Diversity in orthopaedic surgery residency applications–Where are we?

Introduction Gender and racial diversity are key topics for discussion in medical education and, in particular, orthopaedic surgery. Studies have shown patient-physician concordance leads to improved healthcare outcomes. Despite this, the orthopaedic surgery workforce is amongst the least diverse. This study examined trends in gender and race amongst applicants to United States (U.S.) orthopaedic surgery programs to understand the future trajectory of the orthopaedic workforce. With an increasing emphasis on diversity, we hypothesize that gender and racial diversity among orthopaedic surgery applicants have increased. Methods Publicly available demographic data from the Electronic Residency Application Service (ERAS) for applicants to surgical residency programs between 2007 and 2019 were collected. Linear regression analysis by residency application year was performed for orthopaedic surgery and other surgical specialties. Z-tests were used to compare respective proportions. Results Over the 12-year study period, 18,542 applicants applied to U.S. orthopaedic programs. Of those, 14.9% were female and 28.2% were Black, Indigenous, or People of Color (BIPOC). The percentage of female applicants increased from 11.8% to 19.3% at a rate of 0.41% per year (R = 0.79). The percentage of BIPOC applicants between 2007–2019 ranged from 24.8 to 34.1% annually, trending upwards by 0.44% per year. Compared to other surgical specialties, orthopaedic surgery consistently demonstrated a paucity of female and BIPOC applicants. While African American and Hispanic representation in the orthopaedic surgery applicant pool were comparable to other surgical specialties (6.6% and 8.0%, respectively), Asian applicants were underrepresented at 15.4% compared to 19.3–22.6% for other specialties (p < 0.001). Conclusions Application to orthopaedic training programs by female and BIPOC individuals is persistently lower than in other specialties. Despite efforts to increase diversity, diversification has not accelerated signficantly. It remains important for orthopaedic residencies to continue institutional programs and grassroots efforts to encourage a diverse applicant pool.