Women in Sports Medicine
By: Andrea M. Spiker, M.D. and Cassandra A. Lee, M.D.
March is Women’s History Month, which recognizes and honors women’s contributions in the United States. What began as Women’s History Week (the week of March 8) by presidential proclamation in 1980 subsequently became a Women’s History Month in 1987.1 In the spirit of Women’s History Month, we would like to highlight in this month’s Inside AANA E-Newsletter the women in orthopaedic sports medicine.
As Orthopaedic Surgeons, we are in the absolute least diverse specialty in all of medicine by both sex and race. Despite women making up greater than 50% of all graduating medical students, less than 6% of all practicing Orthopaedic Surgeons are women.2 While increased diversity in our field is perhaps on the horizon, with 16% of orthopaedic trainees now being women, this growth in gender diversity is the lowest in medicine and of all the surgical subspecialties.3 Between 2005 and 2016, other historically underrepresented surgical subspecialties have made impressive strides to increase the number of women in their ranks (neurosurgery 11.1% women in 2005, with a 56.8% increase in female Orthopaedic Residents by 2016; thoracic surgery 10.7% women in 2005 with a 111.2% increase in female Orthopaedic Residents by 2016); meanwhile, orthopaedic surgery has only moved forward at a snail’s pace (11.5% female Orthopaedic Residents in 2005, to 14.5% in 2016 and 16% in 2021).3 So why are women choosing not to enter the field of orthopaedic surgery? It is not because they are less qualified than males; female and male trainees achieve similar scores on the Orthopaedic In-Training Examination and American Board of Orthopaedic Surgery examinations. In fact, females have a higher fellowship match rate than their male counterparts (96% vs. 81%, P, 0.001).4,5 The answer to this question of why we cannot attract and retain females in the field of orthopaedics, and orthopaedic sports medicine surgery, is multifaceted.
Women are underrepresented in orthopaedic surgery leadership positions, and women more than men are influenced in their decision to enter orthopaedic surgery based on exposure to a same sex or ethnicity role model.6 Only 18% of full-time orthopaedic surgery faculty are women, and of those, women hold disproportionately lower academic titles than men.3 Women are also underrepresented in academic sports medicine publishing, and when they publish, are less likely to be a senior author, which affects their academic mobility.7 When women are given titles within departments, they are more often education-based positions, such as program director. These positions take a substantial amount of time away from academic pursuits, and are not considered in the same elevated category as leadership positions such as chair, vice chair or division chief. 8 Additionally, this status quo is perpetuated by undertones of phenomena such as implicit bias, imposter syndrome and stereotype threat. Implicit bias is present in everyone and is defined as the existence of cultural stereotypes that lead to preformed mental associations. These associations affect what we say and do, unwittingly and unintentionally, possibly contradicting our conscious beliefs.9 Stereotype-based assumptions also influence our decisions of who to mentor, admit or hire.
Despite the many barriers, we have now seen more and more women taking leadership roles in orthopaedic surgery and in sports medicine. There are now a handful of orthopaedic surgery department chairs: Evangelina Burger, M.D. (University of Colorado Medicine), Lisa Lattanza, M.D. (Yale School of Medicine), Susan Bukata, M.D. (University of California San Diego), Leesa Galatz, M.D. (Mount Sinai), April Armstrong, M.D. (Penn State Health), Michelle Caird, M.D. (University of Michigan Health), Martha Murray, M.D. (Boston Children’s Hospital/Harvard School of Medicine) and Valerae Lewis, M.D. (MD Anderson Cancer Center). While this is an encouraging number, we would be remiss not to note that these have all been named only since 2015, and seven of these names were recognized after 2020.2 The American Academy of Orthopaedic Surgeons (AAOS) has had one female president – Kristy Weber, M.D. – in 2019. The American Orthopaedic Society for Sports Medicine (AOSSM) has had one female president, Jo Hannafin, M.D., and two female inductees into the Hall of Fame, Dr. Hannafin and Sandy Kirkley, M.D.
While AANA has yet to have a female president, there are numerous female members who are heavily involved in the organization, including ourselves in addition to: Laura A. Alberton, M.D., Juliet M. DeCampos, M.D., FAANA, Nicole Friel, M.D., Elizabeth Matzkin, M.D., Mary K. Mulcahey, M.D., FAANA, Lisa K. O'Brien, D.O., Elizabeth J. Scott, M.D., Sarah B. Shubert, M.D., Miho J. Tanaka, M.D., M.A. and Vonda Wright, M.D., M.S. AANA Committee leaders who are female include Rachel M. Frank, M.D. (Research), Dr. Alberton (Bylaws) and Dr. Mulcahey (Emerging Leaders Task Force).
AANA has made a conscious effort in improving diversity within sports medicine, including the inaugural Diversity and Inclusion Lecture presented by Richard K.N. Ryu, M.D. at the AOSSM-AANA Combined 2021 Annual Meeting held last July. This is a start, but we need to do more as a sports medicine community. We need to acknowledge and educate ourselves and our trainees on implicit bias and stereotype threat with corrective actions to diminish their effect. We cannot take a passive role and assume that any organization can make changes to the field of orthopaedic sports medicine without the individual commitment of its members. We as individuals can step back and look at our institutions through a different lens of equity and inclusion, much like how the NFL is attempting to apply the “Rooney Rule” to improve diversity in its coaching ranks. Simple actions like appointing female moderators at national conferences, course faculty, instructors, master instructors or journal reviewers, to creating a pipeline of female leadership into our ranks in AANA, are all a positive start. Because 94% of practicing Orthopaedic Surgeons are male, the social network that includes our female colleagues are less reflexive. The activation energy to make these conscious changes are small, but the inclusive and equitable rewards will be greater than the initial effort.
What can you do? Whether you are in academics or private practice, the time is now to step up, acknowledge and make a conscious change to improve diversity in orthopaedics and sports medicine. As this is Women’s History Month, we can use this opportunity to think about how we as individuals and as a community can improve upon gender diversity as well as diversity in our field. The sum of our efforts will be greater than all of us. Change begins from within. Let us not lose momentum.
- Women’s History Month. https://www.womenshistory.org/womens-history/womens-history-month. Accessed 19 Feb. 2022.
- Scerpella, T.A., Spiker, A.M., Lee, C.A., Mulcahey, M.K., Carnes, M.L. "Next Steps: Advocating for Women in Orthopaedic Surgery." [Published online November 10, 2021]. Journal of the American Academy of Orthopaedic Surgeons. 2021.
- Chambers, C.C., Ihnow, S.B., Monroe, E.J., Suleiman, L.I. "Women in Orthopaedic Surgery: Population Trends in Trainees and Practicing Surgeons." The Journal of Bone & Joint Surgery -- American Volume. 2018;100(17):e116. doi:10.2106/JBJS.17.01291
- Pico, K., Gioe, T.J., Van Heest, A., Tatman, P.J. "Do Men Outperform Women During Orthopaedic Residency Training?" Clinical Orthopaedics and Related Research. 2010;468(7):1804-1808. doi:10.1007/S11999-010-1318-4
- Cannada, L.K. "Women in Orthopaedic Fellowships: What Is Their Match Rate, and What Specialties Do They Choose?" Clinical Orthopaedics and Related Research. 2016;474(9):1957-1961. doi:10.1007/S11999-016-4829-9
- Hill, J.F., Yule, A., Zurakowski, D., Day, C.S. "Residents’ Perceptions of Sex Diversity in Orthopaedic Surgery." The Journal of Bone & Joint Surgery - American Volume. 2013;95(19). doi:10.2106/JBJS.L.00666
- Kim, C.Y., Sivasundaram, L., Trivedi, N.N., et al. "A 46-Year Analysis of Gender Trends in Academic Authorship in Orthopaedic Sports Medicine." Journal of the American Academy of Orthopaedic Surgeons. 2019;27(13):493-501. doi:10.5435/JAAOS-D-18-00669
- Weiss, A., Lee, K.C., Tapia, V., et al. "Equity in Surgical Leadership for Women: More Work to Do." The American Journal of Surgery. 2014;208(3):494-498. doi:10.1016/J.AMJSURG.2013.11.005
- Fitzgerald, C., Hurst, S. "Implicit Bias in Health Care Professionals: A Systematic Review." BMC Medical Ethics. 2017;18(1). doi:10.1186/S12910-017-0179-8