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Exploring gender disparities in academic orthopaedic surgery faculty: analyzing subspecialty and leadership diversity to foster inclusivity Open PDF
(Springer Science and Business Media LLC, 2025-07-11)
Anand, Malini
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Julian, Kaitlyn R.
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Mulcahey, Mary K.
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Wong, Stephanie E.
Background The historic gap in gender diversity within orthopaedic surgery is widely acknowledged and continues to persist. The lack of female representation in orthopaedic surgery has been attributed to a variety of factors, including the absence of female mentors and leaders within the field. As such, we sought to examine the gender diversity among orthopaedic surgery faculty in various subspecialties at academic institutions and the distribution of female faculty in positions of leadership. Methods The American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA) was used to identify all allopathic orthopaedic surgery residency programs during the 2022 to 2023 academic year. The total number of faculty, and distribution of female faculty by subspecialty were collected from January to March 2023. The mean and percentage of female faculty in each subspecialty per program was calculated. Results The total number of orthopaedic surgery female faculty identified was 524. The subspecialty with the highest percentage of female faculty per program was pediatrics at 26.1% (148/511). Hand (18.6%; 113/511), oncology (19.2%; 38/511), foot and ankle (13.6%; 49/511), spine (3.9%; 21/511), shoulder and elbow (7.4%; 7/511) and adult reconstruction (3.7%; 24/511) had lower percentages of female faculty per program. A total of 52 (10.2%) female section chiefs were identified across all programs. Oncology had the highest percentage of female faculty represented in section leadership at 18.4% (7) and sports medicine had the lowest at 4.8% (4). Conclusion Gender diversity of faculty in orthopaedic surgery is low with adult reconstruction (3.7%), spine (3.9%), and shoulder and elbow (7.4%) having the lowest percentages of female faculty. The percentage of female faculty represented in section leadership is also lacking with a total of 52 (10.2%) female section chiefs identified across all programs. Increasing the number of females in leadership positions across all orthopaedic subspecialties may be one step in helping improve gender diversity in the field.
Gender-Based Disparities in Academic Orthopaedic Surgery Physician Compensation in 2023 Open PDF
(Ovid Technologies (Wolters Kluwer Health), 2025-03-11)
Chauhan, Dhun
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DeYoung, Joshua K.
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Goodrich, Ezra
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Templeton, Kimberly
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Day, Charles S.
Background: Orthopaedic surgery remains one of the least diverse specialties in medicine. Parity in opportunity and recognition are key factors in attracting and retaining a diverse group of individuals in the field. The primary purpose of this study was to assess gender-based discrepancies in total salary compensation by rank for academic orthopaedic surgery faculty. Methods: Aggregate data were obtained from the Association of American Medical Colleges for fiscal year 2023. Mean compensation was compared for orthopaedic surgery faculty and total surgery faculty at all academic ranks based on gender and race. Results: Men received markedly higher total compensation for all ranks except chair within orthopaedic surgery. At the instructor level, men earned an average annual income of $554,245 while women received $229,204, demonstrating a significant pay gap (P = 0.0019). At the assistant professor (men: $628,346; women: $475,857), associate professor (men: $732,381; women: $575,877), and professor (men: $743,822; women: $472,140) levels, there existed significant pay disparities (P < 0.0001 for all three academic levels, respectively). At the chief position, men earned an average of $1,185,873 annually while women received $596,270 (P = 0.0006). Aggregate data for other surgical specialties demonstrated similar results, with women receiving lower total compensation at all ranks compared with men. Conclusion: This analysis of the 2023 American Medical Colleges Faculty Salary Report demonstrates a notable pay differential between men and women in orthopaedic surgery and surgical specialties, in general, across multiple academic levels including instructor, assistant professor, associate professor, professor, and chief of division. Although there has been increasing awareness of gender-based compensation disparities within surgical specialties, particularly in orthopaedic surgery, these disparities are still clearly present.
Shattering the Glass Scalpel: Analyzing Female Representation in Orthopedic Surgery Across the United States Open PDF
(Springer Science and Business Media LLC, 2025-03-05)
Loyst, Rachel A
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Hidalgo Perea, Sofia
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Vanhelmond, Taylor
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Patterson, Diana
Background Orthopedic surgery has historically been a male-dominated field, with slower growth in female participation compared to other surgical specialties. The present study aims to assess the extent of this influence, examine whether the dynamic is changing, and further analyze female participation trends, focusing on various regions of the United States and including analyses of female residents. Methodology Orthopedic surgery residency programs were surveyed online. A list of 200 programs was sourced from the Association of American Medical Colleges, which provided details including the program names, cities, states, regions, and website links. The homepages of the residency program as well as the department of orthopedic surgery were surveyed for any mention of women or female in orthopedics, number of female residents, total number of residents (class of 2025-2029), number of female faculty operative orthopedic faculty, total number of operative orthopedic faculty physicians, specialty of the female orthopedic faculty, program director gender, assistant program director gender, and chair of the program gender. Data analyses were performed using SPSS Software version 28.0 (IBM Corp., Armonk, NY, USA) and Rstudio version 1.4.1106 (Boston, MA, USA). Results In total, 55 Midwest (28%), 53 Northeast (27%), 63 South (32%), and 27 West (14%) orthopedic surgery residency programs were included. Female orthopedic surgery residents comprised 23.7% of all orthopedic residents across the United States. When analyzed by geographic region, female residents comprised 22.7% of all residents in the Midwest, 24.3% in the Northeast, 22.5% in the South, and 27.0% in the West. In the Northeast region, there was a notable upward trend in the percentage of female residents across PGY5 to PGY1 years (τ = 1, p = 0.027). A total of 25 (12.6%) programs had a section in their residency program or orthopedic department website homepage that mentioned and/or was dedicated to women or females. There was a significant association between region and homepage mention of women (χ² (8, N = 198) = 105.7; p < 0.001). A total of 12.9% of all orthopedic residency program directors were female, while 21.2% of all associate program directors were female. Conclusions These findings underscore the importance of monitoring and addressing regional disparities in gender representation within orthopedic surgery residency programs. By identifying trends and disparities, healthcare institutions and policymakers can implement targeted interventions to promote gender equity and cultivate a diverse and inclusive workforce.
The Role of Women in the Top 100 Most Influential Arthroplasty Publications: A Bibliometric Analysis Open PDF
(Elsevier BV, 2025-04)
Payne, Camryn S.
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Boddu, Sayi P.
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Beckett, Nathan C.
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Cancio-Bello, Alexandra M.
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Bingham, Joshua S.
BACKGROUND: Women account for 2% of arthroplasty surgeons in the United States. It is important to understand how women contribute to the literature in the field of arthroplasty currently. We compared the proportion of first, middle, and senior authorship by women in the top 100 most-cited hip and knee arthroplasty studies published between 2010 and 2024 to the national proportion of women hip and knee arthroplasty surgeons and evaluated the H-indices of authors by gender. METHODS: The literature search was performed on the Clarivate Analytics Web of Knowledge database. Once 100 studies met the inclusion criteria, those that did not originate from the United States or whose author first names were not included were excluded. The author's gender was determined by first name. The Scopus author database was used to determine the H-index for first and senior authors. RESULTS: There were 91 papers that met the criteria. These papers were produced by a total of 458 authors, of whom 13.7% were women. There were six (7.4%) of 81 unique first authors, 50 (15.8%) of 315 middle authors, and seven (11.3%) of 62 unique senior authors who were women. Women had lower average H-indices than men. CONCLUSIONS: Women's contributions to the most influential hip and knee arthroplasty articles are much higher than predicted given their underrepresentation in the field, indicating the substantial value they add to leading arthroplasty research. Despite this, disparities exist for women in authorship rank and H-index. These disparities may be mitigated by intentionally fostering greater support for women throughout all phases of orthopaedic surgery training to improve opportunities for impactful research and career advancement.
Revisiting the Gender Gap in Orthopaedic Surgery: Investigating the Relationship Between Orthopaedic Surgery Female Faculty and Female Residency Applicants. Open PDF
(2019)
Munger, Alana M.
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Heckmann, Nathanael
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McKnight, Braden
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Dusch, Marie N.
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Hatch, George F. 3rd
INTRODUCTION: Although women now constitute approximately half of all graduating medical students, orthopaedic surgery continues to lag behind in its ability to recruit female applicants. One hypothesis for this discrepancy is the lack of female faculty mentors at academic institutions. The three objectives of this study were the following: (1) to quantify the proportion of female orthopaedic surgery residency applicants, (2) to quantify the proportion of female orthopaedic surgery faculty, and (3) to investigate the relationship between female orthopaedic surgery faculty at an academic institution and the corresponding number of female orthopaedic surgery residency applicants. METHODS: Data from the Association of American Medical Colleges from 2005 to 2014 were used to calculate the number of medical school graduates, the number of orthopaedic surgery residency applicants, and the number of orthopaedic full-time faculty in the United States. Institutions were excluded if they had incomplete data. A Spearman rank correlation was used to assess for a correlation between the 9-year total number of female orthopaedic surgery applicants and the average number of female orthopaedic surgery faculty members. RESULTS: A total of 101 U.S. medical schools were included in the final analysis. During the period examined, women accounted for 48.7% of medical school graduates, 14.9% of orthopaedic surgery applicants, and 13.2% of full-time orthopaedic surgery faculty. The percentage of female residency applicants increased from 13.91% in 2005 to 2006 to 16.02% in 2013 to 2014 while the percentage of female faculty increased from 12.26% in 2005 to 2006 to 15.79% in 2013 to 2014. No correlation was found between the average number of female orthopaedic surgery faculty at an institution and the total number of female orthopaedic surgery applicants from that institution during the study period examined (Rho, 0.0176; P = 0.5957). CONCLUSIONS: The data presented in this study failed to demonstrate a relationship between the number of female faculty and the number of women who apply into orthopaedic surgery, which highlights the complex nature of this issue. More research is needed to examine factors influencing the recruitment of female medical students.
Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties Open PDF
(2018)
Lett, Elle
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Orji, Whitney U.
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Sebro, Ronnie
OBJECTIVE: To evaluate trends in racial, ethnic, and sex representation at US medical schools across 16 specialties: internal medicine, pediatrics, surgery, psychiatry, radiology, anesthesiology, obstetrics and gynecology, neurology, family practice, pathology, emergency medicine, orthopedic surgery, ophthalmology, otolaryngology, physical medicine and rehabilitation, and dermatology. Using a novel, Census-derived statistical measure of diversity, the S-score, we quantified the degree of underrepresentation for racial minority groups and female faculty by rank for assistant, associate, and full professors from 1990-2016. METHODS: This longitudinal study of faculty diversity uses data obtained from the American Association of Medical Colleges (AAMC) Faculty Roster from US allopathic medical schools. The proportion of professors of racial minority groups and female faculty by rank was compared to the US population based on data from the US Census Bureau. The Roster includes data on 52,939 clinical medical faculty in 1990, and 129,545 in 2016, at the assistant professor level or higher. The primary measure used in this study was the S-score, a measure of representation based on the probability of the observed frequency of faculty from a racial/ethnic group and sex, given the racial and ethnic distribution of the US. Pearson correlations and 95% confidence intervals for S-score with time were used to measure trends. RESULTS: Blacks and Hispanics showed statistically significant trends (p<0.05) towards increasing underrepresentation in most specialties and are more underrepresented in 2016 than in 1990 across all ranks and specialties analyzed, except for Black females in obstetrics & gynecology. White females were also underrepresented in many specialties and in a subset of specialties trended toward greater underrepresentation. CONCLUSIONS: Current efforts to improve faculty diversity are inadequate in generating an academic physician workforce that represents the diversity of the US. More aggressive measures for faculty recruitment, retention, and promotion are necessary to reach equity in academia and healthcare.
Prevalence of female authors in case reports published in the medical literature Open PDF
(2019)
Hsiehchen, D.
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Hsieh, A.
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Espinoza, M.
IMPORTANCE Underrepresentation of female authors in research publications is prevalent, but it is unclear whether this is attributable to sex disparities in research conduct or authorship practices. Case reports are a poorly understood component of the biomedical corpus, and the production of anecdotal observations is not confounded by factors associated with disparities in female representation in research publications. Whether female authorship disparities exist in nonresearch publications of clinical information is unknown. OBJECTIVES To examine the authorship of case reports and elucidate factors associated with sex disparity. DESIGN AND SETTING Cross-sectional study of all case reports published by US authors in 2014 and 2015 indexed in PubMed performed from July 2015 to July 2018. MAIN OUTCOMES AND MEASURES The primary outcome measure was the proportion of female first authors. The secondary outcome measures were the proportion of female last authors and female authorship representation among different clinical specialties. RESULTS Bibliometric data was abstracted from 20 427 case reports published across 2538 journals. A total of 7252 (36%) and 4825 (25%) case reports had a female first and last author, respectively. In comparison, 44%and 34%of US trainees and physicians, respectively, were female in 2015. Among adult case reports, female authorship was more prevalent in academic environments compared with community settings (34.0%vs 28.2%for female first authors and 23.4%vs 19.7% for female last authors). Across states, the proportions of female first authors and last authors were universally less than the proportions of female trainees and active female physicians, respectively. Female first authorship was associated with larger author teams (odds ratio [OR], 1.02; 95%CI, 1.01-1.03), an academic affiliation (OR, 1.16; 95%CI, 1.06-1.27), and a female last author (OR, 1.58; 95%CI, 1.47-1.70). Relative to general internal medicine, specialties dominated by male clinicians were less frequently associated with female first authors. Several exceptions displaying a relatively equivalent tendency for male and female first authorship included oncology (OR, 0.97; 95%CI, 0.81-1.16), ophthalmology (OR, 0.87; 95%CI, 0.72-1.05), and radiation oncology (OR, 0.94 95%CI, 0.56-1.56). CONCLUSIONS AND RELEVANCE The underrepresentation of women among first and last authors in publications of case reports underscores the pervasiveness of sex disparities in medicine. Collaboration and female mentors may be critical instruments in upsetting longstanding practices associated with sex bias. Not all clinical specialties were associated with lower-than-expected female authorship, and further exploration of specialty-specific norms in publication and mentorship may elucidate specific barriers to female authorship. © 2019 JAMA Network Open.All right reserved.
Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis Open PDF
(2021)
Ha, Giang L.
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Lehrer, Eric J.
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Wang, Ming
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Holliday, Emma
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Jagsi, Reshma
Importance: Despite equal numbers of men and women entering medical school, women are underrepresented in the upper echelons of academic medicine and receive less compensation and research funding. Citation-related publication productivity metrics, such as the h-index, are increasingly used for hiring, salary, grants, retention, promotion, and tenure decisions. Exploring sex differences in these metrics across academic medicine provides deeper insight into why differences are observed in career outcomes. Objective: To systematically examine the available literature on sex differences in h-index of academic faculty physicians across all medical specialties and all levels of academic rank. Data Sources: Medical literature with the term h-index found in PubMed and published between January 1, 2009, and December 31, 2018, was used. Study Selection: A PICOS (Population, Intervention, Comparison, and Outcomes), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and MOOSE (Meta-analysis of Observational Studies in Epidemiology) selection protocol was used to find observational studies that published h-indexes for faculty physicians that were stratified by sex. Studies were excluded if they were review articles, retracted, or unavailable online. Ultimately, 14 of 786 studies (1.78%) met the inclusion criteria. Data Extraction and Synthesis: Data from 9 studies across 16 specialties were examined using weighted random-effects meta-analyses. Five studies were excluded because of overlapping specialties with another study or because they were missing appropriate statistics for the meta-analysis. Four of these studies were included in qualitative synthesis to bring the total to 13 studies. Main Outcomes and Measures: The primary study outcome was the h-index. Results: The meta-analysis included 10 665 North American unique academic physicians across 9 different studies from the years 2009 to 2018. Of the 10 665 physicians, 2655 (24.89%) were women. Summary effect sizes for mean h-indexes of men and women and mean h-index difference between men and women were determined for all faculty physicians and at each academic rank. Overall, female faculty had lower h-indexes than male faculty (mean difference, -4.09; 95% CI, -5.44 to -2.73; P < .001). When adjusting for academic rank, female faculty still had lower h-indexes than male faculty at the ranks of assistant professor (mean difference, -1.3; 95% CI, -1.90 to -0.72; P < .001), associate professor (mean difference, -2.09; 95% CI, -3.40 to -0.78; P = .002), and professor (mean difference, -3.41; 95% CI, -6.24 to -0.58; P = .02). Conclusions and Relevance: In this systematic review and meta-analysis, women had lower h-indexes than men across most specialties and at all academic ranks, but it is unclear why these differences exist. These findings suggest that future investigation should be conducted regarding the causes of lower h-indexes in women and that interventions should be developed to provide a more equitable environment for all physicians regardless of sex.
Trends in Gender Disparities in Authorship of Arthroplasty Research Open PDF
(2020)
Xu, Raylin F.
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Varady, Nathan H.
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Chen, Antonia F.
BACKGROUND: Despite efforts to address gender disparities in medicine, female representation in orthopaedics lags behind that of other fields, and little work has evaluated gender disparities within the subspecialty of arthroplasty surgery. The objective of this study was to analyze female authorship trends in arthroplasty research from 2002 to 2019. METHODS: Articles published from 2002 to 2019 in 12 clinical orthopaedic and arthroplasty journals were extracted from PubMed. Articles that provided the full name of the first author and contained the terms "arthroplasty," "hip replacement," "knee replacement," or "joint replacement" in the title and/or as keywords were analyzed. The gender of the author was determined with the validated Genderize algorithm, and publication trends were analyzed over time. Descriptive and comparative statistics were computed, and logistic regression was used to evaluate gender trends. RESULTS: From 2002 to 2019, 14,692 articles met the inclusion criteria, and the gender of 63,628 authors was identified. There were 23,626 unique authors; 4,003 (16.9%) were women and 19,623 (83.1%) were men. Female involvement in arthroplasty publications increased from 11.1% in 2002 to 12.6% in 2019 (p < 0.001), and the percentage of female first authors increased from 5.0% in 2002 to 11.3% in 2019 (p < 0.001). Critically, however, the proportion of women as senior authors significantly declined from 8.5% in 2002 to 6.2% in 2019 (p < 0.001). From our analysis of U.S. publications with physician senior authors, the proportion of female senior authors remained relatively stable from 1.7% in 2002 to 2.4% in 2019 without a significantly increasing trend (p = 0.88). Overall, on average, women published a mean (and 95% confidence interval) of 1.9 ± 0.1 publications, while men published 2.9 ± 0.1 publications (p < 0.001). The proportion of female senior authors in arthroplasty publications (6.6%) was lower than that of other orthopaedic subspecialties such as sports medicine (9.2%), spine (13.6%), and foot and ankle (13.1%). CONCLUSIONS: While overall female representation and first authorship in arthroplasty literature have increased over time, the paucity of women in senior author roles remains troubling. Future studies should examine why the proportion of women publishing in arthroplasty remains lower than that in most other orthopaedic subspecialties.
Gender Trends in Authorship of Foot and Ankle Academic Literature Over 24 Years Open PDF
(2019)
Vora, M.
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Kuripla, C.
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Ouyang, D.
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Sing, D.C.
Underrepresentation of females in surgery is reflected in research productivity across academic medicine, with male faculty being more likely to publish research than their female counterparts. In this study, we aimed to describe the representation and longevity of female investigators among the authors of articles in 3 foot and ankle research journals from 1993 to 2017. In this retrospective bibliometric analysis, authors from 3 prominent foot and ankle research journals (Foot and Ankle International, The Journal of Foot and Ankle Surgery, and Foot and Ankle Clinics) were identified. The proportion of female authors who were first, middle, and senior authors and the total publication count per author were determined. From 1993 to 2017, 8132 original articles were published and a total of 6597 (81.1%) had an accessible author list. This allowed us to identify 25,329 total authors, of whom 22,961 (90.7%) were successfully matched to a gender. A total of 9273 unique authors were identified (females, 19.2%). Female representation increased for first and senior authors over the years from 6.5% and 5.9% (1993 to 1997) to 16.9% and 13.1% (2013 to 2017, p < .001), respectively. However, compared with male authors, female authors published fewer articles (mean: 1.7 versus 2.4, p < .001). Of the 2691 authors who first published during 2006 to 2011, 369 authors (13%), consisting of 8.1% females and 15% males (p < .001), continued to publish 5 years after their initial publication. Female representation in academic foot and ankle research has increased >2-fold over the past 2 decades. But despite these advances, compared to male authors, female authors are less likely to continue publishing 5 years after initial publication, and on average publish fewer articles. © 2019 the American College of Foot and Ankle Surgeons

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