Where are the Women?

by Deana Mercer, MD and Robert R. Schenck, MD

The number of women in orthopedic surgery continues to be a challenge for the  specialty.  Despite the percentage of women in medical school having increased from 6.9% in 1965 to 47% in 2014, the percentage of women in orthopedic surgery residency programs is less than 15%, the lowest percentage of women in all surgical subspecialties (women make up 25% of urology residents).  Women orthopedic surgeons comprise a mere 7% of full time orthopedic faculty. In comparison, 31% of faculty positions in ENT are held by women. In surgery 22% are women.  Less than 5% of board-certified orthopedic surgeons are women.

So, where are the women? The percentage of women in surgical subspecialties is rising, so women are interested in becoming surgeons.   Women comprise a higher percentage in fields perceived to be more female-friendly: women in OBGYN make up 57% of faculty and in ophthalmology 34%, two generally accepted female-friendly specialties.   There are several factors that may be discouraging women from entering the field of orthopedic surgery.  The field is predominantly male, which can be intimidating to some women.  There is also a false perception that the job requires brawn.  There may be a perceived negative sentiment when women initially inquire about pursuing the field where the immediate instinctive focus of the mentor may be work-life balance instead of the more “appropriate” topic: how to match into a good orthopedic residency program.  In fact the most important factor may be a lack of mentorship.  A good mentor can help dispel these myths and facilitate the process.

Women interested in becoming orthopedic surgeons have trouble getting their foot in the door.  The student’s initial show of interest, before they have solidified their direction in medicine, is our best opportunity to strategically build and guide them towards becoming orthopedic surgeons. The initial discussion needs to center around how to become a competitive candidate and successfully match into a good orthopedic .

We face several challenges in the recruitment effort.  The first is in introducing pre-medical and medical women students to the field of orthopedic surgery.  The majority of medical schools do not have orthopedic surgery as a curriculum requirement and an orthopedic rotation may be offered only as an elective.  Unless women medical students had some introduction to the field by chance, they don’t know it exists.  Two organizations have taken on the initiative to introduce young women at different stages of training to the field of orthopedic surgery: the Ruth Jackson Orthopaedic Society (RJOS), geared towards medical students and the Perry Initiative Program, aimed towards high school and pre-medical students (http://rjos.org/; http://perryinitiative.org/.  Both programs have improved the exposure of women to the field of orthopedics. It is a concerted, worthwhile effort and both are great programs to build upon.

The second challenge is providing mentorship.  Women and leaders in orthopedics can help by getting the word out and being available as mentors.   One of the most powerful accomplishments of the RJOS is the establishment of mentorship avenues.  Through the RJOS mentorship program, young women who aspire to become orthopedic surgeons can connect with women orthopedic surgeons at other institutions for guidance and advice.  This resource is particularly useful for women in programs where there are no women faculty.  These resources can make a difference in providing a support system for women entering the field of orthopedics.

Diversity in healthcare providers is important.  Women are an important part of the work force.  Patients want a choice in healthcare providers.   Mentorship of aspiring women orthopedic surgeons is the best way to rectify this disparity.  The balancing act of work and life is another topic of discussion and there is certainly room in orthopedic surgery for improvement in that realm for both women and men.  We are making progress and can make greater gains by funneling energy into recruitment and mentorship efforts.