Is orthopaedics making any progress in gender diversity? Despite the naysayers, orthopaedics has, in fact, made great strides in gender diversity—and has a promising future.

In 2014, women made up half of undergraduate students, 44 percent of medical students, and 14 percent of orthopaedic residents. As Table 1 shows, the percentage of female residents in orthopaedics is slowly increasing—yet remains lower than in other surgical specialties. But figures can be deceiving.

Based on raw numbers, not percentages, orthopaedics far surpasses other surgical specialties in attracting women to the field. The numbers of female residents in orthopaedics has increased from 67 in 2007 to 105 in 2015—more than a 40 percent increase in less than 10 years. There are more women in orthopaedics than in any other surgical specialty, with the exception of general surgery.

Women who apply to orthopaedic programs are accepted at rates similar to their male colleagues. The performance of women in orthopaedic surgery residency programs is comparable to that of men, and women in orthopaedics are satisfied with their career choice. Orthopaedic residency programs are changing and attracting women. The most recent data found 39 programs with more than 20 percent female residents, and fewer than 20 programs without any women.

The AAOS has 1,273 female members (270 in training, 968 fellows, and 35 emeritus members)—another significant increase over the past several years (Fig. 1). And women are continuing to make inroads in leadership, breaking down doors and through glass ceilings. Thirteen female orthopaedic surgeons have served on the AAOS Board of Directors, and one (Laura Tosi, MD) has been elected twice. In addition to the Ruth Jackson Orthopaedic Society (RJOS), women have been president of the following 11 specialty organizations:

• Orthopaedic Research Society
• American Association for Hand Surgery
• Musculoskeletal Tumor Society
• Limb-Lengthening and Reconstruction Society
• American Orthopaedic Foot and Ankle Society
• North American Spine Society
• Pediatric Orthopaedic Society of North America
• American Association of Hip and Knee Surgeons
• American Orthopaedic Society of Sports Medicine
• American Spinal Injury Association
• Cervical Spine Research Society

The Academy's CEO, Karen L. Hackett, FACHE, CAE, has been leading the AAOS since 2003. Leesa M. Galatz, MD, is the first woman to chair a department of orthopaedic surgery, at New York's Mount Sinai Hospital. Judith F. Baumhauer, MD, MPH, was the first (but not likely the last) female president of the American Board of Orthopaedic Surgery.

A promising future
The AAOS supports and promotes gender diversity in many ways, including through its Diversity Advisory Board and Women's Health Issues Advisory Board. It works with other organizations to attract top female applicants to orthopaedic training programs. The Perry Initiative offers hands-on workshops for high school, undergraduate, and medical students.

The RJOS is dedicated to mentorship and professional development, providing medical student scholarships, research awards, and opportunities to attend educational meetings. The second edition of the RJOS Guide for Women in Orthopaedic Surgery was published in 2014. Membership has increased 34 percent since 2008.

To maintain this positive momentum, research and surveys are providing some guidance. A recent study on factors motivating medical student career choice found that concentrating recruitment efforts might be best in the first year(s) of medical school. According to a survey of RJOS members, women are influenced by personal attributes such as intellectual stimulation, personal satisfaction, and enjoyment from working with their hands and treating a variety of conditions. Only 27 percent cited mentorship, and just 16 percent had been exposed to musculoskeletal medicine prior to entering medical school. A profile of female academic orthopaedic surgeons found the following:

• most had a mentor who positively influenced a career choice
• 93 percent were satisfied with their career choice
• 77 percent would choose orthopaedics again
• 62 percent had children
• 73 percent were in a relationship

Attitudes and policies on maternity and paternity leave during training not only affect potential female trainees, but also affect their married male counterparts who are making family and lifestyle decisions. Residency directors must define the rules and options for applicants to attract the best candidates and a gender-balanced group to their programs.

The benefits will quickly become obvious. When women are part of a program, they bring a different perspective to the treatment of all patients with orthopaedic conditions. They also encourage a focus on research to understand the differences that sex and gender have on musculoskeletal conditions.

A word about mentors
A role model for a female medical student or resident does not have to be another female; it can be a male willing to provide support, foster opportunities, acknowledge difficulties, and appreciate the different perspectives of women surgeons. However, when they see women as orthopaedic surgeons, younger individuals can envision themselves in the role. In addition, women attract more women, so once a breakthrough is made, a team can soon be built.

Successful mentoring is proactive, and mentoring best practices include holding career days, lunches or dinners, and medical student orientation sessions. Participation in medical school orthopaedic interest groups, as well as community, state, and national associations, is also helpful. The Orthopaedic Trauma Association's Women in Trauma breakfast, for example, has grown to a lunch attended by more than 65 members.

Be creative with your ideas; opportunities exist daily for attracting women to a career in orthopaedics. Support other women—your female colleagues—whether you are male or female. See "Tips to Help with Mentoring" at the end of the article for easy ways to get started. At the end of every day, if imitation is the greatest form of flattery, then we will succeed in demonstrating the role of women in orthopaedics.

David D. Teuscher, MD, is the immediate past president of the AAOS. Lisa K. Cannada, MD, sits on the AAOS Board of Directors as the secretary for the Board of Specialty Societies.

Tips to Help with Mentoring
Lisa K. Cannada, MD

• In mentoring, it is important to show other aspects of life in addition to professional achievements. My office is filled with pictures of my daughter and my family.
• Have a plan, set goals, review your goals, and get your support team together to succeed.
• Always reach for the top and use your strengths. Women listen and think differently than men, so think outside the box.
• Remember that saying "no" is acceptable; say "yes" to tasks that will help advance your career, that you are interested in, and that you can deliver on.
• Always think before you speak.
• Remember that a little bit of honey goes a long way.
• Teamwork is learned at an early age with kids; keep it up.
• Be like an alligator: Develop thick skin.
• Remember the totem pole concept: You are only going to get as good as you treat the person on the bottom of the totem pole.
• Do not spill all of the beans at work; never tell stories about your personal life to people you do not know or cannot trust.
• Remember to include your family in your life as often as possible. A meeting for you can be a vacation for them.
• Never forget your family and friends.
• Build layers of support. If you do not have your family around, make sure you have adequate help.

References:

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5. Pico K, Gioe TJ, Vanheest A, Tatman PJ: Do men outperform women during orthopaedic residency training? Clin Orthop Relat Res 2010;468:1804–1808.
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