Diversity in Orthopedic Surgery Residency: Is There Equal Academic Productivity?

Background Despite efforts to promote gender and racial equality in medicine, orthopedic remains one of the least diverse medical specialties . Currently, women make up only 15% of orthopedic surgery residents, compared to 40% in general surgery. Similarly, underrepresented minorities remain poorly represented, with minimal change despite targeted recruitment. Research productivity during residency is often used as a benchmak for competitiveness in fellowship and academic advancement. However, there is limited data on academic productivity among these groups during residency. The purpose of this study is to evaluate the academic productivity of women and URM orthopedic surgery residents compared to their male and majority ethnicity/race counterparts. Methods A search was conducted of the top 50 highest-funded orthopedic residency programs in the United States between 2022-2023 with publicly available resident alumni data. Resident demographics including gender, race, residency, under-represented minority [URM] status, and academic productivity (number of publications, number of citations, h-index during residency) were collected from publicly available sources including residency websites, Scopus, ResearchGate, PubMed, Google Scholar, and LinkedIn. The Association of American Medical Colleges definitions of URM and ORM were used. ORM (Overrepresented in medicine) includes individuals of White or Asian descent, and URM includes individuals of Black or African American, Latino/a or of Spanish descent, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander. Residents were separated into male, female, URM, and ORM cohorts. Bivariate analysis was performed to compare academic productivity among the different cohorts. Results A total of 573 orthopedic surgery residents (n=102 women, n=471 men; n=48 URM, n=525 ORM) from the graduating classes of 2022 and 2023 were included in this analysis. Women had significantly fewer total publications (4.50 [IQR 6.75] vs. 6.00 [IQR 9.00], p = 0.04), fewer middle-author publications (2.00 [4.00] vs. 3.00 [6.00], p = 0.01), fewer last-author publications (22.00 [63.75] vs. 34.00 [102.00], p = 0.04), fewer total citations (22.00 [63.75] vs. 34.00 [102.00], p = 0.04), and lower h-index (3.00 [3.75] vs. 3.00 [4.50], p = 0.03) compared to men. No differences were observed in number of first-author publications between these genders. URM and ORM residents were comparable among all academic productivity measurements (all, p > 0.15). Conclusions Women orthopedic surgery residents demonstrated lower publication output, citation counts, and h-index compared to men. These findings reflect ongoing gender-based differences in academic productivity during training. Further investigation is needed to understand what factors contribute to these differences and hopefully provide solutions to make research productivity equatable for all residents.