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. 2023;43(1):7–13.

Publication and Career Trends of Ruth Jackson Orthopaedic Society Grant Winners Over the Past Decade

Natalia Czerwonka 1,✉, Christen M Russo 1, Lisa K Cannada 2
PMCID: PMC10296483  PMID: 37383854

Abstract

Background

The Ruth Jackson Orthopaedic Society awards the Jacquelin Perry, MD Resident Research Grant and RJOS/Zimmer Biomet Clinical/Basic Science Research Grant to female orthopedic surgeons, intending to aid women in the progression and completion of their orthopedic research and bolster their pursuit or current career in academic orthopedic surgery. The impact of these grants has not yet been studied. The purpose of this study is to determine the percentage of scholarship/grant-winners who went on to publish the findings of their research, pursue academic positions, and currently hold positions of leadership in the field of orthopedic surgery.

Methods

The titles of the winning research projects were searched in PubMed, Embase, and/or Web of Science to ascertain publication status. For each award recipient, the number of publications prior to the award year, number of publications after the award year, total number of publications, and H-index were calculated. Each award recipient was searched online through the websites of their employment and social media pages to determine their residency institution, whether they pursued a fellowship, the number of fellowships they pursued, their subspecialty within orthopedics, their current job, and whether they are in academic or private practice.

Results

Of the fifteen Jacquelin Perry, MD Resident Research Grant winners, 73.3% of awarded research projects have since been published. 76.9% of award winners currently work in an academic setting and are affiliated with a residency program, and 0% currently hold leadership positions in orthopedic surgery. Of the eight winners of the RJOS/Zimmer Biomet Clinical/Basic Science Research Grant, 25% have published the findings of their awarded grant. 87.5% of award winners currently work in academics, and 75% hold leadership positions in orthopedic surgery.

Conclusion

Our results show that many of the winners of the Jacquelin Perry, MD Resident Research Grant and RJOS/Zimmer Biomet Clinical/ Basic Science Research Grant have published their research findings, continued research within the field of orthopedic surgery, and pursued academic careers and leadership positions. Many of the barriers to career progression and entry into orthopedic surgery that women and underrepresented groups face could be overcome through more grant opportunities and mentorship.

Level of Evidence: V

Keywords: diversity, equity, inclusion, orthopedic surgery

Introduction

The number of female residents in surgical specialties has been increasing concurrently with the number of female medical students.1 As of 2020 in the United States, women constitute 53.7% of medical students and 36.3% of the physician workforce.2 While American medical schools have come to achieve balance in the proportion of male and female graduates, orthopedic surgery has shown less progress and is the least diverse surgical specialty.2,3 In orthopedic surgery, 15% of residents as of 2019 and 7% of practicing surgeons as of 2022 are women, respectively.4,5 This is much lower than general surgery (38.4-43.1% of female residents, 22% of female staff).6,2,7 Further, these numbers have made little improvement since 2016, when 14% of women were orthopedic surgery residents.8 In academic medicine, the number of women in academic positions across all medical specialties was found to be 40.8% in 2020, while the percentage of female academic orthopedic faculty is 17.8%; though this is a slight increase from 13% in 2010, the percentage of female academic orthopedic faculty remains lower than any other medical specialty.2,8,9,10 In an effort to level the playing field and support the growth and leadership of current and prospective women in orthopedic surgery, the Ruth Jackson Orthopaedic Society (RJOS) was founded in 1983 and the organization has been a fervent advocate and recruiter for women in orthopedic surgery. RJOS offers a variety of grants and scholarships to help boost women in academic orthopedic surgery, as well.

The Jacquelin Perry, MD Resident Research Grant is open to any resident currently enrolled in an accredited orthopedic surgery residency program who is the primary investigator of a clinical or basic science research project. Any current RJOS member in any year of residency is eligible to receive the award. The RJOS/ Zimmer Biomet Clinical/Basic Science Research Grant is a $30,000 grant awarded to any active RJOS member in good standing who is Board Certified or Board eligible, who is the primary investigator of a clinical or basic science research project in the field of orthopedic surgery. Furthermore, recipients of both awards receive reimbursement to attend the annual RJOS meeting.

The primary purpose of this study is to determine the percentage of grant-winners who went on to publish the findings of their research. Secondarily, our purpose was to determine the percentage of women who continued to publish after receiving these awards, the percentage who pursued academic positions, and the percentage who are currently in positions of leadership in the field of orthopedic surgery.

Methods

The recipients of the Jacquelin Perry, MD Resident Research Grant and RJOS/Zimmer Biomet Clinical/ Basic Science Research Grant award winners from 2013 to the present were extracted from the RJOS database. The Jacquelin Perry, MD Research Grant was first awarded in 2013; the RJOS/Zimmer Biomet Grant was first awarded in 2014. Neither the Jacquelin Perry nor RJOS/Zimmer Biomet Grants were awarded during 2021 due to the COVID-19 pandemic. Both grants are advertised through the RJOS website and newsletter, and more recently through social media outlets such as Instagram and Twitter.

The titles of the winning research projects were searched in PubMed, Embase, and/or Web of Science to ascertain publication status. If neither of these searches provided sufficient information to determine the publication status of the research project, a Google search was performed to identify the publication status from sources such as university websites, press releases, social media pages, and online CVs. If insufficient data was unable to be extracted from these additional searches, the publication status was marked as not published. For projects that were found to be published, the journal(s) of publication was/were noted. For each award recipient, the number of publications prior to the award year, number of publications after the award year, total number of publications, and H-index were calculated.

Each award recipient was searched through the RJOS website to determine their status of membership. They were then searched online through the websites of their place of employment, as well as via social media to determine their residency institution, whether they pursued a fellowship, the number of fellowships they pursued, their subspecialty within orthopedics, their current job, and whether they are in academic or private practice. Those who currently hold positions of leadership were noted. In this study, we define leadership positions as any role in which an individual is in charge of a residency program (such as a chair, program director, or associate program director) or in charge of an orthopedic team (such as the division chief of their orthopedic subspecialty division, director of the department of research, or director of the department of education).

Results

Jacquelin Perry, MD Resident Research Grant

There were fifteen recipients of the Jacquelin Perry, MD Resident Research Grant since its inception in 2013. Of the fifteen award winners, 73.3% of awarded research projects have since been published. Clinical Orthopaedics and Related Research and Journal of Orthopedic Research were the most common journals of publication. The average number of publications prior to the year of a resident’s award was 13.6 (range: 1 to 81). The average number of publications after the year of the award was 32.5 (range: 0 to 191). The sole recipient who had 0 publications after the year of their award was the most recent award recipient from the year 2022. Of the fifteen recipients, nine had more publications after their award than before. The average number of total publications was 46.1 (range: 2 to 252). The highest H-index was 31, and the average H-index was 8.6. The percentage of women who are current members of RJOS was 50%.

From the available information, 100% of women went on to complete a fellowship in a subspecialty of orthopedics, excluding the most recent grant winner who is a current resident. The percentage of women who completed two fellowships was 11.8%. The most common fellowship/subspecialty among award winners was Sports Medicine (43.8%), while no award winner pursued an Arthroplasty, Foot and Ankle, or Spine Fellowship. Excluding two award recipients who are currently in their residency and fellowship, 76.9% of award winners currently work in an academic setting and are affiliated with a residency program (Figure 1A). Three are associate professors of orthopedic surgery, and seven are assistant professors. Four of the fifteen award winners hold academic positions at one of the top five orthopedic residency programs in the country, as determined by Doximity 2021 rankings.

Figure 1A to 1B.

Figure 1A to 1B.

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The percentage of (1A) Jacquelin Perry, MD Resident Research Grant Winners and (1B) RJOS/Zimmer Biomet Clinical/ Basic Science Research Grant Winners in academic orthopedic surgery.

RJOS/Zimmer Biomet Clinical/Basic Science Research Grant

There were eight recipients of the RJOS/Zimmer Biomet Clinical/Basic Science Research Grant since its inception in 2014. Of the eight winners, 25% have published the findings of their awarded grant. The average number of publications prior to the award year was 47.4 (range: 0 to 198). The average number of publications after the award year was 30.6 (range: 4 to 97). The average total number of publications was 78 (range: 5 to 295). The average H-index was 15.1, and the highest H-index was 35. The percentage of women who are current RJOS members is 87.5%.

All of the included women completed a fellowship in a subspecialty of orthopedics. None completed two fellowships. The most common subspecialty was Hand (37.5%), followed by Pediatrics (25%) and Sports Medicine (25%). Eighty seven and a half percent of award winners currently work in academics (Figure 1B). One is the current program director of an orthopedic surgery residency program; one is the current Vice-Chair of Education; three are directors of their respective subspecialty research departments; one is the Director and Chief of Orthopedic Surgery at their affiliated hospital; and two are the chiefs of their respective orthopedic subspecialty divisions at their respective hospitals. Four are associate professors, and three are professors (Figure 2). The majority of the award winners currently practice in the northeast (37.5%), followed by the midwest (25%) and south (25%). Three of the award recipients are current faculty members at one of the top five orthopedic surgery residency programs in the country. Furthermore, all award recipients graduated from an orthopedic surgery residency program that is in the top 25 in the United States.

Figure 2.

Figure 2.

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The number of RJOS/Zimmer Biomet Clinical/Basic Science Research Grant Winners in leadership positions in orthopedic surgery.

Discussion

Top-performing businesses and teams value diversity, as it enables individuals of different backgrounds, experiences, and training environments to bring forth new ideas, creative problem-solving methods, or out-of-the-box thinking to the team environment.11,12 In the traditionally male-dominated fields of technology and computer science, Microsoft, Google, Intel and IBM have all created professional platforms geared towards increasing diversity within their workforce and community-based programs designed to introduce tech as a career option to young women from middle school to college.13 Moreover, women make up 25-30% of all employees at these companies, which is the same percentage as women in the technology and computer science fields overall.14,15,16 Medicine as a whole has also progressed in creating a more diverse community of physicians, with more women than men now matriculated into medical school. Yet, the number of women in orthopedic surgery has increased at a glacial pace and is on track to continue to do so. Chambers et al. found that not only does orthopedic surgery have the lowest proportion of female residents, but it also has seen the least growth in female representation.8 This is despite the proven data that women do no worse than men in orthopedic surgery: female residents have been found to perform well and comparably to their male counterparts on exams such as the Orthopedic In-training Exam (OITE) and American Board of Orthopedic Surgery (ABOS) Credentialing Exams, Part 1 and Part 2.17 Thus, while other medical specialties and fields within science, technology, engineering, and mathematics (STEM) have recognized and responded to the value of diversity and have taken measurable action to increase it within their workforces, orthopedic surgery has fallen behind.

The advantages of having a diverse healthcare team are not novel and are in fact well-documented. Doctors who identify as underrepresented minorities or hail from a disadvantaged background are more likely to practice in underserved locations.18,19 Further, patients themselves may be more willing to trust physicians who look, speak, and even behave like them.19 Additionally, Wallis et al. found that patients treated by female surgeons are less likely to die or experience complications within 30 days of surgery, compared to those patients treated by male surgeons.20 A more recent study has demonstrated that additionally, worse outcomes are experienced by female patients who are treated by male surgeons, than female patients treated by female surgeons.21 Altogether, a more diverse workplace in orthopedic surgery may lead to greater trust between patient and doctor, reduction in disparities in patient care, and therefore improved patient care as a result.22 Recruiting physicians of diverse gender, race, ethnicity, religion, and sexual orientation is therefore a logical next step that the field of orthopedic surgery is late to take.

The Jacquelin Perry, MD Resident Research Grant and the RJOS/Zimmer Biomet Clinical/Basic Science Research Grant are awarded each year by RJOS to promote the growth and development of research and leadership in women in the field of orthopedic surgery. Within the past ten years, 73.3% of the research projects that were awarded the Jacquelin Perry, MD Resident Research Grant and 25% of the research projects awarded the RJOS/Zimmer Biomet Clinical/Basic Science Research Grant have been published. Of the resident winners, 60% published more papers after winning their award than prior; nearly 77% went on to work in academic orthopedic surgery; and 26.7% are currently on faculty at a top 5 orthopedic surgery residency. Of the attending winners, 37.5% published more papers after winning their award than prior; 87% work in academic orthopedic surgery; and 37.5% are on faculty at a top 5 orthopedic surgery residency. Further, 62.5% hold leadership positions at their current place of employment.

The paucity of women in positions of leadership is not unique to orthopedic surgery or medicine: globally, less than 5% of Fortune 500 CEOs are women and only 34% hold managerial positions.10 The lack of balance of women in leadership is a significant cultural, societal, and organizational problem. Aiding women in the funding of their orthopedic research is the primary and obvious aim of these grants; however, a by-product of these research grants is the increase of women in positions of leadership in orthopedic surgery residencies and medical schools. Currently, 3% of orthopedic surgery chairs, 11% of program directors, 27% of assistant program directors, and 9% of division chiefs are women.23 The percentage of female program directors and assistant program directors can be viewed as promising: though these percentages are still quite low, they imply a growth in junior female leadership, which can create a pipeline of women who are well-qualified and prepared to take on more senior leadership roles. However, these percentages are a snapshot in time. It is important to analyze these percentages in the coming years: the goal is for the percentages of women in both junior and senior leadership roles to increase over time. It is not enough if only the percentage of female junior leaders increases over time without a corresponding increase in female senior leaders.

In medicine, research may be an effective means of ascending the leadership ladder: physicians who conduct research are by default more likely to hold faculty positions at residency programs and medical schools, where they can teach and mentor residents and medical students. Mentorship is fundamental in many trade professions: taking on an apprentice is how one teaches the next generation useful tips and tricks. A mentor can help their apprentice recognize and overcome the obstacles that they themselves once faced. Orthopedic surgery is no different: having a variety of mentors willing to offer different perspectives, recommendations, and advocacy is transformational for one’s career. Okike et al. found that female medical students whose medical schools are affiliated with a gender-diverse orthopedic surgery residency program were more likely to apply for a position in orthopedic surgery residency.24 Further, it has been shown that having mentors of the same sex and race can positively influence one’s decision to enter a particular field of medicine. A 2013 survey study showed that women are more likely than men to indicate that having a mentor of the same sex or race would positively influence their decision to pursue orthopedic surgery as a career.25 Thus, teaching institutions with available research opportunities are an important means of promoting global increases in gender representation in orthopedic surgery. Having more women in academic orthopedics, where they are easily visible by medical students and undergraduates alike, may be an important way to attract more women into orthopedic surgery. Our data demonstrate that within the last ten years, slightly more than three-quarters of resident award winners and nearly 90% of RJOS/Zimmer Biomet award-winning attendings went on to or continued to work at teaching institutions. Further, the majority of attending grant winters hold important leadership positions such as program directors of a residency program or vice-chairs of education. These achievements are due to these women’s own efforts and prowess. Perhaps by providing them with a means to advance their research and connections within the field of orthopedic surgery, RJOS may have played a small role in moving them up the research and leadership ladders.

Just as research may help women achieve leadership positions in orthopedic surgery, so too may involvement in professional societies. Subspecialty societies can play a pivotal role in improving diversity and providing leadership opportunities in all areas of orthopedics. Many surgeons who are in leadership positions in societies such as the Orthopedic Trauma Association (OTA) and American Academy of Hip and Knee Surgeons (AAHKS) are likewise leaders in education and research; thus, they have access and the ability to advise residents and junior faculty.

In a survey study of 304 women in orthopedics, Bratescu et al. found that meaningful mentorship within a subspecialty of orthopedics was the greatest factor that influenced a female resident to pursue a particular orthopedic subspecialty.26 Specialties such as Hand and Pediatrics have historically been composed of higher percentages of women, while other specialties such as Spine and Arthroplasty lag behind.27,28 One potential logical method to increase gender diversity within the least diverse subspecialties would be to engage women leaders within said fields in mentoring, education, and training events for junior trainees. For example, RJOS has partnered with the Arthroscopy Association of North America (AANA) and the OTA for Specialty Day at the last two American Academy of Orthopedic Surgeons (AAOS) Annual Meetings. Having more women on the podium representing specialties with less gender diversity is a step toward more exposure on an esteemed level at a national meeting. The networking that often follows at such a meeting can be a natural segue to mentorship and advocacy moving forward.

Another means of actively recruiting women to a subspecialty is to recruit women as board and committee members of subspecialty societies. In 2020, Saxena et al. found a strong correlation between the percentage of women in a specialty society and the percentage of women on that society’s board of directors.29 The American Society for Surgery of the Hand (ASSH) was composed of 14% of women at the time of the study, and had a board of directors made up of 31% of women. ASSH has had two female Presidents despite the high number of female members. In contrast, AAHKS was composed of 5% of women, and had no women on the board of directors at the time of study publication.29 To date, there has been one female president of the OTA, one female president of the American Shoulder and Elbow Society (ASES), and currently one woman in the presidential line of AAHKS. Though there have been no studies that have investigated whether the percentage of women in an orthopedic society predicts the percentage of women in future leadership positions in that society, it is worth considering this as a potential avenue to both increase diversity within orthopedic subspecialties and increase the percentage of women in leadership roles. Because the majority of each subspecialty society’s board of directors is composed of men,29 women cannot be alone in this endeavor to increase the percentage of women in leadership positions. Men have played a pivotal role in increasing diversity in orthopedics when acting as allies and sponsors, and must continue to do so.

Lastly, in addition to research opportunities and professional societies, cultural changes are needed to support the advancement of female faculty within orthopedic surgery. One important method is to address factors that have been acknowledged as critical to women’s wellbeing and career in medicine. In a survey study of 163 female faculty at Stanford University School of Medicine, McGuire et al. found that a flexible work environment without negative consequences for women with young children, departmental mentoring for academic career development, and support for grant and manuscript preparation were indicated as specific interventions that would advance female faculty member’s careers in academic medicine and would improve their wellbeing.30 For pregnant orthopedic surgeons, provision of appropriate shielding from radiation during cases involving fluoroscopy, designated lactation rooms in the hospital, and facilities to store breast milk, have been identified as specific supportive measures during residency and in practice and supported with ACGME Common Program Requirments.31,32,33 Finally, civility is also paramount – in a survey study of 190 US orthopedic surgery residents, Mulcahey et al. found that about 1 in 5 women delayed becoming pregnant in residency due to the fear of negative perception by male faculty or residents; nearly 60% of those who became pregnant in residency received biased and unsupportive comments from their co-residents and attendings regarding pregnancy during training; and nearly 50% of pregnant residents felt unsupported by their residency’s culture during their pregnancy.34

The culture of a program is set by its leadership. An environment that is free of discrimination, bullying, and harassment is crucial. Currently, the literature does not demonstrate that. In general, female orthopedic surgeons in the US are twice as likely than men to experience discrimination, bullying, and harassment as attendings, fellows, and residents.35 Workplace leadership must define the parameters of appropriate workplace behaviors, strictly define which behaviors qualify as discrimination, harassment, and bullying, and encourage professionalism and a zero-tolerance policy for such actions.36 Further, leadership must make it obvious to employees that there are methods available to report such behaviors within the workplace, and how to take such steps, ensuring that reporting is conducted in a genuinely confidential and safe manner. When untoward events occur, the leadership can set the tone for zero tolerance and resources to support those involved.

There are some limitations to our study. Foremost, some of our data were collected from online sources such as departmental websites and social media pages. Not all award winners had available online information or easily accessible social media pages, nor did all departmental websites frequently update their pages. Therefore, the data collected from these websites and social media pages may not be entirely complete.

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Articles from The Iowa Orthopaedic Journal are provided here courtesy of The University of Iowa

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