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Oyem PC, Runsewe OI, Huffman N, Pasqualini I, Rullán PJ, Klika AK, Deren ME, Molloy RM, Piuzzi NS. Recognizing the Sex Disparity in Surgeons Performing Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00460-1. [PMID: 38750831 DOI: 10.1016/j.arth.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND There is an unambiguous sex disparity in the field of orthopaedic surgery, with women making up only 7.4% of practicing orthopaedic surgeons in 2022. This study seeks to evaluate the sex distribution among orthopaedic surgeons engaged in primary total knee arthroplasty (TKA) between 2013 and 2020, as well as the procedural volume attributed to each provider. METHODS We retrospectively queried the Medicare dataset to quantify all physicians reporting orthopaedic surgery as their specialty and performing primary TKA from 2013 to 2020. Healthcare Common Procedure Coding System codes for primary TKA procedures were used to extract associated utilization and billing provider information. Trend analyses were performed with 2-sided correlated Mann-Kendall tests to evaluate trends in the number of surgeons by sex and the women-to-men surgeon ratio. RESULTS During the study period, 6,198 to 7,189 surgeons billed for primary TKA. Of this number, an average of 2% were women. The mean number of procedures billed for by men was 39.02/y (standard deviation: 34.54), and by women was 28.76/y (standard deviation: 20.62) (P < .001). There was no significant trend in the number of men or women surgeons who billed for primary TKA during the study period. Trend analysis of the women-to-men ratio demonstrated an increasing trend of statistical significance (P = .0187). CONCLUSIONS There was a significant upward trend in the women-to-men ratio of surgeons who billed for primary TKA. However, there remains a colossal gender gap, as women only made up 2.4% of surgeons who billed for the procedure. The current study raises awareness of the notable discrepancy in the average number of TKAs performed by women as compared to men. The orthopaedic community should aim to determine ways to increase the number of women arthroplasty surgeons along with the opportunities that women have to perform TKAs.
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Affiliation(s)
- Precious C Oyem
- Department of Orthopedic Surgery, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Oluwapeyibomi I Runsewe
- Department of Orthopedic Surgery, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ignacio Pasqualini
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Pedro J Rullán
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Kliethermes SA, Asif IM, Blauwet C, Christensen L, Coleman N, Lavallee ME, Moeller JL, Phillips SF, Rao A, Rizzone KH, Sund S, Tanji JL, Tuakli-Wosornu YA, Stafford CD. Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review. Br J Sports Med 2024; 58:164-171. [PMID: 38216322 PMCID: PMC10961938 DOI: 10.1136/bjsports-2023-107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base. DESIGN Scoping review. DATA SOURCES Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials. ELIGIBILITY CRITERIA Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included. RESULTS 103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90). CONCLUSION Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.
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Affiliation(s)
- Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Irfan M Asif
- Family and Community Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Leslie Christensen
- Department of Library Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nailah Coleman
- Pediatric Primary Care, Children's National Hospital, Washington, District of Columbia, USA
| | - Mark E Lavallee
- Department of Orthopedics, UPMC, Harrisburg, Pennsylvania, USA
| | - James L Moeller
- Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Shawn F Phillips
- Department of Family and Community Medicine, Penn State Health, Mount Joy, Pennsylvania, USA
| | - Ashwin Rao
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine H Rizzone
- Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Sund
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Jeffrey L Tanji
- Orthopedics, UC Davis Sports Medicine, Sacramento, California, USA
| | - Yetsa A Tuakli-Wosornu
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Cleo D Stafford
- Department of Orthopaedics and Rehabilitations Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Benes G, ElNemer W, Avendano J, Hsu N, Aiyer A. Research Productivity and Impact in Foot and Ankle Surgery: Insights From Relative Citation Ratio Analysis of Recent Fellowship Graduates. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00003. [PMID: 38323927 PMCID: PMC10846775 DOI: 10.5435/jaaosglobal-d-23-00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The relative citation ratio (RCR), a novel bibliometric tool supported by the National Institute of Health, provides a standardized approach to evaluate research productivity and impact across different fields. This study aims to evaluate RCR of fellowship-trained foot and ankle orthopaedic surgeons to analyze the influence of various surgeon demographics. METHODS Fellow names listed on the American Orthopaedic Foot and Ankle Society website were extracted from the year 2008 to 2009 to the year 2022 to 2023. Demographic information for each fellow was collected including sex, degree type, and academic title. The iCite database developed by the National Institute of Health was used to obtain total publications, mean RCR, weighted RCR, and change in RCR after fellowship graduation for each fellow. Univariate and multivariate analysis was conducted to predict these four parameters based on sex, degree type, academic position, and career longevity. RESULTS Of the 820 fellows, 674 (82%) were male. Most fellows (n = 587, 71%) did not go on to hold academic positions. Multivariate analysis revealed that male sex (β = 2.32, P < 0.001), holding an academic position (β = 6.44, P < 0.001), holding a PhD (β = 22.96, P < 0.001), and a shorter length time since graduation (β = -0.50, P < 0.001) were independent predictors of number of total publications. Holding a DO degree was an independent predictor of decreased mean RCR (β = 0.39, P = 0.039). Finally, multivariate analysis revealed that male sex (β = 4.05, P = 0.003), a career in academics (β = 4.61, P < 0.001), and a shorter time since graduation (β = -0.45, P = 0.001) were associated with a larger weighted RCR. DISCUSSION The findings highlight the importance of addressing gender disparities and promoting research opportunities across different programs. Moreover, academic institutions should provide adequate support and mentorship to early-career foot and ankle-trained orthopaedic surgeons to foster sustained research productivity.
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Affiliation(s)
- Gregory Benes
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - William ElNemer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - John Avendano
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Nigel Hsu
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amiethab Aiyer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Bertha N, Visser T, Haines N. New Patient Referral Patterns May Reflect Gender Biases in Orthopedics. Cureus 2023; 15:e40935. [PMID: 37496543 PMCID: PMC10368298 DOI: 10.7759/cureus.40935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
Background Orthopedic surgery traditionally has been a male-dominant specialty with the lowest percentage of female residents and female faculty of all medical specialties. Prior studies demonstrate gender biases from both referring providers and patients. This study investigates surgeon, referring provider, and patient demographic differences in new patient orthopedic referrals. Methodology A retrospective chart review was performed to analyze the demographics of new patients referred to male and female orthopedic surgeons within adult reconstruction and shoulder/elbow specialties at a single academic institution. Patients and referring provider demographics were compared for male and female orthopedic surgeons. Statistical analysis utilized Student's t-test and chi-square analyses for quantitative and qualitative data, respectively. Results In total, 2,642 new patients were analyzed, with 2,084 patients being referred from a provider, and 306 patients requesting specific providers. When compared to male surgeons, female surgeons had fewer referrals from male providers (45.3% vs. 50.3%, p = 0.03) and no difference from female providers (30.6% vs, 29.9%, p = 0.72). The female adult reconstruction surgeon had fewer internal referrals compared to a male surgeon of similar experience and time at the institution (8.4% vs. 12.8%, p = 0.03). Female patients requested male surgeons more frequently than female surgeons (76.7% vs. 23.3%, p = 0.02). Conclusions New patient demographics differed between male and female orthopedic surgeons at a single academic institution with more male referring providers referring to male surgeons. Female patients requesting male orthopedic providers may reflect patient and specialty-driven biases. There remains a need for additional female representation in orthopedic surgery, and new patient referral patterns may be a marker to assess and monitor gender biases.
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Affiliation(s)
- Nicholas Bertha
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Timothy Visser
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Nikkole Haines
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Stevens CR, Merk K, Ierulli VK, Mulcahey MK. Analysis of Social Media Posts That Promote Women Surgeons. JOURNAL OF SURGICAL EDUCATION 2023; 80:682-688. [PMID: 36872167 DOI: 10.1016/j.jsurg.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze the content, interaction, and use of posts related to women surgeons on Instagram and Twitter, with specific analysis of female orthopedic surgeon related content. DESIGN A retrospective search of Instagram and Twitter from March 14, 2022, to June 16, 2022 was conducted using the hashtags, #womeninortho, #womeninorthopedics, #ilooklikeasurgeon, #womensurgeons, and #womeninsurgery. Additional searches were performed on Twitter that consisted of #orthotwitter in combination with #ilooklikeasurgeon, #womensurgeons, and #womeninsurgery. Once identified, posts were analyzed for the hashtag used, number of likes, number of comments, number of retweets (Twitter only), source type, type of post, and medical specialty. Descriptive statistics were used to analyze the data. RESULTS Over the 3-month period, a total of 3248 posts were identified that included 1669 Instagram (50.5%) and 1639 Twitter (49.6%) posts. The majority of overall posts and Instagram posts were made by general (32.3%, 28.9%), plastic (12.7%, 22.1%), and orthopedic surgeons (8.3%, 7.8%). On Twitter, general surgeons tweeted the most (35.6%), followed by orthopaedic surgeons (8.8%). Instagram had a greater mean number of and comments per post than Twitter. For orthopedic hashtags, #womeninortho was used more than #womeninorthopedics (78.0% vs. 22.0%, p < 0.001). On #orthotwitter, #ilooklikeasurgeon was used more than #womeninsurgery and #womensurgeons (75.0% vs. 23.6% vs. 1.4%, p < 0.001). CONCLUSIONS This study demonstrated that both Instagram and Twitter are regularly used to promote women surgeons. Instagram is the preferred platform of physicians for promoting women surgeons via personal and outcome-based content, while Twitter is used more by students and primarily includes outcome-based posts. Female orthopedic surgeons should continue to use the preferred hashtag, #womeninortho, to maximize the reach of this content. By promoting women surgeons on social media, practicing surgeons can converse, collaborate, and provide mentorship to the next generation of surgeons.
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Affiliation(s)
- Carly R Stevens
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Katie Merk
- Tulane University, New Orleans, Louisiana
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
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Identifying and Addressing Burnout in the Orthopaedic Surgeon. J Am Acad Orthop Surg 2023; 31:229-238. [PMID: 36727894 DOI: 10.5435/jaaos-d-22-00722] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023] Open
Abstract
Throughout the career of a physician, they are subjected to long working hours, high stress, life and death situations, risk of malpractice, significant financial debt, and an increasing bureaucratic load. This, in turn, has led to significant rates of burnout and potential suicidal ideation. Suicide prevalence has increased roughly 30% over the past 2 decades, with surgeon suicide rates reaching as high as 3x that of the general cohort. Orthopedic surgeons are most severely affected, composing 28.2% of physician suicides and seeing one third of their suicides from 2003 to 2017 occurring in the last 2 years alone. We provide the latest data and the current trends in orthopedic burnout and suicide rates, delve into the possible inciting factors driving their increase, and provide recommendations to identify their early signs and mitigate progression.
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Recruitment of the Next Generation of Diverse Hand Surgeons. Hand Clin 2023; 39:111-118. [PMID: 36402521 DOI: 10.1016/j.hcl.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hand surgery encompasses a diaspora of pathology and patients, but the surgeons treating this population are not commensurately diverse. A physician population that reflects the population it treats consistently leads to improved patient outcomes. Despite increasing diversity amongst surgeons entering into pipeline specialties such as General Surgery, Plastic Surgery, and Orthopaedic Surgery, the overall makeup of practicing hand surgeons remains largely homogenous. This article outlines organizations, such as the Perry Initiative, which have increased recruitment of women and underrepresented minorities into pipeline programs. Techniques of minimizing bias and increasing opportunities for underrepresented groups are also discussed.
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Julian KR, Anand M, Sobel AD, Mulcahey MK, Wong SE. A 5-Year Update and Comparison of Factors Related to the Sex Diversity of Orthopaedic Residency Programs in the United States. JB JS Open Access 2023; 8:JBJSOA-D-22-00116. [PMID: 36896147 PMCID: PMC9990829 DOI: 10.2106/jbjs.oa.22.00116] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Female physicians have been historically underrepresented in orthopaedic surgery residencies. The purpose of this study was to determine whether sex diversity among orthopaedic residency programs and faculty is associated with an increased number of female residents matriculating into that program. In addition, we sought to analyze female resident matriculation trends in the past 5 years. Methods The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all allopathic orthopaedic surgery residency programs during the 2021 to 2022 academic year. The number of female residents and interns; the number of female faculty, professors, and associate professors; and the number of women in leadership positions were compared with data from the academic year 2016 to 2017. Continuous data were analyzed with independent t-tests, and significance was set at p < 0.05. Results A total of 696 female residents (19.2%) were identified from 3,624 orthopaedic residents, an increase from 13.5% in 2016. Programs in the top quartile of female residents had 3 times the number of female residents per program when compared to other quartiles and almost double the number of female interns per program. Programs in the top quartile of female residents had a significantly greater number of female faculty per program than the lower quartiles; 5.76 vs. 4.18. Compared with 2016 to 2017, there were significant increases in female faculty per program from 2.77 to 4.54 along with female full professors from 0.274 to 0.694. These increases contribute to the overall growth in the number of women in leadership positions per program over the past 5 years to 1.01 from 0.35 (p < 0.001). Conclusion In the past 5 years, the percentage of female residents has increased from 13.5% to 19.2%. Furthermore, women make up 22.1% of interns. Orthopaedic surgery residency programs with higher percentages of female faculty had higher numbers of female residents. By encouraging programs to promote female representation within leadership and residents, we may continue to see the gap in orthopaedic sex diversity close. Level of Evidence III.
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Affiliation(s)
- Kaitlyn R Julian
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Malini Anand
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Stephanie E Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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Membership and Feedback on the American Academy of Orthopaedic Surgeons and Other Subspecialty Societies: A Survey Study of Orthopaedic Surgeons. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00005. [PMID: 36733995 PMCID: PMC9635038 DOI: 10.5435/jaaosglobal-d-22-00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Orthopaedic surgeons face decreased reimbursement, lower income, and increased rates of burnout. As subspecializing through fellowship training in orthopaedics becomes more and more prevalent, the value of membership to a general orthopaedic society (American Academy of Orthopaedic Surgeons [AAOS]) warrants investigation. METHODS One hundred thirty orthopaedic surgeons were surveyed by e-mail through a 14-item anonymous survey administered through SurveyMonkey. The survey inquired about surgeon experience, practice type, fellowship training, and details regarding AAOS and subspecialty society membership. RESULTS The response rate was 67%, with 94% of respondents indicating that they were members of AAOS and a subspecialty society. The most common reasons for AAOS membership were tradition (65, 74.7%), continuing medical education (46, 52.9%), maintenance of board certification (44, 50.6%), and political advocacy (40, 46.0%). The most common reasons for subspecialty society membership were continuing medical education (73, 83.9%), tradition (49, 59.8%), and political advocacy (33, 40.2%). DISCUSSION Most surgeons in our study cohort were members of both AAOS and a subspecialty society, but the reasons for membership in each differed. Almost 80% of respondents think their subspecialty society provides all their professional needs. The orthopaedic societies need to continue to evolve to provide value to their members to succeed in the future.
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