Orthopaedic Foot and Ankle Surgery Leadership Trends: A Cross-Sectional Study of Fellowship Directors and Division Chiefs

Abstract

Category: Other Introduction/Purpose: Foot and ankle surgery is a growing subspecialty within orthopaedic surgery due to the increasing demand for lower extremity trained specialists. Fellowship directors for foot and ankle surgery are uniquely tasked with the responsibilities of creating an educational experience while teaching trainees to manage lower extremity pathology. Similarly, foot and ankle division chiefs serve as clinical leaders who oversee their department's delivery of lower extremity care while acting as mentors. The primary aim of this study was to quantitatively describe and compare the demographic and professional characteristics of current foot and ankle surgery fellowship directors and division chiefs. Methods: The American Orthopaedic Foot & Ankle Society (AOFAS) fellowship directory for 2021 to 2022 was reviewed for the 48 AOFAS-recognized fellowship programs in the United States. After screening all institutional websites, fellowship directors and division chiefs were directly contacted via email. Surveys were administered between March 31, 2021 and June 1, 2021 to collect demographic, education, and professional data. Publicly accessible online sources such as institutional biographies, media accounts, uploaded curriculum vitae, and the Scopus Web of Science database were accessed to collect any missing information. The H-index value was determined for each leader by accessing the Scopus Web of Science search engine, a database that analyzes peer-reviewed scientific publications with a built-in citation tracking feature. Univariate and bivariate statistical analyses were performed. Results: A total of 42 of the 48 (87.5%) fellowship directors and 18 of the 23 (78.3%) division chiefs responded to the questionnaire. Of the 48 fellowship directors, 45 (93.8%) were male, 43 (89.6%) identified as Caucasian, their average age at leadership appointment was 42.6+-7.5 (range, 32-70) years, and the average time between fellowship graduation and leadership appointment was 9.9+-7.8 (range, 0-36) years. Most of the fellowship directors graduated from OrthoCarolina (10.4%), Oakland Bone and Joint Specialists (Roger Mann) (10.4%), and Mercy Medical Center (8.3%) (Figure 1). Of the 23 chiefs, 22 (95.7%) were male, 20 (87.0 %) identified as Caucasians, their average age at leadership appointment was 41.7+-7.8 (range, 32-53) years, and the average time between fellowship graduation and leadership appointment was 9.8+-6.8 (range, 2-21) years. The average H-index for the chiefs was greater than that of the fellowship directors (18.4 vs 13.4, P=.0373) when controlling for years of training. Conclusion: This is the first study to record professional and demographic characteristics amongst orthopaedic foot and ankle surgery fellowship directors and division chiefs. The utility of this analysis comes from highlighting common attributes of successful leaders within the field for aspiring trainees, while also drawing attention to the lack of diversity within the foot and ankle surgery community.