Women in Orthopaedics
There is a well-documented disparity of women applying for and training in orthopaedic residencies. Women comprise approximately 50% of medical students; however, only 14% of current orthopaedic residents are women. There are many factors that contribute to the reluctance of female medical students to enter the field including limited exposure to musculoskeletal medicine during medical school, negative perception of the field, lack of female mentors, barriers to promotion, and acceptance by senior faculty.
Early exposure and access to a female mentor who was an orthopaedic surgeon have been identified as positive factors in encouraging female medical students to pursue a career in orthopaedics. A majority of medical schools do not have formal required musculoskeletal curricula, leaving many students without opportunities for exposure and a chance to learn about orthopaedics in the preclinical years. Additionally, many female medical students are deterred from orthopaedic surgery due to its perceived lack of challenge as a specialty, its lack of permitting time for family life, and the inability of the field to provide the opportunity to work fewer hours. The challenges of maintaining work-life balance, long work hours, and years of extra training apply to all surgical specialties, hence it is unclear why orthopaedic surgery lags behind other surgical fields in terms of the number of female residents.
Residency programs select applicants based on performance during orthopaedic rotations, class rank, USMLE Step 1 and 2 scores, interview performance, and letters of recommendation, while applicants generally rank residency programs based on a variety of factors including academic reputation, lifestyle, and geography. Female applicants tend to weigh their personal interactions on interview days and a program’s proximity to family and friends more heavily when determining their rank list, while eliminating programs based on their perceived sex biases more readily than their male counterparts. Previous studies have demonstrated that only a small proportion of orthopaedic residencies train most of the female residents and that a majority of orthopaedic residency programs have percentages of female trainees well below the national average of 14%.
It is important to understand what factors are present in orthopaedic residency programs that have the highest percentage of female residents compared to programs with lower percentages of women. Programs with more female residents have more female faculty members, a higher percentage of faculty per program who are female, more female associate professors, more women in leadership positions, a higher prevalence of women’s sports medicine programs, and are more likely to offer a research year. Once in residency, female residents tend to have a different experience compared to their male colleagues. Female residents have different interpersonal experiences with colleagues and patients, are more likely to be the recipient of disparaging remarks, and have greater interest in same sex mentorship than their male counterparts. Currently, women account for 17.8% of full-time orthopaedic surgery faculty at American medical schools, 8.7% of orthopaedic surgery professors, and less than 5% of orthopaedic surgery department chairs. Additionally, women comprise only 6.5% of the American Academy of Orthopaedic Surgery (AAOS) membership, with wide variability of female representation in the different specialty societies.
Pipeline programs are an important and effective means of recruiting women into the field of orthopaedic surgery. Two pipeline programs, the Perry Initiative and Nth Dimensions, have successful track records in increasing female and under-represented minorities in orthopaedic surgery residency training. The Perry Initiative was founded in 2009 by Dr. Jennifer Buckley, a mechanical engineer, and Dr. Lisa Lattanza, an orthopaedic surgeon. In 2012, the organization started a medical student outreach program (MSOP) to encourage first and second year female medical students to pursue careers in orthopaedic surgery. Outcomes data demonstrates that medical students participating in the Perry Initiative have a 30% match rate into orthopaedic surgery residency. Another successful pipeline program is Nth Dimensions. Founded in 2004 by Dr. Bonnie Simpson Mason, this program is committed to addressing the low numbers of women and underrepresented minorities in orthopaedic surgery. Nth Dimensions reported an overall retention rate of 75% and overall match rate of 73% with 34% choosing orthopaedic surgery. The success of both of these pipeline programs in providing exposure and mentoring to promote orthopaedic surgery for females and under-represented minorities, with subsequent matriculation and matching in orthopaedic residency programs, underscores ongoing support of pipeline programs as a successful pathway to improve diversity of the orthopaedic workplace.
Diversity in orthopaedics is critical in order to provide culturally competent care. Addressing discrepancies during orthopaedic training may help create a more inclusive work environment for female residents potentially leading to increased female representation in orthopaedic surgery. Additionally, by taking into account factors that have been shown to be associated with an increased complement of female residents (eg more female faculty, having a women’s sports medicine program) departmental and national orthopaedic leaders will be better able enhance the recruitment of female applicants and encourage more women to pursue a career in orthopaedic surgery.
About the author
Mary Mulcahey, MD
Director of Tulane’s Women’s Sports Medicine Program
Dr. Mary Mulcahey joined the faculty in the Department of Orthopaedic Surgery at Tulane in April 2017, as the Director of Tulane’s Women’s Sports Medicine Program. In that role, Dr. Mulcahey has been instrumental in the design, development, and leadership of a comprehensive approach to the care of active women. This cutting edge program combines resources and services of multiple disciplines including orthopaedic surgery, primary care sports medicine, physical therapy, nutrition, and sports psychology. Dr. Mulcahey offers individualized, patient-centered care for both men and women. Her extensive knowledge of non-operative and operative management of orthopaedic and musculoskeletal conditions is reflected in her thorough explanation of injuries and treatment options. She is a skilled surgeon who continuously expands her knowledge base by participating in and teaching at national sports medicine and arthroscopy courses. Dr. Mulcahey is the team physician for Tulane’s Women’s Indoor and Beach Volleyball teams, NOLA gymnastics, the Big Easy Rollergirls, New Orleans Women’s Rugby (Halfmoons), the Hippies (women’s professional football), as well as several of our local all girls’ high schools, including St. Mary’s Dominican, Academy of the Sacred Heart, Cabrini, Mt. Carmel Academy, Archbishop Chapelle, and St. Scholastica Academy.