Barriers to Women Entering the Field of Orthopedic Surgery.

The movement toward official academic training for medical professionals in the 12th and 13th centuries led to the exclusion of women from professional health care because they were excluded from universities.1-3 Although women were barred from the practice of surgery, they were able to fill roles as bonesetters. The treatment of musculoskeletal conditions was largely the domain of bonesetters in the centuries before the 1850s. After the advent of anesthesia and antibiotics, the profession of orthopedic surgery developed rapidly, and the bonesetters slowly disappeared. After passage of the 1972 Education Amendments to the Civil Rights Act in the United States, including Title IX4 on sex-based discrimination, the number of female graduates from medical schools began increasing at a steady rate, tripling by 1980.5 However, the percentage of women in surgery lagged behind that in medicine: in 1980, 12% of physicians, but only 2% of surgeons, were women.6 Notably, the percentage of female residents in orthopedic surgery grew at a slower rate than that in other surgical subspecialties (Table 1).6,7 This editorial takes a historical perspective to investigate the key barriers to attracting women to the field. We distributed a survey that focused on exposure to orthopedic surgery to all members of the Ruth Jackson Orthopaedic Society. Of the 777 members, 267 (34%) female orthopedic surgeons and residents responded (Table 2). This represents approximately 20% of all female orthopedic surgeons. Seven personal oral history interviews were conducted with Drs Liebe Diamond (who completed residency in the 1950s), Michelle James (1980s), Mary O’Connor (1980s), Beth Shubin Stein (1990s), Dawn LaPorte (2000), Casey Humbyrd (2010s), and Julia Smart (2010s). Previous research has shown that women’s performance in orthopedic residency programs equals that of men,8 and that women are accepted into orthopedic surgery residency programs at the same rate as men.9 However, women are more underrepresented in orthopedics than in any other specialty. The authors are from the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Dawn M. LaPorte, MD, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, Fl 5, Baltimore, MD 21205 ([email protected]). doi: 10.3928/01477447-20150902-03 Table 1