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Persistent gender disparities in French orthopaedic surgery: insights from a national survey
Adeline Cambon1, Elvire Servien2, Ophélie Torres3
1Sorbonne University, Orthopaedic and Trauma Surgery, Saint Antoine Hospital, APHP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.
Background:
Despite increasing feminization of the medical workforce, orthopaedic surgery remains markedly male-dominated. Data on gender-related differences in professional trajectories and experiences remain limited, particularly in France. Therefore we performed a cross-sectional study aiming to investigate gender-related differences in professional trajectories, practice patterns, and perceived barriers among orthopaedic surgeons in France.
Hypothesis:
We hypothesized that significant gender-related differences exist across these domains.
Material And Methods:
A national cross-sectional survey using an anonymous online questionnaire was distributed to orthopaedic surgeons and trainees through French professional societies. The survey assessed demographics, professional practice, and gender-related experiences. Comparisons between men and women were performed using chi-square tests and expressed as odds ratios (ORs) with 95% confidence intervals (CIs).
Results:
Among approximately 4100 eligible orthopaedic surgeons and trainees, 1053 questionnaires were analyzed (response rate approximately 25%; 35% women). Female surgeons reported greater exposure to discrimination from supervisors, which remained strongly associated with female gender after adjustment for age and professional status (188/368 [51.1%] vs 25/685 [3.6%]; adjusted OR 27.3; 95%CI: 16.18-48.61 [p < 0.001]), as well as more derogatory remarks related to parenthood (OR 4.87; 95%CI: 3.37-6.98 [p < 0.0001]) and sexual harassment (110/368 [29.9%] vs 31/685 [4.5%]; OR 9.25; 95 IC 6-14.02 [p < 0.001]). They also reported more limited operative exposure and greater assignment to non-clinical tasks during training (172/368 [46.7%] vs 173/685 [25.3%]; OR 2.6; 95%CI: 1.97-3.37 [p < 0.0001]). Women were less likely to hold leadership positions despite similar academic involvement. Marked work-life disparities were observed, with women more frequently single (94/368 [25.5%] vs 43/685 [6.3%]; OR 5.07; 95 IC 3.42-7.49 [p < 0.0001]), childless (166/368 [45.1%] vs 114/685 [16.6%]; OR 4.23; 95%CI: 3.18-5.60), and reporting greater domestic responsibilities. Parenthood was more often reported as a barrier to career progression.
Discussion:
Gender-related disparities persist across multiple dimensions of orthopaedic practice in France, including surgical training, workplace experiences, leadership access, and work-life balance. Although the cross-sectional design precludes causal inference, the consistency of the findings across several independent domains suggests that these disparities are structural rather than isolated. Interventions aimed at improving mentorship, supporting parenthood, promoting equitable access to leadership opportunities, and enhancing workplace culture may contribute to improving equity and the long-term attractiveness of the specialty.
Level Of Evidence:
IV; cross-sectional study.