Men have always dominated orthopedic surgery. In fact, orthopedics has the lowest percentage of women in a surgical specialty, with only 4.3 percent of board-certified orthopedic surgeons being female. People used to attribute the field's gender disparity to the physical force required to maneuver fractured or dislocated bones and joints back into place. While the need for physical strength may have played a role decades ago, advances in modern-day medical equipment have shifted the primary requisites from brute strength to manual dexterity, mechanical ability and an aptitude in three-dimensional visualization. So why are there so few women orthopedic surgeons?
Subtle attitudes continue to discourage women from fulfilling careers in orthopedics. Per unpublished data from Dr. Charles Day's study, "The Perceptions of Orthopaedic Surgery Among Medical Students," both male and female Harvard medical students cited the "jock/ frat culture" as the greatest detractor from choosing an orthopedic surgical residency. Dr. Day's research of "Orthopaedic Residents' Perceptions of Gender Diversity in Orthopaedic Surgery," also pending publication, noted that male orthopedic residents reported that female medical students would more likely choose a residency in general surgery because it would be "less physically demanding" and "easier to match into." Both male and female respondents agreed that the lack of female role models in orthopedics is a barrier to women entering the field. And while residents of both genders identified the availability of a role model in the specialty as an important decision-making factor, females were twice as likely to cite the importance of a role model of the same gender or ethnicity. Women orthopedic residents were also twice as likely to cite a perceived lack of acceptance by senior faculty as a barrier to entering the field.
While the presence of women in orthopedic residency programs has increased nearly five-fold over the past 30 years, only 14 percent of today's orthopedic residents are female. While this is progress, women now account for almost half of medical school graduates. The rising proportion of women in surgical specialties overall disproves the antiquated notion that women are simply not interested in surgery. Moreover, the greatest gains for women in surgery have been in those specialties with a higher percentage of women already in the field, such as ob/gyn and general surgery. As the population continues to age, the need for orthopedic surgeons will increase. In order to continue to attract the best and the brightest, orthopedics needs to become more attractive to women students.
Several organizations have been created to increase the number of women in orthopedic surgery. The Ruth Jackson Orthopaedic Society (RJOS), named after the first female orthopedic surgeon in the United States, was the first. Formed as a support and networking group for women orthopedic surgeons, it now includes both female and male orthopedic surgeons as well as orthopedists-in-training and interested medical students. It also offers a mentoring program and has published The RJOS Guide for Women in Orthopaedic Surgery to guide women all the way from medical school to residency, and throughout their careers.
The Perry Initiative is another organization named after a pioneering woman in orthopedics, Dr. Jacquelin Perry. Its mission is to inspire young women to be leaders in orthopedic surgery and engineering by sponsoring hands-on outreach to young women in high-schools and medical schools across the country. The organization was started in 2009 by two women -- an orthopedic surgeon and a mechanical engineer, on the basis of the necessity for partnerships between surgeons and engineers to develop and improve implants that are safe and effective to address patient needs. Like orthopedics, engineering programs have a very low percentage of female faculty, especially in mechanical engineering. The outreach program's curriculum improves young women's confidence in their abilities in the fields of medicine and science and, for some, provides their first exposure to power tools!
While women in orthopedics are few, minority orthopedic surgeons are even scarcer, at just 3 percent. Nth Dimensions is an organization that seeks to address health care disparities and improve cultural competency by increasing the presence of both women and minorities in orthopedic surgery. This educational non-profit provides mentorships, residency matching guidance and financial resources to female and minority medical students interested in orthopedics. A partnership with the American Academy of Orthopaedic Surgeons (AAOS) has allowed the expansion of a summer internship program to provide additional enrichment activities.
Such dedicated groups are making a difference. Medical students should feel free to pursue any field of interest, regardless of gender, ethnicity, size or a desire to have a family. Role models for young women interested in orthopedics appear to be a critical factor in their decision to enter this male-dominated field and are slowly increasing in numbers. But most importantly, diversity of health care providers in each specialty helps to improve the delivery of care to individual patients. And at the end of the day, that is what matters the most.
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