Diversity and Orthopedics: Still No Change

It wasn’t a difficult choice.

Erica Taylor spent years watching her NFL Hall of Fame father Charley snag passes for the Washington Redskins. It wasn’t the on-field play, however, that intrigued her as much as the off-field activities—i.e., the interactions between team doctors and active roster players.

Watching that sideline interplay helped convince Taylor to become a physician herself. An orthopedic surgeon, specifically.

Though she was only a teenager at the time of her decision, Taylor knew the medical field was the right choice for her. Yet she was profoundly unaware of the difficulties she would face in pursuing her professional passion.

Those troubles began fairly quickly, too: As a college sophomore, Taylor met with an orthopedic surgeon who suggested she pursue family medicine or obstetrics rather than musculoskeletal care. “Breaking records, being the best, being competitive, that was something I grew up expecting for myself,” Taylor told Duke University School of Medicine’s news service in March. “That one event in college was the first time someone had created a narrative for me or had insinuated there was something unavailable or not attainable for me. The only characteristics he knew about me was my visible diversity.”

But that was cause enough for the remark, given that Taylor—as a Black woman—was attempting to infiltrate a white male-dominated field. Industry data indicate orthopedics is the least diverse medical subspecialty, with abysmally low percentages of every minority group.

Minority representation, in fact, barely budged between 2008 and 2018 while Caucasians maintained their command. American Academy of Orthopaedic Surgeons (AAOS) statistics show Native American representation flatlined throughout the decade at 0.4%, and multiracial physicians comprised 1.2% of the industry total. Just 2.2% of practicing surgeons were Hispanic/Latino in 2018, 1.9% were African-American, 6.7% were Asian (the highest of any ethnic group), and 2.9% were identified as “Other.” Caucasians, meanwhile, made up 84.7% of the orthopedic surgeon population.

Growth among the various ethnic groups was barely measurable: the “Other” group recorded the largest increase between 2008 and 2018 (1.8%), followed by Asian (1.5%), multiracial (0.6%), and Hispanic/Latino and African-American (both 0.3%). The Caucasian group concurrently lost 4.6% of its population during the decade.

Orthopedics’ gender disparity is equally as lopsided. The profession is still very much a boys’ club, with male surgeons outnumbering their female counterparts by a 46:3 ratio. AAOS data show male surgeons comprised 92.3% of the industry’s population in 2018, a 1.8% increase compared with 2008. Females, by contrast, constituted just 5.8% of the total, a 1.7% hike. (A percentage of respondents did not provide an answer.)

“I think the statistic is now 1.3% of orthopedic surgeons identify as Black and then 0.3% identify as Black women,” Taylor said in a Duke University School of Medicine online video. In September 2013, Taylor finally realized her professional dream, joining Duke Health’s surgical staff (the first Black woman to do so). She is also chief of surgery at Duke Raleigh Hospital, and   associate chief medical officer of Diversity and Inclusion at Private Diagnostic Clinic PLLC | Duke Health.

“What we need to recognize—we need to break down some of these barriers to achieving respect for Black women, particularly Black women leaders in medicine,” she added. “I think that will be the key to moving forward.”

The key, honestly, will be a combination of diversity/inclusion initiatives and time. Earlier this year, AAOS announced a $1 million grant program for funding diversity, equity, access, and inclusion projects.

The AAOS IDEA Grant Program aims to better fund and support a more diverse lineup of orthopedic surgical candidates; foster DEI initiatives for community-based or academic orthopedic surgeons; and expand the availability of AAOS educational and networking opportunities to diverse students and practicing surgeons. The program’s diversity focus areas include gender, race/ethnicity, LGBTQ+, socioeconomic, veteran status, and disability. Program funds will be allocated between four tracks, each with a different DEI focus and target recipient.

“Fostering diversity is one of AAOS’ strategic goals…” AAOS Diversity Advisory Board Chair Anthony E. Johnson, M.D., said upon announcing the initiative. “Through the AAOS IDEA Grant program, we are making strides—one step at a time—to fundamentally address the gaps across gender, culture, and ethnicity in our field. It is going to take time to break down barriers, but we believe this program will inspire further action and change.”

Indeed, diversifying orthopedics is likely to take time: The training pipeline averages about a decade (four years for medical school, five years for residency, one for fellowship), so even the most successful recruiting efforts won’t bear fruit for at least another 10 years.

Better late than never.