Factors Influencing Growth in Gender Diversity Within Orthopaedic Surgery

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.

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.

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.

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.