Editor’s Spotlight/Take 5: What Characteristics of Orthopaedic Surgery Residency Programs Are Associated With Increased Percentage of Matched Women Residents?
Year: 2025
Type: article
Abstract: Not long ago, Clinical Orthopaedics and Related Research® published a paper [1] with some grave news: If nothing came along to bend the curve, it would take 217 years for the proportion of women in orthopaedic surgery to match the proportion of women in the medical profession more generally (which was about 36% then), and 326 years for our specialty to be on par with the percentage of women in the United States. I haven’t seen much in the way of curve-bending interventions since then, and even the descriptive research hasn’t been so encouraging. One recent study [4] found that orthopaedic residency programs run by women did not contain a higher percentage of women residents than did those run by men, which has since has been confirmed by another study [7]. And in an even sadder twist, the first of those studies [4] also found that women were placed in program director roles earlier in their careers than men, which may have put them at career risk, since the program director position is an especially taxing one that leaves little time for other academic pursuits. But in this month’s CORR®, we get a little good news. If the observational findings reported here by Dr. Andrea Spiker’s group from the University of Wisconsin [2] translate into any cause-effect relationships, we may not have to wait until the year 2351 for gender parity in our specialty. Dr. Spiker’s team found that a higher percentage of women faculty members was modestly correlated with more women matching into those programs, and programs with more women residents seemed to have a similar association. This study also identified a few reputational factors of programs—like higher US News and World Report rankings and Doximity rankings—that were associated with more women matching into those programs. The rich get richer, I suppose. One has to be careful when trying to extrapolate from observed associations to cause-effect relationships in this context, but it was nice to see that programs might have opportunities to move our specialty toward gender parity without exposing young women faculty members to the torments of program directorship before they are ready to take them on. So, join me in the Take 5 interview that follows with Andrea M. Spiker MD, senior author of “What Characteristics of Orthopaedic Surgery Residency Programs Are Associated With Increased Percentage of Matched Women Residents?” [2], to discuss things orthopaedic residency programs can and should do on this important topic.Andrea M. Spiker MDTake 5 Interview with Andrea M. Spiker MD, senior author of “What Characteristics of Orthopaedic Surgery Residency Programs Are Associated With Increased Percentage of Matched Women Residents?” Seth S. Leopold MD:Congratulations on this study [2], which is some of the first good news I’ve seen on this topic. To what degree do you think your main findings—about the percentage of women faculty and residents correlating with a greater percentage of women matching into those programs—represent cause and effect rather than simple association, and why do you feel this way? Andrea M. Spiker MD: Thank you very much. I, too, was very encouraged to see our results reflect the recent growth of women matching into orthopaedic residency programs. I remember feeling devastated when I read the CORR article [1] that projected orthopaedic surgery would take 217 years to reach gender parity with the rest of the medical profession. That meant that not only would I not see this goal reached in my lifetime, but neither would my daughters or even their great granddaughters. The fact that our findings [2] suggest a faster pace in growth over recent years is encouraging. It’s difficult to know based on the data available whether this is a cause-effect relationship or one of association, but I tend to believe (and hope) that it is cause and effect. Between the 2020 and 2023 match cycles, we found that the percentage of women faculty grew from 10% to 12%, as did the percentage of women medical students matching into orthopaedic residency, increasing from 18% to 24% [2]. We also saw that more programs matched women residents in 2023 than they did in 2020. This growth was steady over the four consecutive match cycles we analyzed, despite serious disruption in the residency interview process that occurred during the COVID-19 pandemic. Of course, our study only captured a short timeframe—orthopaedic surgery residencies are at least 5 years long, after all—but I am hopeful that these numbers will only grow from here, especially when you consider our findings in a broader, historical context: Between the early 2000s and 2018, the number of women trainees in orthopaedic surgery was crawling upward at a slower pace than any other specialty [3], and a 2020 study [9] confirmed that we were at the bottom of the heap, with only 15.4% of orthopaedic residents being women. So our results, published just a few years after those studies, are much more optimistic! Dr. Leopold:One thing I found difficult about your study was that, in a sense, the number of women in academic orthopaedics can be seen as a supply-side labor constraint or a scarce resource, since your findings might make lots of programs want to hire more women faculty, but there are comparatively few who are looking for work at any given moment. This seems to give a leg-up to programs that already are reputationally strong (another finding of your study), but doesn’t necessarily point to a broader, implementable solution that will increase the proportion of incoming women overall; rather, it seems like it would just distribute those women across programs differently. Am I thinking about this wrong? Dr. Spiker: Based on our results [2], hiring more women faculty could be a strategy that orthopaedic departments use to attract women residents. But you’re right—that’s not necessarily an easy solution, given the long duration of training required to reach faculty status. I would say one encouraging thing was that we found increases in the number of women faculty between 2020 and 2023 across multiple subspecialties: trauma, arthroplasty, sports medicine, pediatrics, and shoulder and elbow [2]. This means that an orthopaedic department’s hiring needs could span a variety of subspecialties, and they are likely going to see more potential women hires in all of those subspecialties. Our study looked at residency programs, which are more representative of what we consider academic practices, but did not look at private practices. So another possibility would be to shift women faculty from private practice to academics, where they would be more visible to trainees. We found that more fellowship offerings, higher Doximity scores, and US News and World Report and NIH-funding rankings were also associated with a higher chance of matching a woman applicant, so focusing on these areas could be another strategy. The important point is that we have to start now and do whatever we can to keep the pipeline of future women orthopaedic surgeons as full as possible. Dr. Leopold:What else might help us bend the curve more quickly so that we don’t have to wait a few hundred years for gender parity? Dr. Spiker: Our study [2] may not provide a simple formula to bend the curve, but I do think it helped us identify certain areas institutions should dive into in order to recruit more women. The findings also give me hope that the orthopaedic landscape may be shifting toward gender parity at a faster pace than we previously thought. One thing we weren’t able to quantify was the value and impact of mentorship, sponsorship, and advocacy at each of these residency programs. We have learned that women medical students value having a role model of the same gender or ethnicity more than men do (59% of women found this to be important compared to 25% of men) [5]. We’ve also seen that early exposure to orthopaedics is associated with matching more women applicants into orthopaedic residencies [6]. Perhaps early exposure dispels some of the stereotypes that might deter women from orthopaedics. And when these findings are taken together, one can imagine how this would strengthen the possibility of a woman medical student choosing to pursue orthopaedics. It's important to note that just because a woman is in a faculty role doesn’t necessarily mean she is actively mentoring, sponsoring, or advocating for other women. In my own career experiences, women orthopaedic surgeons who go out of their way to support, encourage, mentor, and sponsor other women surgeons are most effective at bringing other women into the field. The impact and degree of mentorship and sponsorship are difficult to report objectively, but they are worth exploring, especially for departments that are seeking to bring more women into their institutions. Dr. Leopold:You mentioned that future studies should look at parental leave policies. Do you think that is the driving issue? One way to figure that out might be to compare other specialties that used to have lopsided gender distributions like ours; are parental leave policies very different, say, in general surgery programs than in orthopaedic surgery residencies? Dr. Spiker: I am not sure that it is a driving issue, but this is an area I am very curious about. I had three children during my residency training and early years as faculty, and I can tell you that navigating that time in my life without access to parental leave policies felt like yet another obstacle I had to face that my counterparts who were men did not. If we can mitigate some of these obstacles for our women colleagues, it will only help. And I agree with you—looking at other specialties’ parental leave policies and comparing them to what exists in orthopaedics would be a very good place to start this line of investigation. Dr. Leopold:What is your program doing differently, perhaps in light of your discoveries? People often say that it might be better if more medical students were exposed to orthopaedic surgery during the clinical years, but it hasn’t been so easy to make that happen… Dr. Spiker: At the University of Wisconsin (UW), our department chair and coauthor, Dr. Tamara Scerpella, has been integral in increasing the number of women faculty in our orthopaedics department from one (herself) to 10 over the past 15 years. She has been an incredible mentor, sponsor, and advocate for all of her faculty and trainees (men and women), and I point to her as one of the biggest reasons I joined the UW faculty. Now, 26% of the UW orthopaedic surgeon faculty and 33% of our orthopaedic surgery residents are women. We also have a strong representation of women surgeon leaders in our department, with Dr. Scerpella as Department Chair, Dr. Kathryn Williams as Residency Program Director, and myself as the Sports Medicine Fellowship Director. This is something that is visible to all trainees, which I think makes an impact. I also feel like we are particularly mindful of our outreach to future orthopaedic surgeons, and Dr. Scerpella and I recently coauthored an article [8] that shares specific steps of our process. Our research group on this paper [2]—Megan Baughman, Tessa Griffin, Reagan Beyer, and Dr. Elizabeth Turner—are all women trainees I have mentored in research and who have extremely promising future careers in orthopaedic surgery. Their work on this study is demonstrative of what can come of this type of mentorship and collaboration, which is why I continue to say “yes” to almost every opportunity to mentor women trainees who are interested in orthopaedic surgery. We still have some work to do at UW to improve our racial and ethnic parity—like all orthopaedic surgery residency programs must do—but I am hopeful that we can apply what we’ve learned here to improve across the board.
Author: Seth S. Leopold
Institution: Clinical Orthopaedics and Related Research
Language: English
Subfield: Gender Studies
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W4412401215