Published 4/1/2008

Readers have theories about women in orthopaedics

I just finished reading the article about women orthopaedists (“Where are the women orthopaedists?” February 2008). I am happy to know that the Academy has been and will continue to encourage women and minorities to become a part of this great field.

I am one of seven female orthopaedic residents in my program. Unfortunately, I have not been as actively involved in the recruitment of women and minorities for orthopaedics. However, as I near the end of my fifth year, I am looking forward to becoming more involved.

I had a mentor in Maureen A. Finnegan, MD, at the University of Texas Southwestern, when I was a medical student. I only hope that I can become a community/faculty mentor who encourages female medical, college, and grade school students to pursue a career in orthopaedics.

Capt. Shawn E. Johnson, MD
El Paso, Texas

I asked my wife, who is board-certified in two medical specialties, why she did not choose orthopaedics. She quickly answered that the time commitments were too much and that she wanted a better lifestyle. She also stated that to increase the number of women going into orthopaedics, more part-time and shared positions need to be created.

I believe that women are smart enough to see that the time requirements for orthopaedics after residency are less flexible and more demanding than other specialties and are choosing to go a different route.

W. Christopher Patton, MD
Mobile, Ala.

I really enjoyed the article on women orthopaedists. I had my first child during the last month of my chief year in residency. I operated until 5 days before he was born. There certainly is a lingering stigma, especially in orthopaedics, about women—even more about pregnant women. Comments were made, but in the end everything worked out. I have since had two more children while in practice, operating up until the day they were born. My male counterparts still groaned a bit, even though I returned a couple of weeks later to see my own patients, and was back full time by 6½ weeks.

Orthopaedics is difficult for women who want to have a family, but the awareness is improving, thanks to articles such as this, so that women can “have it all.” If we can show female medical students that orthopaedic surgery is a very feasible field and show that one can practice orthopaedics and be a mom, we should be able to find more “women orthopaedists.”

Hats off to AAOS Now for a great article. It meant a lot to me, especially in light of what I have experienced. I have not previously been a member of the Ruth Jackson Society, because I always thought that it was a “female” society for the less tough. I was grossly in error. I see that societies like this are invaluable because of the support system they provide. Females face many difficult challenges not only in being orthopaedic surgeons, but also balancing family and career. I plan to join the Ruth Jackson Society. I have certainly been missing out on a great resource.

Monica L. Morman, MD
Gillette, Wyo.

When I saw the cover of the February 2008 AAOS Now, I was so excited. Imagine two articles in the same issue on topics that I really care about. First, there was the article on Dr. Hewett’s work to reduce the incidence of anterior cruciate ligament injuries among female athletes. And second, the article on women in orthopaedics was really inspiring to me.

Life as a female second-year orthopaedic surgery resident isn’t easy. Life choices about the future seem uncertain, but seeing a picture of a pregnant orthopaedic surgeon is incredibly encouraging.

In our program in San Juan, Puerto Rico, four [female] residents have already graduated, two of them in the past two years. Another three are currently completing residency, and we have a newcomer for next year.

I encountered lots of support from my program directors and from most of my fellow residents when I chose this specialty. I’ve been dedicating myself to support and encourage women to follow this path. It’s important to get students in touch with the specialty and musculoskeletal science to get them to love it. As women, we are capable of doing the work, as sacrificing and demanding as it is; our special touch in an area where men are leaders makes a great difference and patients notice it.

We are looking forward to expanding the message. Count on us in Puerto Rico to make this specialty more open to receiving women as equals because of our merits and not only to increase diversity in residency programs, as it is very commonly stated.

Yesenia Rodriguez, MD, PGY-2
San Juan, Puerto Rico

I continue to be amazed at how pathologically naïve and blind our leadership is to the real threats to our profession. So our leadership is now ready to endorse affirmative action for orthopaedic residency for no other logical reason than to reach some magic number of women and minorities in orthopaedics. Did it ever occur to you that the real reason women may not want to pursue a career in orthopaedics is that they are smart enough to see the direction medicine is heading and they see no reason to go through the rigors of surgical training?

We have got to stop judging people by factors that have absolutely nothing to do with one’s abilities just to look politically correct.

Thomas D. Guastavino, MD
Pottsville, Penn.

Other options for ACL injuries

The February 2008 issue of AAOS Now includes a good overview of the work of Dr. Timothy Hewett (“Leveling the playing field”). His theories of ACL injury prevention have certainly raised the awareness of this problem, specifically in young female athletes. Unfortunately, the article would lead one to believe that neuromuscular training is the standard intervention to prevent ACL injuries. These theories are based on epidemiologic data that still need to be corroborated, and in fact have not been fully borne out in controlled studies.

This area is under evaluation by a number of groups. Since the article by Pfeiffer et al in The Journal of Bone and Joint Surgery (“Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate ligament injury,” August 2006), clear efficacy of functional training alone is not universally recognized. There are a number of strengthening strategies, particularly involving eccentric activity of the hamstring muscles, that have a strong basic science rationale (see Gerber et al, “Effects of early progressive eccentric exercise on muscle structure after anterior cruciate ligament reconstruction,” J Bone Joint Surg, March 2007).

The physical and psychological consequences of an ACL injury are significant, and we need to make sure that our medical recommendations have the highest assuredness of efficacy. Readers would be best served by a more balanced review of this important topic.

Michael MacMillan, MD
Gainesville, Fla.

AAOS Now welcomes reader comments and efforts to “set Now straight.” We reserve the right to edit your correspondence for length, clarity, or style. Send your letters to the Editor, AAOS Now, 6300 N. River Rd., Rosemont, IL 60018, fax them to (847) 823-8033, or e-mail