Trends in Orthopaedic Surgery Fellowship Match Among Female Residents: Discrepancies in Sex Diversity by Subspecialty

There is a historic sex imbalance in the field of orthopaedic surgery in the United States, with female physicians being vastly underrepresented. In addition, this sex imbalance is particularly pronounced in certain subspecialties. As such, we sought to analyze the distribution of graduating female residents and their fellowship match trends from 2017 to 2022.

The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States during the 2016 to 2017 and the 2021 to 2022 academic years. The data were supplemented with the Accreditation Council for Graduate Medical Education (ACGME) Data Book to include data on all ACGME-accredited programs in 2017 and 2022. The percentage of female orthopaedic surgery residents matching into each subspecialty was calculated. Continuous data were analyzed with independent t test, and significance was set at p < 0.05.

From 2017 to 2022, there has been a significant increase in the percentage of female residents matching in orthopaedic surgery fellowships (14.6% vs. 19.5%, p < 0.001). In the orthopaedic hand subspecialty, 24 (15.8%) female residents matched into a hand fellowship in 2017 vs. 56 (35.2%) in 2022 (p < 0.001). Spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine fellowships have not seen a significant change in the distribution of female residents matching over the past 5 years.

Between 2017 and 2022, the total number of female orthopaedic surgery fellows increased, and there was significant growth in the percentage of matched female fellows in the subspecialty of hand. Other orthopaedic subspecialties including spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine have seen no significant change in the distribution of women fellows over the past 5 years. Further investigation is warranted to determine factors leading to growth in certain fellowships among female residents to encourage sex diversity among all subspecialties in orthopaedic surgery.