Once I formally decided to pursue orthopedic surgery , I heard such unhelpful comments as , “ You ’ ll make a good orthopedic surgeon because you are tall .” Imagine someone saying that to a pathologist or urologist , as if their discipline were a sport . It just sounds silly . Yet , the association of orthopedics with “ jock culture ” is a familiar one that persists . 4 Despite orthopedic surgery being one of the most intellectually demanding careers in medicine , we are often jokingly described as being “ strong as an ox and twice as dumb .” Given these unfortunate stereotypes , it is important that women ( and minorities ) are given early access to musculoskeletal education and , ideally , exposed to mentors who reflect their own experiences and have overcome similar challenges so that women and minorities can be propelled towards careers in orthopedic surgery . 3-4
When I applied to residency , I made a spreadsheet . In the columns , I listed familiar attributes such as location , number of residents per year , academic versus community program , etc . I also had a column for the number of female faculty and another column for the number of female residents . In general , I tried to apply only to programs that had at least one female faculty member or one female resident . Sadly , many programs did not have either and many programs counted female faculty members who weren ’ t surgeons in their numbers , such as women who were PhDs or family medicine trained sports specialists , for example . ( In regard to providing adequate mentorship of orthopedic residents , I think that mentoring should be performed by trained orthopedic surgeons rather than by non-orthopedists , even if they are in the same department .)
On the interview trail , I experienced several reminders that women face unnecessary friction while practicing orthopedic surgery . The most cogent example is when I received an interview invitation that also included a written invitation to a “ meet and greet ” that came addressed to “ Applicants and Their Wives .” I was asked at least once if I planned to have children during residency . Incidentally , at one program , the only female resident held my arm and whispered to me on interview day , “ Please come here , we need more women .” The desperation in her words was concerning .
I was fortunate enough to match at the University of Colorado Denver , a program that had a history of encouraging women in orthopedics , and I was in the first class to have two women graduate in the same year . Later on , our program was one of the first in the country to have a woman , Dr . Evalina Burger , as the chair of the entire department . There were a handful of other women faculty in the department , with the greatest combined number ( two ) on the pediatric orthopedic faculty .
I should say that orthopedic surgery training is difficult for everyone , not just women , but my experience was that women had additional obstacles . I would like to say that I became a pediatric orthopedist solely because I love kids , but in reality , it was also because I perceived it as friendlier towards women compared to say , the field of joint reconstruction . In my fellowship at the University of Michigan in Ann Arbor , most of the pediatric orthopedic faculty
DIVERSITY & INCLUSION members were women , and now they , too , have a female department chair , Dr . Michelle Caird – another pediatric orthopedist . These women were excellent mentors to me , and they continue to be a resource in this stage of my career .
Being an attending is definitely more advantageous in all sorts of ways than being a trainee , not the least of which is implicit respect from others in the hospital . I still , however , get mistaken for the nurse or the physical therapist by parents even when I have just performed their child ’ s surgery . And , I am often called by my first name or referred to as Miss Nixon instead of Dr . Nixon , by the parents of my patients , which is not necessarily something I have observed happening to my male colleagues . In speaking to my friends in medicine across the country , I get the impression that I am not alone in these experiences .
It is amazing to me , however , that in my relatively short time as an orthopedist , I have seen women rise to prominent positions of leadership in the field . In 2019 , we had the first female president of the American Academy of Orthopaedic Surgeons ( Dr . Kristy L . Weber ), and I have had the privilege of training with two of the first female orthopedic surgery department chairs in the US . This shows that times are indeed changing , though they are changing much more slowly for orthopedics compared to other surgical specialties . While the percentage of women in orthopedic residencies grew by only 27.3 % during the academic year 2016-2017 compared to the academic year 2005-2006 ; during this same time period , the percentage of women in neurosurgery and thoracic surgery residencies grew by 56.8 % and 111.2 %, respectively . 5 Now that I am an attending , this demonstrates to me that I need to be a mentor to mentees who see my experience as a model , and shift paradigmatic trajectories in favor of more diversity in orthopedics .
You might ask yourself why any of this is important . Why should women and underrepresented minorities be encouraged to pursue careers in orthopedic surgery ? The answer is borne out in research that shows that minorities often want doctors who are from their same culture and that in other industries besides medicine , diversity on the board and within the executive suite translates to better market performance . Furthermore , minorities are more likely to take care of patients in underserved areas , and female leadership improves marketing efforts , recruitment of patients , role modeling for students and fostering of more creativity within the institution . 6-8
So while the story of my career in orthopedics begins with challenges , I see more women and minorities being welcomed into the field . And while we have a long way to go to make orthopedic surgery friendlier to women and minorities , I am confident that our profession can ultimately reflect the diversity of our society for the benefit of our patients .
References :
1
Sage , A . Evidence of Stone Age amputation forces rethink over history of surgery . The Times [ Internet ]. 2010 Jan 25 [ cited 2021
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