Racial and Sex Disparities in Resident Attrition in Orthopaedic Surgery.

Area of Science:

• Orthopaedic surgery
• Medical education
• Diversity and inclusion in medicine

Background:

• Female and under-represented in medicine (URiM) individuals experience higher attrition rates in medical residency.
• This disparity contributes to a lack of diversity within the medical field, particularly in specialized areas like orthopaedics.
• Understanding demographic trends and attrition is essential for addressing these inequalities.

Purpose of the Study:

• To characterize the demographic composition of orthopaedic surgery residents from 2001 to 2018.
• To determine race/ethnicity and identify any disparities in orthopaedic residency.
• To analyze attrition rates among different demographic groups in orthopaedic surgery.

Main Methods:

• Utilized demographic and attrition data from the Association of American Medical Colleges (2001-2018).
• Categorized attrition into withdrawals, dismissals, and transfers to other specialties.
• Conducted subgroup analyses by race/ethnicity and sex to compare demographic composition and attrition rates.

Main Results:

• Female orthopaedic residents increased from 8.77% to 15.54%; URiM residents increased from 9.49% to 11.32% between 2001-2018.
• Overall attrition was 3.20%, with unintended attrition at 1.15%.
• Female residents (RR 2.20) and URiM residents (RR 2.36), particularly Black/African American residents (RR 3.80), showed significantly higher risks of all-cause attrition compared to White male residents.

Conclusions:

• Despite an increase in female residents, orthopaedics lags behind other fields in gender diversity.
• Female and URiM residents are disproportionately affected by attrition in orthopaedic surgery.
• Retention efforts, alongside recruitment, are critical for advancing diversity, equity, and inclusion in orthopaedic surgery training.