and plastic surgery. RESULTS Leadership diversity within 58 journals and 55 societies were reviewed. Orthopedics had a significantly lower proportion of females (p < 0.05) and intersectional minorities (p < 0.05). Higher journal impact factor and a greater proportion of intersectional minorities were significantly related (p = 0.0009). CONCLUSION We assessed leadership diversity amongst both journal editorial and society executive boards and identified differences with respect to proportions of females, minorities and intersectional minorities across specialties.
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Affiliation(s)
- Téa C Sue
- Department of Undergraduate Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Isabella F Churchill
- Department of Undergraduate Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Caroline Mallity
- Department of Undergraduate Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Lau
- Department of Undergraduate Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel A Peters
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacinthe Lampron
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Philippe Phan
- Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexandra Stratton
- Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Eugene K Wai
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; The School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Eve C Tsai
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; The School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
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Silvestre J, Neal T, Nelson CL, Lieberman JR, Peters CL, Chen AF. Sex Diversity in the Emerging United States Arthroplasty Workforce Is Limited. J Arthroplasty 2025; 40:1347-1352. [PMID: 39510390 DOI: 10.1016/j.arth.2024.10.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 10/26/2024] [Accepted: 10/30/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND Sex diversity remains limited in the United States arthroplasty workforce. This study evaluates fellowship program characteristics associated with increased sex diversity in US-based fellowship programs and the pipeline of women trainees before arthroplasty fellowship. METHODS Demographic data from 233,981 allopathic medical school graduates, 11,364 orthopaedic surgery residents, and 1,501 arthroplasty fellows were analyzed. Women trainee representation was calculated among allopathic medical students, orthopaedic surgery residents, and arthroplasty fellows (2012 to 2022). Fellowship program characteristics associated with increased sex diversity among arthroplasty fellows were evaluated with Chi-square tests. RESULTS Female representation in arthroplasty fellowship training (5.9%) was less than that in orthopaedic surgery residency (15.1%) and allopathic medical school (47.6%) training (P < 0.001). Sex diversity in arthroplasty fellowship training increased over the study period (2.4 to 9.9%, P < 0.001). The presence of women faculty, geographic region, accreditation status, annual number of fellows, and total number of faculty were not associated with increased sex diversity of arthroplasty fellows (P > 0.05). CONCLUSIONS Sex diversity in arthroplasty fellowship training has improved over the past decade. Yet, women trainees remain under-represented relative to the trainee pipeline. Increased efforts to recruit female medical students and orthopaedic residents may help promote workforce diversity in arthroplasty.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | - Taylor Neal
- Medical University of South Carolina, Charleston, South Carolina
| | - Charles L Nelson
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jay R Lieberman
- Keck School of Medicine of University of Southern California, Los Angeles, California
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Jayaram RH, Futela D, Day W, Malhotra A, Grauer JN. Academic Orthopaedic Surgeon Financial Compensation in the United States: Trends and Distribution. J Am Acad Orthop Surg Glob Res Rev 2025; 9:01979360-202505000-00019. [PMID: 40388497 PMCID: PMC12086778 DOI: 10.5435/jaaosglobal-d-25-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Accepted: 04/03/2025] [Indexed: 05/21/2025]
Abstract
INTRODUCTION The overall trends in academic orthopaedic surgery compensation are not well studied. The aim of this study was to assess trends and distribution of academic orthopaedic surgery financial compensation and consider in relation to academic rank, sex, and race/ethnicity. METHODS The 2017 to 2023 American Association of Medical Colleges Faculty Salary Surveys were used, which collect information for full-time faculty at US medical schools. Financial compensation data for orthopaedic faculty, across subspecialities, were stratified by year, academic rank, sex, race/ethnicity, and geographic region. Trends in median, 25th, and 75th percentile compensation were assessed. RESULTS Responses for 2,601 faculty members across orthopaedic departments were available, including 82 instructors, 1,176 assistant professors, 668 associate professors, 487 full professors, 104 chiefs (lead a division within the larger department), and 84 chairs (head an entire academic department). Median faculty compensation increased on an average of 1.80% to 6.93%, with the greatest increase at the chief and chair levels and smaller increases for instructors and professors of varying rank. From 2017 to 2013, women were consistently compensated less than men at all ranks except chairs. In 2023, women in academic orthopaedic surgery made less cents-on-the-dollar relative to men of equal rank across all ranks. Asian assistant professors made 0.90 cents-on-the-dollar, and Hispanic/Latino and Black/African American assistant professors made 0.87 cents-on-the-dollar compared with White faculty of equal rank. However, among professors, these groups had higher median compensation (1.06 to 1.1 cents-on-the-dollar) compared with White professors. The geographic variations of compensation were within the range of 15k for assistant professors, 32k for associate professors, 196k for chiefs, 95k for professors, and 83k for chairs. CONCLUSION This study summarizes trends of academic orthopaedic faculty compensation and shows salaries barely keeping pace with inflation and persistent compensation inequities, which highlights the need for fair, transparent compensation models and additional studies of factors impacting physician compensation.
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Affiliation(s)
- Rahul H. Jayaram
- From the Yale School of Medicine (Mr. Jayaram); the Department of Radiology and Biomedical Imaging (Dr. Futela and Dr. Malhotra), Yale School of Medicine; and the Department of Orthopaedics and Rehabilitation (Mr. Day and Dr. Grauer), Yale School of Medicine, New Haven, CT
| | - Dheeman Futela
- From the Yale School of Medicine (Mr. Jayaram); the Department of Radiology and Biomedical Imaging (Dr. Futela and Dr. Malhotra), Yale School of Medicine; and the Department of Orthopaedics and Rehabilitation (Mr. Day and Dr. Grauer), Yale School of Medicine, New Haven, CT
| | - Wesley Day
- From the Yale School of Medicine (Mr. Jayaram); the Department of Radiology and Biomedical Imaging (Dr. Futela and Dr. Malhotra), Yale School of Medicine; and the Department of Orthopaedics and Rehabilitation (Mr. Day and Dr. Grauer), Yale School of Medicine, New Haven, CT
| | - Ajay Malhotra
- From the Yale School of Medicine (Mr. Jayaram); the Department of Radiology and Biomedical Imaging (Dr. Futela and Dr. Malhotra), Yale School of Medicine; and the Department of Orthopaedics and Rehabilitation (Mr. Day and Dr. Grauer), Yale School of Medicine, New Haven, CT
| | - Jonathan N. Grauer
- From the Yale School of Medicine (Mr. Jayaram); the Department of Radiology and Biomedical Imaging (Dr. Futela and Dr. Malhotra), Yale School of Medicine; and the Department of Orthopaedics and Rehabilitation (Mr. Day and Dr. Grauer), Yale School of Medicine, New Haven, CT
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Levy MS, Hunt KN, Lindsay KA, Mohan V, Mercadel A, Malecki E, Desai R, Sorondo BM, Pillai A, Huang M. Gender Inequity in Institutional Leadership Roles in US Academic Medical Centers: A Systematic Scoping Review. JAMA Netw Open 2025; 8:e252829. [PMID: 40184068 PMCID: PMC11971677 DOI: 10.1001/jamanetworkopen.2025.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 01/27/2025] [Indexed: 04/05/2025] Open
Abstract
Importance Academic medical centers have focused their efforts on promoting gender equity in recent years, but the positive outcomes associated with those efforts remain to be seen in recruiting and retaining diverse institutional leadership. Objective To evaluate the current state of gender inequity in institutional leadership roles, such as deans, department chairs, and residency and fellowship program directors, at US academic medical centers. Evidence Review A search for articles published from January 1, 2019, to August 5, 2022, on gender inequity in institutional leadership roles at academic medical centers was performed using the PubMed, CINAHL, and ERIC databases. Studies were screened for inclusion by sets of 2 independent reviewers (with disagreements resolved by a third reviewer) and evaluated for risk of bias. The Methodological Expectations of Cochrane Intervention Reviews Standards were followed for conducting the review, and the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline was followed for reporting results. Findings A total of 8120 articles were retrieved, of which 6368 were screened by title and abstract, 6166 were excluded, and 202 underwent full-text review. Ultimately, 94 studies reported on institutional leadership roles, including deans (5 studies [5.3%]), department chairs (39 studies [41.5%]), division chiefs (25 studies [26.6%]), and program directors (67 studies [71.3%]), with some overlap. A total of 678 participants were deans (564 men [80.5%] and 132 women [19.5%]), 8518 were department chairs (7160 men [84.1%] and 1358 women [15.9%]), 3734 division chiefs (2997 men [80.3%] and 737 women [19.7%]), and 9548 program directors (7455 men [78.1%] and 2093 women [21.9%]). Even in specialties with 50% or more female faculty, none had equal representation of women as department chairs and division chiefs. Gender inequities were particularly pronounced in surgical specialties. Conclusions and Relevance This systematic scoping review suggests that even though emphasis has been placed on addressing gender inequities in academic medicine, considerable disparities remain at the leadership level. While certain positions and specialties have been observed to have more female leaders, niches of academic medicine almost or completely exclude women from their leadership ranks. Importantly, even female-dominated specialties, such as obstetrics and gynecology, have substantial inequity in leadership roles. It is past time for organizational and systems-level changes to ensure equitable gender representation in academic leadership.
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Affiliation(s)
- Morgan S. Levy
- Department of Radiation Oncology, University of Kentucky College of Medicine, Lexington
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Kelby N. Hunt
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Kara A. Lindsay
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Vikasni Mohan
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Alyssa Mercadel
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Eileen Malecki
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Radhika Desai
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Barbara M. Sorondo
- Louis Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida
| | - Asha Pillai
- Hematology Clinical Development Unit, Regeneron Therapeutics, Tarrytown, New York
| | - Marilyn Huang
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- University of Virginia School of Medicine, Charlottesville
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James CL, Sanii R, Kasto J, Zhu K, Burdick G, Fathima B, Rahman T, Muh S. The Perception of Residency Experiences Among Orthopaedic Surgery Residents in the United States Differs by Race and Gender. Cureus 2025; 17:e81670. [PMID: 40322420 PMCID: PMC12049239 DOI: 10.7759/cureus.81670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2025] [Indexed: 05/08/2025] Open
Abstract
INTRODUCTION Women and racial minorities remain underrepresented in orthopaedic surgery. While there is extensive research into the recruitment of these groups into the field, as well as more recent research regarding their representation in academic medicine and research, there is limited data on their experiences during residency. The purpose of this study is to assess the perceptions of orthopaedic surgery residents regarding their experiences during residency. METHODS In mid-2022, a voluntary survey was sent to 2,122 orthopaedic surgery residents addressing mentorship, access to opportunities, and "fit" within their residency programs. Responses were compared by race and gender, with 345 responses received, yielding a response rate of 16.3%. RESULTS Compared to male and Caucasian residents, female and underrepresented in medicine (URM) residents reported feeling less satisfied with the training they received, felt less supported, and perceived greater difficulty for women and minorities in being promoted within orthopaedics. Female residents also reported having less mentorship, receiving less recognition for their accomplishments, and being less satisfied with their career choice than male residents. CONCLUSIONS The results of this study highlight the need to improve equity and inclusion within orthopaedic surgery residencies in order to continue advancing diversity in the field.
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Affiliation(s)
- Chrystina L James
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Ryan Sanii
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Johnny Kasto
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Kai Zhu
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Gabriel Burdick
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Bushra Fathima
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
| | - Tahsin Rahman
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
| | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA
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Phillips M, Woodhams W, Ogeh T, Willson S, Atkinson T. Factors Influencing Growth in Gender Diversity Within Orthopaedic Surgery. J Am Acad Orthop Surg Glob Res Rev 2025; 9:01979360-202504000-00014. [PMID: 40257831 PMCID: PMC12014126 DOI: 10.5435/jaaosglobal-d-24-00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 12/18/2024] [Accepted: 01/29/2025] [Indexed: 04/22/2025]
Abstract
INTRODUCTION Despite increasing numbers of female medical students, there is low female representation in orthopaedic residencies across the globe. It is unknown whether female representation in orthopaedics is lower than other specialties and whether regional presence relates to patient population or residency positions. METHODS The provider directory from the United States Centers for Medicare and Medicaid Services was reviewed from 2018 to 2023. Data for eight specialty subgroups (anesthesia, family medicine, gastroenterology, general surgery, internal medicine, obstetrics/gynecology, orthopaedics, and urology) were examined and grouped according to regions depicted by the Electronic Residency Application Service. RESULTS The mean percentage of female orthopaedic Centers for Medicare and Medicaid Services providers increased 1.49% over the 6-year period, at a markedly lower rate compared with general surgery (3.7%, P = 0.018) and obstetrics and gynecology (4.7%, P = 0.012). It was also lower compared with gastroenterology (3.73%), family medicine (3.52%), urology (3.10%), internal medicine (1.82%), and anesthesia (1.66%). Pacific-West and South-Atlantic regions demonstrated the greatest increase in representation. The number of female orthopaedic surgeons and growth in all orthopaedic surgeons in a state correlated with increased representation, whereas residency positions and patient population did not. Graduation year was 6 years later for female versus male students. DISCUSSION This study demonstrated a statistically significantly lower rate of change in female representation within orthopaedics compared with other specialties. Presence of practicing female orthopaedic surgeons was associated with growth in certain geographic regions. Future work should investigate factors associated with regional growth if specialties seek to move toward sex representation that reflects the United States population.
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Affiliation(s)
- Maxwell Phillips
- From the Orthopaedic Surgery Residency Program, McLaren Flint Health Care, Flint, MI (Dr. Phillips, Dr. Willson, and Dr. Atkinson); the Orthopaedic Surgery Residency Program, Henry Ford Hospital, Detroit, MI (Dr. Ogeh); Michigan State University College of Human Medicine (Mr. Woodhams); the Department of Engineering, Kettering University, Flint, MI (Dr. Atkinson); and the Attending Physician, OrthoMichigan, Flint, MI (Dr. Willson)
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Petrie K, Garcia-Lopez E, Markes A, Feeley B. Current State of Diversity in Orthopaedic Surgery Residency and Future Direction: A Review. J Am Acad Orthop Surg 2025:00124635-990000000-01241. [PMID: 39899797 DOI: 10.5435/jaaos-d-24-00809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 12/16/2024] [Indexed: 02/05/2025] Open
Abstract
Orthopaedic surgery is one of the least diverse fields in medicine. Barriers to increasing the racial, gender, and sexual minority diversity of residents include pervasive negative impressions about the culture in orthopaedic surgery; lack of early exposure to and education about orthopaedics; new large-scale diversity, equity, and inclusion initiatives that have yet to become fully established; and lack of mentorship from those with shared backgrounds, gender, sexual orientation, or race. Recently, there have been several pipeline initiatives aimed at exposing women and underrepresented minority students to orthopaedics and medicine early in their careers, which have shown remarkable success. Toward this goal, recent recommendations from Nth Dimensions have provided a toolkit to help recruit and maintain diverse trainees. Furthermore, advocating for further funding and support of initiatives from national organizations that lead the field of orthopaedics will be paramount to institutionalizing efforts of diversity, equity, and inclusion within the orthopaedic community.
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Affiliation(s)
- Kyla Petrie
- From the Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA
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Lin ME, Razura DE, Luu NN, Yu AJ, Kim I, Kwon DI, Chambers TN. Understanding the Representation of Asians and Asian Americans Within Academic Otolaryngology Leadership. Otolaryngol Head Neck Surg 2025; 172:500-508. [PMID: 39369437 DOI: 10.1002/ohn.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/26/2024] [Accepted: 09/15/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVE Elucidate the representation of Asian and Asian Americans in academic otolaryngology and the influence of race on promotion and leadership opportunities. STUDY DESIGN Retrospective analysis of the Association of American Medical Colleges Faculty Administrative Management Online User System. SETTING Full-time otolaryngology faculty from all US medical schools from 2020 to 2023. METHODS Faculty demographics, tenure, and rank were collected. Descriptive statistics, Fischer's exact test, Rank Equity Index (REI), and multivariable logistic and ordinal regressions were used to characterize our cohort and assess the impact of race on academic advancement and leadership, defined as promotion to tenure or full professorship. RESULTS Asians comprised 20.53% of 9056 faculty over 4 years. Asians were most likely to hold tenure-eligible positions (n = 600, 30.74%) but were significantly less likely than non-Asians to be tenured (43.00% vs 48.65%, P = .015). Asians were slightly above parity in promotion from assistant to associate professor (REI = 1.09) but below parity in promotion from associate professor to professor (REI = 0.78). Relative to whites, Hispanics, and African Americans, Asians reported the lowest associate/professor and assistant/professor REIs. On multivariable regressions, Asian race was not associated with decreased odds of tenure-eligible positions but was associated with decreased odds of tenure (odds ratio [OR] = 0.77, 95% confidence interval [CI] = [0.64-0.93]) and rank promotion (OR = 0.82, 95% CI = [0.74-0.90]). CONCLUSION Despite strong overall representation in otolaryngology, Asians are less likely to receive promotion, tenure, or full professorship relative to other racial groups. Future efforts should emphasize equitable advancement opportunities to ensure a diverse otolaryngology leadership.
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Affiliation(s)
- Matthew E Lin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Diego E Razura
- East Tennessee State University Quillen College of Medicine, Johnson City, Tennessee, USA
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Neil N Luu
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Alison J Yu
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Ian Kim
- Departments of Pediatrics and Medicine, Stanford University, Stanford, California, USA
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Daniel I Kwon
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tamara N Chambers
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Opara OA, Narayanan R, Tarawneh OH, Lee Y, Tomlak A, Zavitsanos A, Czarnecki J, Hassan W, Lipa SA, Mesfin A, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK, Woods BI. Race, Ethnicity, and Gender Representation Among US Academic Spine Surgeons. J Am Acad Orthop Surg 2025; 33:e151-e160. [PMID: 39378425 DOI: 10.5435/jaaos-d-24-00349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/03/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States. METHODS In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons. Fellowship-trained orthopaedic spine surgeons (professor, associate professor, and assistant professor) who graduated residency between 1990 and 2022 were included. Race, sex, academic rank, residency year of graduation, and H-Index scores were recorded using publicly available information from faculty profile pages and the Doximity database. RESULTS Four hundred fifty-two spine faculty were included in the analysis: 95.1% men and 4.84% women. Across race and ethnicity, 315 surgeons (69.7%) were White, 111 (24.6%) Asian, 15 (3.32%) Black or African American, and 11 (2.43%) Hispanic or Latino or of Spanish origin. Of the 101 professor-level surgeons, 3 (2.97%) were Black men. Among female professors, none were Black, Asian, or Hispanic/Latino. No Hispanic or Latino female professors, associate professors, or assistant professors were identified. The sex and race/ethnicity demographics that have increased in percentage over time include White women (0.92% to 6.08%), Asian men (11.0% to 26.5%), Asian women (0% to 1.66%), and Hispanic/Latino men (1.83% to 3.87%). The surgeon demographic groups that demonstrated minimal fluctuations over time included Black men, Black women, and Hispanic/Latino women. CONCLUSION Our findings demonstrate that underrepresentation among academic spine surgeons remains an ongoing challenge that warrants increased attention. Enhancing the representation of Black and Hispanic men, as well as Black, Asian, and Hispanic women, in spine surgery requires a deliberate effort at every level of orthopaedic training.
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Affiliation(s)
- Olivia A Opara
- From the Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Opara, Narayanan, Tarawneh, Lee, Tomlak, Zavanistos, Czarnecki, Hassan, Canseco, Hilibrand, Vaccaro, Schroeder, Kepler, and Woods), the Department of Orthopaedic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (Lipa), and MedStar Orthopaedic Institute, Georgetown University School of Medicine, Washington, DC (Mesfin)
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Silvestre J, Moore M, LaPorte DM, Sabesan VJ, Van Heest A. Sex Diversity and Equity Among Fellows of the American Orthopaedic Association. J Bone Joint Surg Am 2025; 107:222-227. [PMID: 39052768 DOI: 10.2106/jbjs.24.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND We hypothesized that women are underrepresented among fellows of the American Orthopaedic Association (AOA) relative to their prevalence among faculty at departments of orthopaedic surgery. METHODS Clinical faculty at departments of orthopaedic surgery that are affiliated with residency training programs were analyzed for AOA membership. Participation-to-prevalence ratios (PPRs) were calculated for men and women with AOA membership relative to their prevalence among orthopaedic surgeon faculty. A PPR of <0.8 or >1.2 indicated under- or overrepresentation, respectively. PPR values between 0.8 and 1.2 indicated equivalent representation. Sex disparities in AOA membership were explored by academic rank and orthopaedic subspecialty. RESULTS There were 4,310 orthopaedic surgery faculty, and 998 (23.2%) had AOA membership. Overall, women formed the minority of members in the AOA study cohort (11.4%), but they had equivalent representation relative to their prevalence among faculty (10.0%, PPR = 1.14, p = 0.210). In the AOA study cohort, women were the minority at each academic rank, including assistant professor (20.2% versus 79.8%, p < 0.001), associate professor (16.8% versus 83.2%, p < 0.001), and full professor (7.0% versus 93.0%, p < 0.001). However, women had greater representation in the AOA study cohort at each academic rank than would be expected based on their prevalence among faculty, including the assistant (PPR = 1.45), associate (PPR = 1.56), and full (PPR = 1.27) professor levels. Similarly, in the AOA study cohort, women were the minority in each orthopaedic subspecialty, but were only underrepresented in pediatric orthopaedics (PPR = 0.74). Women had greater representation in the AOA study cohort than would be expected by their prevalence among faculty in hand surgery (PPR = 1.51) and orthopaedic sports medicine (PPR = 1.33). In contrast, men had equivalent representation in each orthopaedic subspecialty. CONCLUSIONS Women form a minority group in the AOA, but they exhibit greater representation in the AOA than would be expected based on their prevalence among faculty at each academic rank, and they have greater representation than men, who exhibit equivalent representation across all academic ranks. Collectively, these results disproved our hypothesis, and suggest that women are participating in the AOA at rates that are greater than their prevalence among faculty. CLINICAL RELEVANCE Equitable participation of women in orthopaedic surgery is necessary to promote diversity and inclusion in the specialty. The AOA may be an important catalyst for future positive diversity and inclusion efforts within orthopaedic surgery.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | - Maya Moore
- University of Miami Miller School of Medicine, Miami, Florida
| | - Dawn M LaPorte
- The Johns Hopkins School of Medicine, Baltimore, Maryland
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Oyem PC, Runsewe OI, Huffman N, Pasqualini I, Rullán PJ, Klika AK, Deren ME, Molloy RM, Piuzzi NS. Trends in Gender Diversity Among Total Hip Arthroplasty Surgeons. J Am Acad Orthop Surg 2024; 32:1130-1137. [PMID: 38739863 DOI: 10.5435/jaaos-d-23-01147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION A pronounced gender imbalance is evident among orthopaedic surgeons. In the field of arthroplasty, there exists a dearth of comprehensive data regarding gender representation. This study aimed to analyze the gender diversity, or lack thereof, within the field of total hip arthroplasty (THA). In addition, this study used literature review to identify possible reasons for the gender disparity among THA surgeons and identify the best next steps to promote gender equity within orthopaedics. METHODS A retrospective analysis was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Practitioners data set to quantify orthopaedic surgeons who performed primary THA procedures from 2013 to 2020. To assess trends in the number of hip surgeons by sex and the evolving female-to-male ratio, two-sided correlated Mann-Kendall tests were conducted. RESULTS Overall, 3,853 to 4,550 surgeons billed for primary THA annually. Of this number, an average of 1.7% was female. The mean number of services billed for by male surgeons was 31.62 ± 24.78 per year and by female surgeons was 26.43 ± 19.49 per year. Trend analysis of female-to-male ratio demonstrated an increasing trend of statistical significance ( P = 0.009). The average number of procedures by female surgeons annually remained stable throughout the study, whereas there was a steady increase in that for male surgeons. CONCLUSION Results showed a notable and sustained upward trajectory from 2013 to 2020 in the number of female surgeons billing for THA along with the female-to-male ratio. However, female surgeons constitute a mere 2% of surgeons engaging in primary THA billing. Furthermore, the annual average number of THAs conducted by female surgeons exhibited constancy, whereas there was a gradual increase in the median number of annual procedures performed by their male counterparts. Future studies should aim to identify and resolve specific barriers prohibiting female medical students from pursuing and obtaining a career as an orthopaedic THA surgeon. STUDY DESCRIPTION Retrospective analysis using the Medicare Provider Utilization and Payment Data: Physician and Other Practitioners data set.
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Affiliation(s)
- Precious C Oyem
- From the Department of Orthopedic Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH (Oyem and Runsewe), and the Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH (Huffman, Pasqualini, Rullán, Klika, Deren, Molloy, Piuzzi)
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Silvestre J, Kermanshahi N, Ahn J, Harris MB, Dehghan N. Factors Associated With Increased Sex Diversity in Orthopaedic Trauma Association-Accredited Fellowship Training. J Am Acad Orthop Surg 2024:00124635-990000000-01181. [PMID: 39661771 DOI: 10.5435/jaaos-d-24-00457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Indexed: 12/13/2024] Open
Abstract
INTRODUCTION This study quantifies the state of sex diversity in orthopaedic trauma training and analyzes fellowship program characteristics associated with greater sex diversity among trainees. We hypothesized that greater sex diversity among orthopaedic trauma fellows would be associated with the presence of female faculty. METHODS This was a retrospective, cross-sectional study of orthopaedic trauma faculty (2023 to 2024) and fellows (2009 to 2024). A trainee analysis for orthopaedic trauma fellows was done relative to orthopaedic surgery residents and allopathic medical students. Fellowship program characteristics associated with increased sex diversity among fellows were elucidated with chi square tests. Temporal analyses were done with linear regression. RESULTS Overall, 1,266 orthopaedic trauma fellows and 200 were female (15.8%). Sex diversity in orthopaedic trauma fellowships was similar to orthopaedic surgery residency programs (14.2%, P = 0.135) but less than allopathic medical schools (47.5%, P < 0.001). Female representation in orthopaedic trauma fellowship training increased over the study period (9.1% vs. 31.5%, P < 0.001); 349 orthopaedic trauma faculty at 65 orthopaedic trauma fellowships and 41 were female (11.7%). Of the 65 fellowship program directors, only four were female (6.2%). The presence of female faculty was associated with greater sex diversity among orthopaedic trauma fellows (P = 0.017). Additional program characteristics, like geographic region, accreditation status, and number of faculty, were not associated with greater sex diversity. DISCUSSION Sex diversity is increasing in orthopaedic trauma fellowship training and is associated with the presence of female faculty. Efforts to mentor and recruit female trainees in orthopaedic trauma fellowship training may lead to greater workforce diversity in orthopaedic trauma.
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Affiliation(s)
- Jason Silvestre
- From the Medical University of South Carolina, Charleston, SC (Silvestre), the University of Arizona College of Medicine Phoenix, Phoenix, AZ (Kermanshahi and Dehghan), the University of Michigan Medical School, Ann Arbor, MI (Ahn), and the Massachusetts General Hospital, Boston, MA (Harris)
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Murray IR, Makaram NS, Geeslin AG, Chahla J, Moatshe G, Crossley K, Kew ME, Davis A, Tuca M, Potter H, Janse van Rensburg DC, Emery CA, Eun S, Grindem H, Noyes FR, Marx RG, Harner C, Levy BA, King E, Cook JL, Whelan DB, Hatch GF, Wahl CJ, Thorborg K, Irrgang JJ, Pujol N, Medvecky MJ, Stuart MJ, Krych AJ, Engebretsen L, Stannard JP, MacDonald P, Seil R, Fanelli GC, Maak TG, Shelbourne KD, Verhagen E, Musahl V, Hirschmann MT, Miller MD, Schenck RC, LaPrade RF. Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation. Br J Sports Med 2024; 58:1385-1400. [PMID: 39237264 DOI: 10.1136/bjsports-2024-108089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 09/07/2024]
Abstract
Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined 'a priori' if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
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Affiliation(s)
- Iain Robert Murray
- Edinburgh Orthopaedics, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - Navnit S Makaram
- Edinburgh Orthopaedics, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | | | | | - Gilbert Moatshe
- Orthopaedic Division, Oslo University Hospital, Oslo, Norway
- Oslo Sports Trauma Research Center, Oslo, Norway
| | - Kay Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australian IOC Research Centre, Melbourne, Victoria, Australia
| | | | | | - Maria Tuca
- Pontificia Universidad Catolica De Chile School of Medicine, Santiago, Chile
| | - Hollis Potter
- Weill Cornell Medical College, New York, New York, USA
| | - Dina C Janse van Rensburg
- Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
- Chair, Medical Advisory Panel, World Netball, Manchester, UK
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - SeungPyo Eun
- Dr. Eun's Korea Orthopaedic Clinic, Seoul, The Republic of Korea
| | - Hege Grindem
- Oslo Sports Trauma Research Center, Oslo, Norway
| | - Frank R Noyes
- Department of Orthopedic Surgery, Mercyhealth-Cincinnati Sports Medicine and Orthopedics, Cincinnati, Ohio, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | - Chris Harner
- Office of Orthopedic Devices, Office of Health Technology 6, Silverspring, Maryland, USA
| | - Bruce A Levy
- Jewett Orthopedic Institute, Orlando Health, Orlando, Florida, USA
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, Mizzou Joint & Limb Preservation Center, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Daniel B Whelan
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - George F Hatch
- USC Keck School of Medicine, Los Angeles, California, USA
| | - Christopher J Wahl
- Surgical Sports Medicine and Trauma, Proliance Orthopedics & Sports Medicine, Seattle, Washington, USA
| | - Kristian Thorborg
- Orthopedic Department, Sports Orthopedic Research Center - Copenhagen (SORC-C), Amager - Hvidovre Hospital, Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - James J Irrgang
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicolas Pujol
- Department of Orthopedics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Michael J Medvecky
- Section of Sports Medicine, Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Lars Engebretsen
- Orthopaedic Division, Oslo University Hospital, Oslo, Norway
- Oslo Sports Trauma Research Center, Oslo, Norway
| | - James P Stannard
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | | | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hopsitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
| | - Gregory C Fanelli
- Geisinger Orthopaedics and Sports Medicine, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA
| | - Travis G Maak
- University of Utah Health, Salt Lake City, Utah, USA
| | | | - Evert Verhagen
- Department of Public and Occupational Health, Amsterdam Collaboration on Health & Safety in Sports, Amsterdam, Netherlands
- Movement Sciences, Amsterdam, University Medical Centres - Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Mark D Miller
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Robert C Schenck
- Department of Orthopedic Surgery and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Robert F LaPrade
- Orthopedic Surgery, Twin Cities Orthopedics Edina-Crosstown, Edina, Minnesota, USA
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Shimizu MR, Rumps MV, Schiff AP, Mulcahey MK. Demographics and Characteristics of Vice Chairs in Academic Orthopaedic Surgery Programs: A Descriptive Study. JOURNAL OF SURGICAL EDUCATION 2024; 81:1504-1512. [PMID: 39217681 DOI: 10.1016/j.jsurg.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/27/2024] [Accepted: 07/28/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The Vice-chair (VC) position is gaining popularity in academic orthopaedic surgery departments; however, there is a paucity of information regarding qualifications and career advancements associated with this role. The purpose of this study was to define the characteristics of current orthopaedic surgery department VCs. DESIGN Descriptive study following a retrospective web-based search utilizing the Fellowship and Residency Electronic Interactive Database (FREIDA) database and orthopaedic surgery residency program websites. SETTING 200 ACGME-accredited orthopaedic surgery residency programs across the United States. PARTICIPANTS Program name and hospital affiliations were collected from the FREIDA database to account for all ACGME-accredited programs. The following information was derived from publicly available program websites: title, role description, previously trained institutions, academic rank, and concurrent roles of VCs. Research productivity was measured using the H-index. The previous roles of current Department Chairs (DC) were also evaluated. RESULTS Of the 178 VCs identified, VC of Research (n = 36; 20%), Education (n = 25; 14%), and Clinical Operations/Affairs (n = 21; 12%) were the most common titles. Women made up 17% (n = 30) of the VCs. Trauma (n = 36; 20%) was the most common fellowship subspecialty among VCs. The average H-index for VCs was 25. Among VCs, 94 (53%) were professors, 78 were also Chiefs/Heads/Directors (44%), 7 (4%) were Fellowship Directors, and 18 (10%) were Residency Directors. Twenty-six of 95 (27%) current DC had VC experience. CONCLUSION The findings can facilitate effective leadership development, promotion of diversity and inclusion in these roles, and guidance for those who seek such leadership positions.
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Affiliation(s)
- Michelle R Shimizu
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Mia V Rumps
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Adam P Schiff
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, Illinois.
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Smith TZ, DeYoung JK, Pum JM, Zurakowski D, Templeton K, Day CS. Odds of Attaining Orthopaedic Leadership Based on Race, Ethnicity, and Sex. J Am Acad Orthop Surg 2024; 32:1003-1010. [PMID: 39018573 DOI: 10.5435/jaaos-d-24-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/23/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Despite widespread acceptance of the importance of diversity in leadership, systemic challenges in leadership attainment in orthopaedic surgery still exist for several groups. We hypothesize that women, underrepresented in medicine groups, and Asians have decreased odds of achieving program director and chairperson positions compared with peers. METHODS Demographic data were collected from the Association of American Medical Colleges for faculty, program directors, and chairpersons in orthopaedic surgery. Odds ratios were calculated treating race, ethnicity, or sex as the predictor variables and attainment of a leadership position as the outcome, comparing the composition of program directors in 2020 and chairpersons in 2019 with faculty in 2019. RESULTS Significantly decreased odds were found for women at 0.37 (0.264 to 0.51 [ P < 0.0001]) and the Other category at 0.16 (0.065 to 0.3864 [ P = 0.0001]) while significantly increased odds were found for White and Black/African American faculty at 1.32 (1.02 to 1.71 [ P = 0.0314]) and 1.95 (1.17 to 3.26 [ P = 0.011]), respectively, in holding program director positions. Significantly decreased odds of attaining chairpersonship were found for women at 0.17 (0.07 to 0.41 [ P = 0.0075]) and Asian faculty at 0.33 (0.14 to 0.75 [ P = 0.0062]) while White faculty demonstrated significantly increased odds at 2.43 (1.41 to 4.19 [ P = 0.0013]). CONCLUSIONS Women showed markedly decreased odds of leadership attainment while Black/African American faculty had increased likelihood of becoming program directors but were not markedly more likely to become chairs. Asian faculty were less likely to become program directors and markedly less likely to become chairs. While decreased odds for women were expected based on current literature, decreased odds of Asians becoming chairs and an increased likelihood of Black/African American orthopaedic surgeons becoming program directors but not attaining the role of chairs at the same rate were novel findings, revealing concerning trends for these groups.
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Affiliation(s)
- Tobin Z Smith
- From the Wayne State University School of Medicine, Detroit, MI (Smith, DeYoung, and Pum), Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA (Zurakowski), Harvard Medical School, Cambridge, MA (Zurakowski), Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS (Templeton), Department of Orthopedic Surgery at Henry Ford Health, Wayne State University School of Medicine, Detroit, MI (Day), Michigan State University College of Human Medicine, East Lansing, MI (Day)
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Silvestre J, Rivas GA, Ravinsky RA, Kang JD, Wu HH, Lawrence JP, Reitman CA. Sex diversity in spine surgery fellowship training: analysis of recent trends and program characteristics associated with increased diversity. Spine J 2024:S1529-9430(24)00984-7. [PMID: 39276869 DOI: 10.1016/j.spinee.2024.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/20/2024] [Accepted: 08/24/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND CONTEXT Sex diversity in the spine surgery workforce remains limited. Accelerated efforts to recruit more female trainees into spine surgery fellowship training may help promote diversity and inclusion in the emerging spine surgery workforce. PURPOSE This study assessed the representation of female trainees in spine surgery fellowship training and program factors associated with greater sex diversity among fellows. STUDY DESIGN/SETTING This was a cross-sectional analysis of spine surgery fellows in the United States during the 2016-2017 to 2022-2023 academic years. PATIENT SAMPLE N/A. OUTCOME MEASURES Representation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of female trainees in spine surgery fellowship training divided by the prevalence of female trainees in previous training cohorts. PPR values <0.8 indicated underrepresentation. METHODS Sex diversity was assessed among spine surgery faculty, spine surgery fellows, orthopaedic surgery residents, neurosurgery residents, and allopathic medical students. Fellowship program characteristics associated with increased sex diversity were calculated with chi square tests. RESULTS There were 693 spine surgery fellows and 41 were female (5.9%). Sex diversity in spine surgery fellowship training decreased over the study period (6.4% vs. 4.1%, p=.025). Female trainee representation in spine surgery fellowship training was less than that in orthopaedic surgery residency (14.2%, PPR=0.42), neurosurgery residency (17.1%, PPR=0.35), and allopathic medical school (47.6%, PPR=0.12) training (p<.001). There were 508 faculty at 78 spine surgery fellowships and 25 were female (4.9%). There were 3 female fellowship program directors (3.8%). Fellowship program characteristics associated with increased sex diversity included the presence of female faculty (p=.020). Additional program characteristics including geographic region, accreditation status, number of faculty and fellows were not associated with sex diversity (p>.05). CONCLUSIONS Female representation in spine surgery fellowship training decreased over the study period and remains underrepresented relative to earlier stages of medical and surgical training. There was a positive association between female faculty and increased sex diversity among fellows. Greater efforts are needed to create training environments that promote diversity, equity, and inclusion in spine surgery fellowship training.
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Affiliation(s)
- Jason Silvestre
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA.
| | - Gabriella A Rivas
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
| | - Robert A Ravinsky
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
| | - James D Kang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hao Hua Wu
- Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA, USA
| | - James P Lawrence
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
| | - Charles A Reitman
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
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Williams AJ, Malewicz JI, Pum JM, Zurakowski D, Day CS. How Did Black and Hispanic Orthopaedic Applicants and Residents Compare to General Surgery Between 2015 and 2022? Clin Orthop Relat Res 2024; 482:1361-1370. [PMID: 38578021 PMCID: PMC11272338 DOI: 10.1097/corr.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Despite the heavy demand for and knowledge of the benefits of diversity, there is a persistent lack of racial, ethnic, and gender diversity in orthopaedic surgery. Since the implementation of diversity initiatives, data have shown that general surgery has been one of the top competitive surgical fields and has demonstrated growth in racial, ethnic, and gender diversity, making general surgery a good point of reference and comparison when analyzing racial and ethnic growth in orthopaedic surgery. QUESTIONS/PURPOSES (1) What were the growth rates for Black and Hispanic orthopaedic residency applicants and residents between 2015 and 2022? (2) How did the growth rates of Black and Hispanic individuals in orthopaedic surgery compare with those of general surgery? (3) How did applicant recruitment and resident acceptance differ between Black and Hispanic people in orthopaedic surgery? METHODS Applicant data were obtained from historical specialty-specific data from the Association of American Medical Colleges Electronic Residency Application Service Statistics database between 2018 and 2022, and resident data were obtained from the Accreditation Council of Graduate Medical Education Data Resource Book between 2015 and 2021. Between 2018 and 2022, the number of residency applicants totaled 216,677, with 17,912 Black residency applicants and 20,413 Hispanic residency applicants. Between 2015 and 2021, the number of active residents totaled 977,877, with 48,600 Black residents and 62,605 Hispanic residents. Because the applicant and resident data do not overlap throughout all years of observation, a sensitivity analysis of overlapping years (between 2018 and 2021) was conducted to ensure observed trends were consistent and valid throughout the study. All datasets obtained were used to establish the different racial and ethnic proportions of Black and Hispanic residency applicants and residents in four nonsurgical primary care specialties and four surgical subspecialties. A reference slope was created using data from the Association of American Medical Colleges and Accreditation Council of Graduate Medical Education to represent the growth rate for total residency applicants and residents, independently, across all residency specialties reported in each database. This slope was used for comparison among the resident and applicant growth rates for all eight selected specialties. Datapoints were placed into a scatterplot with regression lines, using slope equations to depict rate of growth and R 2 values to depict linear fit. Applicant growth corresponded to applicant recruitment and resident growth corresponded to resident acceptance. Chi-square tests were used to compare residents and residency applicants for the Black and Hispanic populations, separately. Two-way analysis of variance with a time-by-specialty interaction term (F-test) was conducted to determine differences between growth slopes. RESULTS There was no difference in the growth rate of Black orthopaedic surgery applicants between 2018 and 2022, and there was no difference in the growth rate of Hispanic orthopaedic surgery applicants (R 2 = 0.43; p = 0.23 and R 2 = 0.63; p = 0.11, respectively). However, there was a very slight increase in the growth rate of Black orthopaedic surgery residents between 2015 and 2021, and a very slight increase in the growth rate of Hispanic orthopaedic surgery residents (R 2 = 0.73; p = 0.02 and R 2 = 0.79; p = 0.01, respectively). There were no differences in orthopaedic and general surgery rates of growth for Black applicants between 2018 and 2022 (0.004 applicants/year versus -0.001 applicants/year; p = 0.22), and no differences were found in orthopaedic and general surgery rates of growth for Black residents between 2015 and 2021 (0.003 residents/year versus 0.002 residents/year; p = 0.59). Likewise, Hispanic orthopaedic applicant growth rates did not differ between 2018 and 2022 from the rates of general surgery (0.004 applicants/year versus 0.005 applicants/year; p = 0.68), and there were no differences in orthopaedic and general surgery rates of growth for Hispanic residents (0.007 residents/year versus 0.01 residents/year; p = 0.35). Furthermore, growth rate comparisons between Black orthopaedic applicants and residents between 2018 and 2021 showed applicant growth was larger than resident growth, illustrating that the recruitment of Black applicants increased slightly more rapidly than resident acceptance. Growth rate comparisons between Hispanic applicants and residents showed a larger rate of resident growth, illustrating Hispanic resident acceptance increased slightly faster than applicant recruitment during that time. CONCLUSION We found low acceptance of Black residents compared with the higher recruitment of Black applicants, as well as overall low proportions of Black and Hispanic applicants and residents. Future studies might explore the factors contributing to the higher acceptances of Hispanic orthopaedic residents than Black orthopaedic residents. CLINICAL RELEVANCE We recommend that more emphasis should be placed on increasing Black and Hispanic representation at the department level to ensure cultural considerations remain at the forefront of applicant recruitment. Internal or external reviews of residency selection processes should be considered, and more immersive, longitudinal orthopaedic surgery clerkships and research mentorship experiences should be targeted toward Black and Hispanic students. Holistic reviews of applications and selection processes should be implemented to produce an increased racially and ethnically diverse applicant pool and a diverse residency work force, and implicit bias training should be implemented to address potential biases and diversity barriers that are present in residency programs and leadership.
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Affiliation(s)
- Alisha J. Williams
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Julia I. Malewicz
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - John M. Pum
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - David Zurakowski
- Director of Biostatistics for Departments of Anesthesiology and Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Charles S. Day
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan State University College of Human Medicine, Detroit, MI, USA
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Silvestre J, Benn L, Chen AF, Lieberman JR, Peters CL, Nelson CL. Diversity of Backgrounds and Academic Accomplishments for Presidents Elected to Hip and Knee Arthroplasty Societies in the United States. J Arthroplasty 2024; 39:1856-1862. [PMID: 38309637 DOI: 10.1016/j.arth.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Academic accomplishments and demographics for presidents of hip and knee arthroplasty societies are poorly understood. This study compares the characteristics of presidents nominated to serve the Hip Society, Knee Society, and American Association of Hip and Knee Surgeons. METHODS This was a cross-sectional study of arthroplasty presidents in the United States (1990 to 2022). Curriculum vitae and academic websites were analyzed for demographic, training, bibliometric, and National Institutes of Health (NIH) funding data. Comparisons were made between organizations and time periods (1990 to 2005 versus 2006 to 2022). RESULTS There were 97 appointments of 78 unique arthroplasty presidents (80%). Most presidents were male (99%) and Caucasian (95%). There was 1 woman (1%) and 5 non-Caucasian presidents (2% Asian, 3% Hispanic). There were no differences in demographics between the 3 arthroplasty organizations and the 2 time periods (P > .05). Presidents were appointed at 55 ± 10 years old, which was on average 24 years after completion of residency training. Most presidents had arthroplasty fellowship training (68%), and the most common were the Hospital for Special Surgery (21%) and Massachusetts General Hospital (8%). The median h-index was 53 resulting from 191 peer-reviewed publications, which was similar between the 3 organizations (P > .05). There were 2 presidents who had NIH funding (2%), and there were no differences in NIH funding between the 3 organizations (P > .05). CONCLUSIONS Arthroplasty society presidents have diverse training pedigrees, high levels of scholarly output, and similar demographics. There may be future opportunities to promote diversity and inclusion among the highest levels of leadership in total joint arthroplasty.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | - Lancelot Benn
- Howard University College of Medicine, Washington, District of Columbia
| | | | - Jay R Lieberman
- Keck School of Medicine of University of Southern California, Los Angeles, California
| | | | - Charles L Nelson
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Cho E, McCarthy MV, Hodkiewicz V, Rumps MV, Mulcahey MK. Gender Disparity in Authorship Among Orthopaedic Surgery Residents. JB JS Open Access 2024; 9:e24.00061. [PMID: 39045396 PMCID: PMC11262817 DOI: 10.2106/jbjs.oa.24.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Background Gender disparity remains pervasive in orthopaedic surgery, which affects the research pursuits of orthopaedic surgeons. The purpose of this study was to characterize gender-related authorship trends of orthopaedic surgery residents, including evaluation of gender-concordant publication rates. Methods An observational cross-sectional analysis of US orthopaedic surgery residency programs was performed. Information on residency programs and demographics of each cohort was collected. Publication metrics consisting of number of first and non-first author publications and H-indices were manually obtained for PGY-3 to PGY-5 residents attending the 25 programs ranked the highest for research output by Doximity. Gender of each resident and senior author was determined from institutional websites using photos, biographies, and preferred pronouns when available. Results A total of 532 residents, 169 (31.8%) female and 363 (68.2%) male, were included for authorship analysis. Of them, 415 (78%) had at least one first author publication, which did not vary significantly by gender. Female residents had disproportionately fewer first author publications compared with their representation (22% vs. 31.8%, p < 0.00001). Female residents averaged fewer first and non-first author publications compared with male residents (2.8 vs. 4.6, p = 0.0003; 6.4 vs. 10, p = 0.0001 respectively). Despite fewer publications overall, a greater subset of publications by female residents were written in collaboration with a female senior author compared with publications by male residents (p < 0.0001). Male residents had a higher average H-index of 5.4 vs. 3.9 among female residents (p = 0.00007). Conclusion Despite similar rates of first author publication among male and female residents, female residents had fewer publications overall, lower H-indices, and disproportionately fewer first author publications than would be expected given their representation. Findings from this study suggest that gender disparity in orthopaedic surgery extends to differences in research productivity as early as in residency. This may have negative implications on the career advancement of female orthopaedic surgeons. Additional work is needed to identify and understand biases in research productivity and career advancement, to promote more equitable strategies for academic achievement. Level of Evidence IV.
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Affiliation(s)
- Elizabeth Cho
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Mary V. McCarthy
- Stritch School of Medicine, Loyola University of Chicago, Maywood, Illinois
| | | | - Mia V. Rumps
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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Silvestre J, Benn L, Chang B, Wilson RH, Levin LS. Benchmarking Accomplishments of Presidents Elected to Hand Surgery Societies in the United States. J Hand Microsurg 2024; 16:100043. [PMID: 38855515 PMCID: PMC11144641 DOI: 10.1055/s-0043-1769750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Objective Qualifications needed to achieve national leadership positions in hand surgery are poorly defined. This study compares the academic accomplishments, demographics, and training backgrounds of presidents elected to serve the American Society for Surgery of the Hand (ASSH) and the American Association for Hand Surgery (AAHS). Methods The ASSH and AAHS provided names of elected Presidents (1990-2022, n = 64). Curriculum vitae and academic web sites were used to collect demographic, training, bibliometric, and National Institutes of Health (NIH) funding data of presidents. Results Presidents were predominately male (95%), Caucasian (90%), and orthopaedic surgery residency-trained (66%). Only 9% were racial minorities (8% Asian, 2% Hispanic, and 0% African American). The average age at appointment was 59 ± 7 years old, which was an average of 23 years from completion of hand surgery fellowship. More presidents received plastic surgery residency training in AAHS than ASSH (50 vs. 19%). The most represented hand surgery fellowships were Mayo Clinic (14%), University of Louisville (11%), and Duke University (9%). Twenty-one presidents participated in a travel fellowship (33%). Thirty presidents served as Department Chair or Division Chief at time of election (47%). The average h-index was 34 ± 18 resulting from 164 ± 160 peer-reviewed manuscripts and was similar between the two organizations. Eleven presidents had NIH grant funding (18%) and there were no differences in procurement or funding totals between the two organizations. Conclusion Presidents of American hand surgery societies obtain high levels of scholarly activity regardless of training specialty. Women and racial minorities remain underrepresented at the highest levels of leadership.
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Affiliation(s)
- Jason Silvestre
- Department of Orthopedic Surgery, Howard University College of Medicine, Washington, Dist. of Columbia, United States
| | - Lancelot Benn
- Department of Orthopedic Surgery, Howard University College of Medicine, Washington, Dist. of Columbia, United States
| | - Benjamin Chang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robert H. Wilson
- Department of Orthopedic Surgery, Howard University College of Medicine, Washington, Dist. of Columbia, United States
| | - L. Scott Levin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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21
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Haddad D, Nelson D, Sherman N, Tatusko M, DeSilva G. Gender Diversity in Orthopaedic Surgery Residencies Does Not Translate to Accreditation Council for Graduate Medical Education-Accredited Fellowships. JB JS Open Access 2024; 9:e23.00124. [PMID: 38751665 PMCID: PMC11093577 DOI: 10.2106/jbjs.oa.23.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Introduction Gender representation among orthopaedic surgery applicants and residents has increased over the past two decades. The aims of this study were to evaluate trends of female fellows in ACGME-accredited orthopaedic subspecialties between 2007 and 2021, and to compare the fellowship trends of female representation to those of ACGME-accredited orthopaedic residencies. Methods We conducted a retrospective review of publicly available ACGME-accredited fellowship demographic data from 2007 to 2021. The distribution of genders (male vs. female) across subspecialties and orthopaedic surgery residency programs was compared. Chi-square, Spearman correlation, and logistic regression tests were performed to analyze the relationships between year, gender, and fellowship. Results Chi-square analysis demonstrated a significant relationship between gender and year for orthopaedic residency (p < 0.001), but not for any fellowship. There was a significant negative Spearman correlation between the two variables for hand (r(1844) = -0.06, p = 0.02) and sports medicine (r(2804) = -0.05, p = 0.01) fellowships. The negative Spearman correlation for pediatrics (r(499) = -0.09, p = 0.054) approached but did not reach statistical significance. Logistic regression analysis revealed that, holding year constant and comparing to orthopaedic residency, the odds of male participation increased by 173% (95% CI, 1.8-4.1) in spine, increased by 138% (95% CI, 1.7-3.3) in adult reconstruction, increased by 51% (95% CI, 1.3-1.7) in sports medicine, decreased by 41% (95% CI, 0.5-0.7) in hand, decreased by 36% (95% CI, 0.5-0.9) in foot and ankle, decreased by 48% (95% CI, 0.4-0.7) in musculoskeletal oncology, and decreased by 68% (95% CI, 0.3-0.4) in pediatrics. Conclusion Although the percentage of female orthopaedic residents in ACGME-accredited programs increased significantly from 2007 to 2021, this has not translated to ACGME-accredited fellowship positions. Future research optimizing methods to improve the representation of females in orthopaedic surgery should be considered. Level of Evidence III.
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Affiliation(s)
- David Haddad
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - Deborah Nelson
- The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - Nathan Sherman
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - Megan Tatusko
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - Gregory DeSilva
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, Arizona
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22
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Pujari A, Johnson F, Little MT, Forsh DA, Okike K. Racial/Ethnic and Gender Diversity of Orthopaedic Journal Editorial Boards. J Bone Joint Surg Am 2024; 106:460-465. [PMID: 37713501 DOI: 10.2106/jbjs.23.00384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND In the current era of evidence-based medicine, scientific publications play a crucial role in guiding patient care. While the lack of diversity among orthopaedic surgeons has been well documented, little is known about the diversity of orthopaedic journal editorial boards. The purpose of this study was to assess the racial/ethnic and gender diversity of U.S. orthopaedic journal editorial boards. METHODS The editorial boards of 13 orthopaedic journals were examined, including 10 subspecialty and 3 general orthopaedic journals. Race/ethnicity and gender were determined for each editorial board member. The representation observed on orthopaedic journal editorial boards was compared with representation at other phases of the orthopaedic pipeline, as well as within the various subspecialty fields of orthopaedics. Logistic regression and t tests were used to evaluate these comparisons. RESULTS We identified 876 editorial board members of the 13 journals; 14.0% were Asian, 1.9% were Black, 1.9% were Hispanic, 2.4% were multiracial/other, and 79.7% were White. Racial/ethnic representation was similar across the subspecialty fields of orthopaedics (p > 0.05). The representation of women on orthopaedic editorial boards was 7.9%, with differences in gender diversity observed across subspecialty fields (p < 0.05). Among journals in the subspecialty fields of spine and trauma, female editorial board representation was lower than expected, even after taking into account the representation of women in these subspecialty fields (2.0% versus 9.0% [p = 0.002] and 3.8% versus 10.0% [p = 0.03], respectively). CONCLUSIONS In this study of 13 subspecialty and general orthopaedic journals, the representation of racial/ethnic minorities and women on editorial boards was similar to their representation in academic orthopaedics. However, these values remain low in comparison with the population of patients treated by orthopaedic surgeons. Given the importance of scientific publications in the current era of evidence-based medicine, orthopaedic journals should continue working to diversify the membership of their editorial boards.
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Affiliation(s)
- Amit Pujari
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - David A Forsh
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kanu Okike
- Hawaii Permanente Medical Group, Honolulu, Hawaii
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23
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Han Y, Fones L, Shakked R, Hammoud S. Orthopedic Surgery Residency Program Rankings and Gender Diversity. Cureus 2024; 16:e56365. [PMID: 38633926 PMCID: PMC11022666 DOI: 10.7759/cureus.56365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Background Orthopedic surgery residency programs are some of the least gender-diverse specialty programs in medicine. Despite strong representation at the undergraduate and medical school levels and increased applications to orthopedic surgery residency programs by women, there is still a substantial gender gap at the resident level. This study explores the relationship between the gender diversity of orthopedic surgery residency programs and program rankings. Methodology Program rank, program director gender identity, and gender diversity data were collected for the top 100 programs by reputation in Doximity. Gender diversity was measured as the proportion of female residents in the program and alumni. Results The greatest percentage of women in a program was 33% and the smallest was 3%. After linear regression analysis, we found that there was a statistically significant positive correlation between program rank and the proportion of women. The higher ranked a program was, the greater the proportion of women. There was no significant correlation between program director gender, appointment year, and program rank. Conclusions These results suggest that, although there is still a long way to go before closing the gender gap in orthopedic surgery residency programs, higher-ranked programs are associated with greater gender diversity than their lower-ranked counterparts.
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Affiliation(s)
- Yuri Han
- Orthopedic Surgery, Robert Wood Johnson Medical School, Piscataway, USA
| | - Lilah Fones
- Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Rachel Shakked
- Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Sommer Hammoud
- Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
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24
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Silvestre J, Tippabhatla A, Chopra A, Nelson CL, LaPorte DM. Sex Disparities Among Fellowship Program Directors in Orthopaedic Surgery. J Bone Joint Surg Am 2024; 106:251-257. [PMID: 38323988 DOI: 10.2106/jbjs.23.00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Women are underrepresented in the orthopaedic surgery workforce in the U.S. The purpose of this study was to elucidate the representation of women among fellowship program directors (PDs) in orthopaedic surgery. METHODS This was a retrospective cohort study of fellowship PDs in orthopaedic surgery during the 2022 to 2023 academic year. Academic, training, and demographic characteristics were collected from internet-based resources. Participation-to-prevalence ratios (PPRs) were calculated for both men and women. A PPR of <0.8 indicated underrepresentation and a PPR of >1.2 indicated overrepresentation. Bivariate analyses were utilized to assess the correlation between sex diversity and geographic region and between sex diversity and Accreditation Council for Graduate Medical Education (ACGME)-accreditation status. The relationship between the median annual salary and the sex diversity of each orthopaedic subspecialty was analyzed with use of the Pearson correlation coefficient. RESULTS This study included 600 fellowship PDs, 40 (6.7%) of whom were women. In total, 24.5% of the fellowship PDs were assistant professors (8.8% women versus 91.2% men, p < 0.001); 26.2% were associate professors (9.6% women versus 90.4% men, p < 0.001); 36.8% were full professors (4.5% women versus 95.5% men, p < 0.001); and 12.5% were unranked (2.7% women versus 97.3% men, p < 0.001). The representation of women increased with academic rank, as reflected in their prevalence at the assistant (PPR = 0.67), associate (PPR = 0.77), and full professor (PPR = 0.80) levels. Among the orthopaedic subspecialties, musculoskeletal oncology (19.0%), pediatric orthopaedics (14.6%), and hand surgery (12.6%) had the highest proportions of women fellowship PDs. PPRs were lowest for orthopaedic sports medicine (PPR = 0.35), shoulder and elbow (PPR = 0.45), and adult reconstruction (PPR = 0.52). Women PDs had equitable representation in musculoskeletal oncology (PPR = 1.17), hand surgery (PPR = 1.02), foot and ankle (PPR = 0.84), and orthopaedic trauma (PPR = 0.80). Median subspecialty compensation was negatively correlated with the prevalence of women among fellowship PDs (r = -0.70, p = 0.036). Geographic region was not associated with sex diversity (p = 0.434), but programs with ACGME accreditation had significantly more women fellowship PDs than those without (11.0% versus 3.9%, p < 0.001). CONCLUSIONS Women are underrepresented among orthopaedic fellowship PDs, especially in certain subspecialties (orthopaedic sports medicine, shoulder and elbow, and adult reconstruction). More research is needed to understand the barriers that impact the representation of women among leadership positions in orthopaedic surgery. CLINICAL RELEVANCE Greater sex diversity among fellowship PDs may help to increase the recruitment of women into orthopaedic subspecialties. The equitable consideration of orthopaedic surgeons from all backgrounds for leadership positions can increase workforce diversity, which may improve the vitality of the orthopaedic community.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Ambica Chopra
- Howard University College of Medicine, Washington, DC
| | - Charles L Nelson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dawn M LaPorte
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Fanfan D, Larios F, Gonzalez MR, Rodriguez A, Nichols D, Alvarez JC, Pretell-Mazzini J. A Bibliometric Analysis of the 500 Most Cited Papers in Orthopaedic Oncology. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00004. [PMID: 38236058 PMCID: PMC10796143 DOI: 10.5435/jaaosglobal-d-23-00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Despite notable progress over time, broad insight into the scientific landscape of orthopaedic oncology is lacking. We conducted a bibliometric analysis of the 500 most cited papers in the field. METHODS We searched the Science Citation Index Expanded database of the Web of Science Core Collection to find the 500 most cited articles in the field. RESULTS Citation count ranged from 81 to 1,808. Articles were published from 1965 to 2018. Over half of all articles were published in the United States (53.6%). The 2000s was the most productive decade with 170 (34%) articles. All articles were written in English and were published across 29 journals. Female participation as first authors significantly increased from the 1960s to the 2010s (0% vs 14.6%, P = 0.0434). Similarly, female involvement as senior authors grew from the 1960s to the 2010s (0% vs 12.2%, P = 0.0607). Primary bone sarcomas were the most cited topic among articles from the 1970s to the 1980s. From studies produced in the 1990s up until the 2010s, reconstruction procedures were the most cited topic. CONCLUSION Trends over the years have resulted in an emphasis on a surgical technique. Notable progress has been made regarding gender diversity, yet disparities still exist.
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Affiliation(s)
- Dino Fanfan
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, FL (Mr. Fanfan, Mr. Rodriguez, Ms. Nichols, and Mr. Alvarez Jr); the Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru (Dr. Larios); the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Gonzalez); and the Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL (Dr. Pretell-Mazzini)
| | - Felipe Larios
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, FL (Mr. Fanfan, Mr. Rodriguez, Ms. Nichols, and Mr. Alvarez Jr); the Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru (Dr. Larios); the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Gonzalez); and the Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL (Dr. Pretell-Mazzini)
| | - Marcos R. Gonzalez
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, FL (Mr. Fanfan, Mr. Rodriguez, Ms. Nichols, and Mr. Alvarez Jr); the Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru (Dr. Larios); the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Gonzalez); and the Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL (Dr. Pretell-Mazzini)
| | - Alexander Rodriguez
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, FL (Mr. Fanfan, Mr. Rodriguez, Ms. Nichols, and Mr. Alvarez Jr); the Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru (Dr. Larios); the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Gonzalez); and the Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL (Dr. Pretell-Mazzini)
| | - Domonique Nichols
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, FL (Mr. Fanfan, Mr. Rodriguez, Ms. Nichols, and Mr. Alvarez Jr); the Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru (Dr. Larios); the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Gonzalez); and the Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL (Dr. Pretell-Mazzini)
| | - Juan C. Alvarez
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, FL (Mr. Fanfan, Mr. Rodriguez, Ms. Nichols, and Mr. Alvarez Jr); the Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru (Dr. Larios); the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Gonzalez); and the Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL (Dr. Pretell-Mazzini)
| | - Juan Pretell-Mazzini
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, FL (Mr. Fanfan, Mr. Rodriguez, Ms. Nichols, and Mr. Alvarez Jr); the Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru (Dr. Larios); the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Gonzalez); and the Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL (Dr. Pretell-Mazzini)
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26
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Rama E, Ekhtiari S, Thevendran G, Green J, Weber K, Khanduja V. Overcoming the Barriers to Diversity in Orthopaedic Surgery: A Global Perspective. J Bone Joint Surg Am 2023; 105:1910-1919. [PMID: 37639495 DOI: 10.2106/jbjs.23.00238] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Diversity in orthopaedics continues to lag behind that in other surgical specialties. This pattern exists globally and is not unique to gender or race. This review offers a global perspective on overcoming the barriers to diversity in orthopaedics. METHODS A literature search of MEDLINE and Embase was conducted and a narrative review was undertaken. Publications that discussed any aspect of diversity or solutions to diversity within orthopaedics or academic orthopaedics were identified. RESULTS A total of 62 studies were included. Studies showed that diversity in orthopaedic training is limited by structural barriers such as long hours, requirements to relocate during training, training inflexibility, and a lack of exposure to orthopaedics. Implicit bias during the selection process for training, discrimination, and a lack of role models are additional barriers that are experienced by both minority and female surgeons. The global lack of diversity suggests that there are also inherent "cultural barriers" that are unique to orthopaedics; however, these barriers are not uniformly experienced. Perceptions of orthopaedics as promoting an unhealthy work-life balance and the existence of a "boys' club" must be addressed. Strong, committed leaders can embed cultural norms, support trainees, and act as visible role models. Targeted efforts to increase diverse recruitment and to reduce bias in selection processes for medical school and specialty training will increase diversity in the "training pipeline." CONCLUSIONS Diversity in orthopaedics continues to lag behind that in other specialties. Increasing diversity is important for providing a more inclusive training environment, improving patient care, and reducing health disparities. Structural and cultural barriers need to be addressed to improve diversity in orthopaedics. Promoting a culture supportive of all surgeons is essential to reframing perceptions that may prevent individuals from even considering a career as an orthopaedic surgeon. Changing attitudes require focused efforts from committed leadership in a "top-down" approach that prioritizes diversity. The efforts from national bodies seeking to tackle the lack of diversity, as well as the establishment of organizations committed to diversity, such as the International Orthopaedic Diversity Alliance, provide reasons to be optimistic for the future.
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Affiliation(s)
- Essam Rama
- University of Cambridge, Cambridge, United Kingdom
| | - Seper Ekhtiari
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Kristy Weber
- Penn Orthopaedics Perelman, Penn Medicine, Philadelphia, Pennsylvania
| | - Vikas Khanduja
- University of Cambridge, Cambridge, United Kingdom
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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LaPorte ZL, Cherian NJ, Eberlin CT, Dean MC, Torabian KA, Dowley KS, Martin SD. Operative management of rotator cuff tears: identifying disparities in access on a national level. J Shoulder Elbow Surg 2023; 32:2276-2285. [PMID: 37245619 DOI: 10.1016/j.jse.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The purpose of this study was to identify nationwide disparities in the rates of operative management of rotator cuff tears based on race, ethnicity, insurance type, and socioeconomic status. METHODS Patients diagnosed with a full or partial rotator cuff tear from 2006 to 2014 were identified in the Healthcare Cost and Utilization Project's National Inpatient Sample database using International Classification of Diseases, Ninth Revision diagnosis codes. Bivariate analysis using chi-square tests and adjusted, multivariable logistic regression models were used to evaluate differences in the rates of operative vs. nonoperative management for rotator cuff tears. RESULTS This study included 46,167 patients. When compared with white patients, adjusted analysis showed that minority race and ethnicity were associated with lower rates of operative management for Black (adjusted odds ratio [AOR]: 0.31, 95% confidence interval [CI]: 0.29-0.33; P < .001), Hispanic (AOR: 0.49, 95% CI: 0.45-0.52; P < .001), Asian or Pacific Islander (AOR: 0.72, 95% CI: 0.61-0.84; P < .001), and Native American patients (AOR: 0.65, 95% CI: 0.50-0.86; P = .002). In comparison to privately insured patients, our analysis also found that self-payers (AOR: 0.08, 95% CI: 0.07-0.10; P < .001), Medicare beneficiaries (AOR: 0.76, 95% CI: 0.72-0.81; P < .001), and Medicaid beneficiaries (AOR: 0.33, 95% CI: 0.30-0.36; P < .001) had lower odds of receiving surgical intervention. Additionally, relative to those in the bottom income quartile, patients in all other quartiles experienced nominally higher rates of operative repair; these differences were statistically significant for the second quartile (AOR: 1.09, 95% CI: 1.03-1.16; P = .004). CONCLUSION There are significant nationwide disparities in the likelihood of receiving operative management for rotator cuff tear patients of differing race/ethnicity, payer status, and socioeconomic status. Further investigation is needed to fully understand and address causes of these discrepancies to optimize care pathways.
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Affiliation(s)
- Zachary L LaPorte
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Nathan J Cherian
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA.
| | - Christopher T Eberlin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Michael C Dean
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Kaveh A Torabian
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Kieran S Dowley
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
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Silvestre J, Walker JJ, LaPorte DM, Nelson CL. Women Are Underrepresented Among Principal Investigators of Hip and Knee Arthroplasty Clinical Trials in the United States. J Bone Joint Surg Am 2023; 105:1734-1739. [PMID: 37315108 DOI: 10.2106/jbjs.23.00205] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Leadership of clinical trials confers national recognition and promotes academic advancement. We hypothesized that women would be underrepresented among principal investigators (PIs) of hip and knee arthroplasty clinical trials in the United States. METHODS A query of hip and knee arthroplasty clinical trials from 2015 to 2021 was performed on ClinicalTrials.gov. Clinical trials were included if they involved a U.S.-based orthopaedic-surgeon PI. We analyzed the sex representation of arthroplasty PIs among junior-level (assistant professor) and senior-level (associate or full professor) faculty. Participation-to-prevalence ratios (PPRs) were calculated by comparing the sex representation among arthroplasty PIs with that among academic arthroplasty faculty at institutions conducting hip and knee arthroplasty clinical trials. A PPR of <0.8 indicated underrepresentation and a PPR of >1.2 indicated overrepresentation. RESULTS A total of 157 clinical trials involving 192 arthroplasty PIs were included. Of these PIs, only 2 (1.0%) were women. PIs were mostly funded by academic institutions (66%) and industry (33%). U.S. federal sources funded a minority (1%) of PIs. Of the 243 male arthroplasty faculty who were eligible, 190 men (78.2%) served as PIs. In contrast, of the 17 female arthroplasty faculty who were eligible, only 2 women (11.8%) served as PIs (p < 0.001). Across the entire cohort of arthroplasty PIs, women were underrepresented (PPR = 0.16), whereas men were equitably represented (PPR = 1.06). Women were underrepresented at the assistant professor (PPR = 0.0), associate professor (PPR = 0.52), and full professor (PPR = 0.58) levels. CONCLUSIONS Women were underrepresented among PIs of hip and knee arthroplasty clinical trials, which may lead to disparities in academic promotion and advancement. More research is needed to understand the potential barriers to female leadership of clinical trials. Greater awareness and engagement are needed to create sex equity in clinical trial leadership for hip and knee arthroplasty research. CLINICAL RELEVANCE The underrepresentation of women among arthroplasty PIs may lead to fewer options in surgical providers for patients and may limit access to musculoskeletal care for certain patient populations. A diverse arthroplasty workforce can promote attention to issues that disproportionately affect historically underrepresented and vulnerable patient populations.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Dawn M LaPorte
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles L Nelson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Iwai Y, Yu AYL, Thomas SM, Fayanju OA, Sudan R, Bynum DL, Fayanju OM. Leadership and Impostor Syndrome in Surgery. J Am Coll Surg 2023; 237:585-595. [PMID: 37350479 PMCID: PMC10846669 DOI: 10.1097/xcs.0000000000000788] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Impostor syndrome is an internalized sense of incompetence and not belonging. We examined associations between impostor syndrome and holding leadership positions in medicine. STUDY DESIGN A cross-sectional survey was distributed to US physicians from June 2021 to December 2021 through medical schools and professional organizations. Differences were tested with the chi-square test and t -test for categorical and continuous variables, respectively. Logistic regression was used to identify factors associated with holding leadership positions and experiencing impostor syndrome. RESULTS A total of 2,183 attending and retired physicians were included in the analytic cohort; 1,471 (67.4%) were in leadership roles and 712 (32.6%) were not. After adjustment, male physicians were more likely than women to hold leadership positions (odds ratio 1.4; 95% CI 1.16 to 1.69; p < 0.001). Non-US citizens (permanent resident or visa holder) were less likely to hold leadership positions than US citizens (odds ratio 0.3; 95% CI 0.16 to 0.55; p < 0.001). Having a leadership position was associated with lower odds of impostor syndrome (odds ratio 0.54; 95% CI 0.43 to 0.68; p < 0.001). Female surgeons were more likely to report impostor syndrome compared to male surgeons (90.0% vs 67.7%; p < 0.001), an association that persisted even when female surgeons held leadership roles. Similar trends were appreciated for female and male nonsurgeons. Impostor syndrome rates did not differ by race and ethnicity, including among those underrepresented in medicine, even after adjustment for gender and leadership role. CONCLUSIONS Female physicians were more likely to experience impostor syndrome than men, regardless of specialty or leadership role. Although several identity-based gaps persist in leadership, impostor syndrome among racially minoritized groups may not be a significant contributor.
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Affiliation(s)
- Yoshiko Iwai
- From the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (Iwai)
| | - Alice Yunzi L Yu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL (Yu)
| | - Samantha M Thomas
- Duke Cancer Institute (Thomas), Duke University School of Medicine, Durham, NC
- Departments of Biostatistics and Bioinformatics (Thomas), Duke University School of Medicine, Durham, NC
| | - Oluseyi A Fayanju
- Department of Medicine, Stanford University, Palo Alto, CA (QA Fayanju)
| | - Ranjan Sudan
- Surgery (Sudan), Duke University School of Medicine, Durham, NC
| | - Debra L Bynum
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (Bynum)
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine (OM Fayanju), The University of Pennsylvania, Philadelphia, PA
- Penn Center for Cancer Care Innovation (PC3I) (OM Fayanju), The University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics (LDI) (OM Fayanju), The University of Pennsylvania, Philadelphia, PA
- Rena Rowan Breast Center, Abramson Cancer Center, Philadelphia, PA (OM Fayanju)
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Meadows AM, Skinner MM, Hazime AA, Day RG, Fore JA, Day CS. Racial, Ethnic, and Sex Diversity in Academic Medical Leadership. JAMA Netw Open 2023; 6:e2335529. [PMID: 37747731 PMCID: PMC10520740 DOI: 10.1001/jamanetworkopen.2023.35529] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Importance For the past 50 years, significant gaps have existed in gender and racial diversity across various medical specialties, despite the many benefits of a diverse physician workforce. One proposed approach to increasing diversity is top-down diversification, in which diverse leadership results in increased minority and female workforce representation. Objective To investigate the changes in academic medical leadership diversity from 2007 to 2019 and to assess the recent leadership diversity of various specialties compared with the averages across all specialties. Design, Setting, and Participants This was a cross-sectional analysis of physicians in varying academic roles in 2007, 2019, and 2020. Demographic data were collected via specialized reports from the Association of American Medical Colleges. Included were 4 primary care specialties (internal medicine, family medicine, pediatrics, obstetrics/gynecology [OB/GYN] and 4 surgical specialties (orthopedic surgery, neurologic surgery, otolaryngology [ENT], general surgery). Study participants were faculty, program directors, and chairpersons. Data were analyzed for the years 2007, 2019, and 2020. Intervention Self-reporting of demographic information to residency programs collected via the Graduate Medical Education Track Survey. Main Outcomes and Measures Proportions of each race/ethnicity and sex among cohorts of participants and comparisons between them. Results The total number of individuals investigated included 186 210 faculty from 2019 (79 441 female [42.7%]), 6417 program directors from 2020 (2392 female [37.3%]), 1016 chairpersons from 2007 (89 female [8.8%]), and 2424 chairpersons from 2019 (435 female [17.9%]). When comparing chairperson diversity from 2007 to 2019, only internal medicine and general surgery experienced significant increases in minority (aggregate category used throughout the investigation to refer to anyone who self-identified as anything other than non-Hispanic White) representation (90% increase [11.7 percentage points, from 13.0% in 2007 to 24.7% in 2019]; P = .01 and 96% increase [13.0 percentage points, from 13.5% in 2007 to 26.5% in 2019]; P < .001), respectively; meanwhile, several specialties saw significant increases in female representation during this period (family medicine by 107.4%, P =.002; pediatrics by 83.1%, P =.006; OB/GYN by 53.2%, P =.045; orthopedic surgery by +4.1 percentage points, P =.04; general surgery by 226.9%, P =.005). In general, surgical specialties had lower leadership diversity than the average diversity of all residency programs, whereas primary care specialties had similar or increased diversity. Conclusions and Relevance Study results suggest that some specialties have made significant contributions toward bridging diversity gaps whereas others continue to lag behind. Our recommendations to improve academic medical leadership diversity include programs and institutions (1) publishing efforts and outcomes of diversity representation, (2) incorporating a representative demographic for leadership selection committees, and (3) actively promoting the importance of diversity throughout the selection process.
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Affiliation(s)
- Austin M. Meadows
- Henry Ford Health, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
| | | | | | | | | | - Charles S. Day
- Henry Ford Health, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
- Michigan State University College of Human Medicine, Grand Rapids
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Day CS, Lattanza L, Van Heest A, Templeton K, Fore JA, Ode GE. AOA Critical Issues: Gender Justice in Academic Medicine: What It Might Look Like in Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:1214-1219. [PMID: 37027484 DOI: 10.2106/jbjs.22.01204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
ABSTRACT As the number of women entering medicine has increased, so has the number of women entering orthopaedics; however, many orthopaedic programs struggle to create an equitable space for women, particularly in leadership. Struggles experienced by women include sexual harassment and gender bias, lack of visibility, lack of well-being, disproportionate family care responsibilities, and lack of flexibility in the criteria for promotions. Historically, sexual harassment and bias has been a problem faced by women physicians, and often the harassment continues even when the issue has been reported; many women find that reporting it results in negative consequences for their career and training. Additionally, throughout medical training, women are less exposed to orthopaedics and lack the mentorship that is given to their colleagues who are men. The late exposure and lack of support prevent women from entering and advancing in orthopaedic training. Typical surgery culture can also result in women orthopaedic surgeons avoiding help for mental wellness. Improving well-being culture requires systemic changes. Finally, women in academics perceive decreased equality in promotional considerations and face leadership that already lacks representation of women. This paper presents solutions to assist in developing equitable work environments for all academic clinicians.
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Affiliation(s)
| | | | | | | | - Jessi A Fore
- Henry Ford Health, Detroit, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Steele M, Gianakos AL, Stamm MA, Mulcahey MK. Diversity in Orthopaedic Sports Medicine Societies. Arthrosc Sports Med Rehabil 2023; 5:100752. [PMID: 37645393 PMCID: PMC10461193 DOI: 10.1016/j.asmr.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose The purpose of this study was to report demographic trends in terms of ethnicity/race and gender among the membership and leadership positions of the Arthroscopy Association of North America (AANA) and the American Orthopaedic Society of Sports Medicine (AOSSM). Over the years both AANA and AOSSM will increase in diversity through their committee membership and leadership positions. Methods AANA and AOSSM membership and leadership were reviewed for the years 2010, 2015, and 2020. Race/ethnicity was divided into Caucasian, Asian, African American (AA), Hispanic/Latin/South American (HLSA), and Middle Eastern (ME). Gender was limited to male or female, based on name and photographic depiction. Results Diversity in AANA and AOSSM committee and leadership positions is summarized in Table 1 and Table 2, respectively. In 2010, 166/191 (87%) AANA committee members were Caucasian, as compared with 125/186 (67%) in 2020. Asian committee members were similar in 2010 (13/191, 7%) and 2015 (13/216, 6%) but increased to 17/186 (10%) in 2020. HLSA committee members increased from 5/191 (3%) 2010 to 11/186 (6%) in 2020. AA committee membership increased from 2/191 (1%) in 2010 to 5/186 (3%) in 2020. The diversity of AANA Board of Director leadership positions increased, with Caucasian representation decreasing from 14/14 (100%) 2010 to 11/12 (92%) in 2020 and Asian representation increasing from 0% in 2010 to 1/12 (8%) in 2020, with HLSA, AA and ME remaining the same with 0/12 (0%). In AANA, men comprised 181/191 (95%) committee members in 2010 and 166/186 (89%) in 2020. The percentage of female committee members increased from 10/191 (5%) in 2010 to 20/186 (11%) in 2020. In 2010, 73/79 (92%) AOSSM committee members were Caucasian compared to 62/81 (77%) in 2020 with AA having the largest increase in committee members from 0% in 2010 to 6/81 (7%) in 2020 (Table 2). Within AOSSM, men comprised 73/79 (92%) committee members in 2010 and 70/81 (86%) in 2020. The percentage of female committee members in AOSSM increased from 6/79 (8%) in 2010 to 11/81 (14%) in 2020. Conclusion There has been a progressive trend toward increasing diversity in both committee membership and leadership positions in AANA and AOSSM from 2010 to 2020. Within AANA, there has been a decrease in the Caucasian representation from 87% in 2010 to 67% in 2020 and an increase in the female representation from 5% in 2010 to 11% in 2020. AOSSM demonstrated a similar trend, with Caucasian representation decreasing from 92% in 2010 to 77% in 2020, in addition to female percentage increasing from 8% in 2010 to 14% in 2020. Although there has been an increase in representation of minority and female orthopaedic surgeons within both societies, there is still room for more diversity and inclusion within committee membership and leadership. It is important to progress toward the understanding of the changes that need to be made and work to implement opening the field of orthopaedic sports medicine.
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Affiliation(s)
- Malia Steele
- Tulane University, New Orleans, Louisiana, U.S.A
| | | | - Michaela A. Stamm
- Harvard-Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Mary K. Mulcahey
- Harvard-Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Koech H, Albanese J, Saeks D, Habashi K, Strawser P, Hall M, Kim K, Maitra S. Minority Resident Physicians' Perspectives on the Role of Race/Ethnicity, Culture, and Gender in Their Surgical Training Experiences. JOURNAL OF SURGICAL EDUCATION 2023; 80:833-845. [PMID: 37121866 DOI: 10.1016/j.jsurg.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Female and racial/ethnic minority representation in surgical programs continues to trail behind other medical specialties. Various structural and perceived obstacles which contribute to a difficult path for underrepresented minority (URM) trainees have been identified, and efforts to reduce these hurdles are underway. Gaining perspective and insight from current surgical minority trainees may add valuable insight to aid with improving and innovating strategies to recruit and retain URM surgeons. OBJECTIVE To characterize how race/ethnicity, cultural background, and gender affect the surgical training experience of URM surgical residents in all areas of surgery a focus on the field of Orthopedic Surgery, given its particularly poor rates of diversity. METHODS Authors conducted semi-structured video interviews on current surgical residents or fellows who were members of underrepresented populations including Female, African-American/Black, Latino, Asian, Native American, and First or Second-generation immigrant status. Recruitment was achieved through a combination of voluntary, convenience, and snowball sampling procedures. Interview transcripts were then coded using conventional thematic analysis. Themes were iteratively expanded into subthemes and subsequently categorized utilizing a pile-sorting methodology. RESULTS Among 23 surgical trainees 12 self-identified as Black (60.9%), 5 as Asian (17.4%), 1 as Hispanic (4.4%), and 5 as Caucasian (17.4%). Twelve residents identified as male (52%) and 11 as female (48%). Six surgical specialties were represented with the majority of participants (83%) being trainees in surgical subspecialties, among those orthopedic surgery was most strongly represented (57%). Analysis of their responses revealed 4 major themes: positive experiences, problems related to minority status, coping strategies, and participant suggested interventions. Themes were distilled further to sub-themes. Positive experiences' sub-themes included finding a supportive community, pride in minority status, and being able to better relate to patients. Negative experiences related to minority status' subthemes included perceived microaggressions and additional pressures, such as greater scrutiny and harsher punishments relative to their nonminority counterparts, which negatively impacted their surgical training. Most respondents did not feel there were dedicated resources to help alleviate these additional burdens, so some sought help outside of their training programs while others tried to assimilate, and others felt isolated. Recommended proposed interventions included validating the URM resident experience, providing education/training, and creating opportunities for mentorship. IMPLICATIONS/CONCLUSIONS URM surgical trainees face numerous challenges related to their minority status. Recruitment and retention of URM in medicine would benefit from individual early and longitudinal mentorship, mitigating imposter syndrome, acknowledging the challenges faced by residents, and seeking feedback from both past and current residents.
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Affiliation(s)
- Hilary Koech
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Jessica Albanese
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada; Duke University Department of Orthopedics, Duke University Medical Center, Durham, North Carolina
| | - Douglas Saeks
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas (UNLV), Las Vegas, Nevada.
| | - Kian Habashi
- Duke University Department of Orthopedics, Duke University Medical Center, Durham, North Carolina
| | - Payton Strawser
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Michael Hall
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Kelvin Kim
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Sukanta Maitra
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada; Duke University Department of Orthopedics, Duke University Medical Center, Durham, North Carolina
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Rodarte P, Kammire MS, Israel H, Poon SC, Cannada LK. The other side of conflict: Examining the challenges of female orthopaedic surgeons in the workplace. Am J Surg 2023; 225:46-52. [PMID: 36243560 DOI: 10.1016/j.amjsurg.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/21/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND As more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. METHODS An anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. RESULTS Of the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. CONCLUSIONS Workplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.
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Affiliation(s)
- Patricia Rodarte
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Maria S Kammire
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Selina C Poon
- Shriner's for Children Medical Center, Pasadena, CA, USA
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Wiggins AJ, Agha O, Diaz A, Jones KJ, Feeley BT, Pandya NK. Concerns About the Evaluation of Diversity in "Current Perceptions of Diversity Among Head Team Physicians and Head Athletic Trainers": Response. Orthop J Sports Med 2022; 10:23259671221125463. [PMID: 36338355 PMCID: PMC9629559 DOI: 10.1177/23259671221125463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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