Gender Diversity in Orthopaedic Surgery Residencies Does Not Translate to Accreditation Council for Graduate Medical Education–Accredited Fellowships

Abstract

Introduction:. Gender representation among orthopaedic surgery applicants and residents has increased over the past two decades. The aims of this study were to evaluate trends of female fellows in ACGME-accredited orthopaedic subspecialties between 2007 and 2021, and to compare the fellowship trends of female representation to those of ACGME-accredited orthopaedic residencies. Methods:. We conducted a retrospective review of publicly available ACGME-accredited fellowship demographic data from 2007 to 2021. The distribution of genders (male vs. female) across subspecialties and orthopaedic surgery residency programs was compared. Chi-square, Spearman correlation, and logistic regression tests were performed to analyze the relationships between year, gender, and fellowship. Results:. Chi-square analysis demonstrated a significant relationship between gender and year for orthopaedic residency (p < 0.001), but not for any fellowship. There was a significant negative Spearman correlation between the two variables for hand (r(1844) = −0.06, p = 0.02) and sports medicine (r(2804) = −0.05, p = 0.01) fellowships. The negative Spearman correlation for pediatrics (r(499) = −0.09, p = 0.054) approached but did not reach statistical significance. Logistic regression analysis revealed that, holding year constant and comparing to orthopaedic residency, the odds of male participation increased by 173% (95% CI, 1.8–4.1) in spine, increased by 138% (95% CI, 1.7–3.3) in adult reconstruction, increased by 51% (95% CI, 1.3–1.7) in sports medicine, decreased by 41% (95% CI, 0.5–0.7) in hand, decreased by 36% (95% CI, 0.5–0.9) in foot and ankle, decreased by 48% (95% CI, 0.4–0.7) in musculoskeletal oncology, and decreased by 68% (95% CI, 0.3–0.4) in pediatrics. Conclusion:. Although the percentage of female orthopaedic residents in ACGME-accredited programs increased significantly from 2007 to 2021, this has not translated to ACGME-accredited fellowship positions. Future research optimizing methods to improve the representation of females in orthopaedic surgery should be considered. Level of Evidence:. III