Abstract
Purpose
The purpose of this study was to report demographic trends in terms of ethnicity/race and gender among the membership and leadership positions of the Arthroscopy Association of North America (AANA) and the American Orthopaedic Society of Sports Medicine (AOSSM). Over the years both AANA and AOSSM will increase in diversity through their committee membership and leadership positions.
Methods
AANA and AOSSM membership and leadership were reviewed for the years 2010, 2015, and 2020. Race/ethnicity was divided into Caucasian, Asian, African American (AA), Hispanic/Latin/South American (HLSA), and Middle Eastern (ME). Gender was limited to male or female, based on name and photographic depiction.
Results
Diversity in AANA and AOSSM committee and leadership positions is summarized in Table 1 and Table 2, respectively. In 2010, 166/191 (87%) AANA committee members were Caucasian, as compared with 125/186 (67%) in 2020. Asian committee members were similar in 2010 (13/191, 7%) and 2015 (13/216, 6%) but increased to 17/186 (10%) in 2020. HLSA committee members increased from 5/191 (3%) 2010 to 11/186 (6%) in 2020. AA committee membership increased from 2/191 (1%) in 2010 to 5/186 (3%) in 2020. The diversity of AANA Board of Director leadership positions increased, with Caucasian representation decreasing from 14/14 (100%) 2010 to 11/12 (92%) in 2020 and Asian representation increasing from 0% in 2010 to 1/12 (8%) in 2020, with HLSA, AA and ME remaining the same with 0/12 (0%). In AANA, men comprised 181/191 (95%) committee members in 2010 and 166/186 (89%) in 2020. The percentage of female committee members increased from 10/191 (5%) in 2010 to 20/186 (11%) in 2020. In 2010, 73/79 (92%) AOSSM committee members were Caucasian compared to 62/81 (77%) in 2020 with AA having the largest increase in committee members from 0% in 2010 to 6/81 (7%) in 2020 (Table 2). Within AOSSM, men comprised 73/79 (92%) committee members in 2010 and 70/81 (86%) in 2020. The percentage of female committee members in AOSSM increased from 6/79 (8%) in 2010 to 11/81 (14%) in 2020.
Conclusion
There has been a progressive trend toward increasing diversity in both committee membership and leadership positions in AANA and AOSSM from 2010 to 2020. Within AANA, there has been a decrease in the Caucasian representation from 87% in 2010 to 67% in 2020 and an increase in the female representation from 5% in 2010 to 11% in 2020. AOSSM demonstrated a similar trend, with Caucasian representation decreasing from 92% in 2010 to 77% in 2020, in addition to female percentage increasing from 8% in 2010 to 14% in 2020. Although there has been an increase in representation of minority and female orthopaedic surgeons within both societies, there is still room for more diversity and inclusion within committee membership and leadership. It is important to progress toward the understanding of the changes that need to be made and work to implement opening the field of orthopaedic sports medicine.
Diversity is often conceptualized in terms of ethnicity, gender, socioeconomic status, sexual preference, and professional credentials.1,2 Improving the diversity of medical professions will bring many positive changes such as influencing and promoting innovation through a variety of ideas and backgrounds. Orthopaedic surgery is one of the least diverse medical specialties.3 The representation of women and under-represented minorities in orthopaedics at both the trainee and faculty level lags behind all other specialties. In a study by Yoo et al.4 that focused on female representation in surgical subspecialities, they found that women represented 93/1081 (8.6%) orthopaedic surgeons in 1990, and this increased to 862/4335 (19%) in 2019. In addition, women comprise a minority of team physicians in select NCAA Division collegiate and professional sports organizations.5 Similarly under-represented minorities in medicine (URiM) faculty comprised of 39/1081 (3.6%) orthopaedic surgeons in 1990 and 268/4335 (6.2%) in 2019.4 Two separate studies done by Kamalapathy et al.6 and Schiller et al.7 focused on trends in diversity among orthopaedic sports medicine fellowship directors (FD). Both studies found that out of all the active sports medicine fellowship programs there was majority male dominance. Kamalapathy et. al found that only 1 FD was female whereas 87 FD’s were male. In the study done by Schiller et. al., of the 82 FDs, 80 were male and only 2 were female. Both studies also found that majority of FDs were white followed by Asian Americans, African American, Middle Eastern (3/88), and Hispanic/Latin/South American (HLSA).6,7
Despite increased focus on improving diversity in orthopaedic surgery, progress has been slow compared to other specialties. Data from the US Census Bureau, the Accreditation Council for Graduate Medical Education, and the American Academy of Orthopaedic Surgeons have demonstrated a lack of improvement in diversity in terms of gender and demographic makeup within orthopaedics over the past 20 years.8 Previous studies have demonstrated that early exposure to orthopaedic surgery is effective at encouraging female and minority students to consider a career in this field. The Perry Initiative is a medical student outreach program targeting first-year female medical students to allow them to have first-hand exposure to orthopaedic surgery led by female residents and attending surgeons. This program was shown to increase interest in orthopaedic surgery as a profession, with a match rate for program alumnae of 28% to 31%, which is twice the percentage of females in orthopaedic residency classes over the past decade.9 Another program aimed at combating the under-representation of females and minorities in orthopaedic medicine is the Nth Dimension. This program uses the concept of “paradigmatic trajectories,” and its purpose is to overcome students’ self-selection out of pursing competitive surgical specialties by initiating mentorship programs, summer internships, and one-on-one sessions for wellness and curriculum support. The program is designed to address barriers in early medical school by providing relatable role models, consistent positive affirmation, hands-on surgical and research experiences, and exposure to a community that expects for them to succeed.10 The impact of the Nth Dimension has been encouraging; in 2016, Mason et al.10 demonstrated that women who participated in all of the program’s phases were 45 times more likely to apply to an orthopaedic surgery residency than their nonparticipant counterparts. Under-represented minority participants were 15 times more likely to apply.10
Orthopaedic sports medicine organizations have been working to improve overall diversity in both committee membership and leadership over the past several years. The purpose of this study was to report demographic trends in terms of ethnicity/race and gender among the membership and leadership positions of the Arthroscopy Association of North American (AANA) and the American Orthopaedic Society for Sports Medicine (AOSSM). Over the years both AANA and AOSSM will increase in diversity through their committee membership and leadership positions.
Methods
The data collection methods were similar to the study by Singleton et al.11 Information about committee membership and leadership positions was obtained from both AANA’s and AOSSM’s website and committee roster. AANA committee membership and leadership status were collected by identifying the makeup of the Board of Directors which included the presidential line encompassing president, first vice president, second vice president, immediate past and past president, officers including treasurer and secretary, and members at large. In addition to leadership positions, committee chairs and individual committee members were also identified. No leadership position was counted in the general committee membership total. Committee membership was determined by the organization’s roster. If an individual was a member of more than one committee, then they were counted as part of each committee’s membership total. A board liaison is a member of the board who maintains a critical connection between the board of directors and appointed members of the committee groups.
The AOSSM did not have the same leadership positions as the AANA and instead had a council of delegates, committee chairs, and council of delegates executives. The council of delegates is tasked with grassroots outreach efforts, communicating with members at a local level, and providing a forum for the exchange of information. The board of directors for AOSSM included the president, vice president, treasurer, secretary, 2 past presidents, and 3 members-at-large. Data were collected from 3 different census brackets: 2010, 2015, and present (2020–2021) membership and leadership positions. Members who were part of both leadership and membership positions were included in both categories.
Gender was determined based on name and photographic depiction and was limited to male or female. Race/ethnicity was determined from a photograph found via preliminary google search with publicly available information, from member information, or from the historical origin of the member’s last name. If race/ethnicity was questioned, additional historical origin of name was found and categorized accordingly. This method to determine race/ethnicity was based on the approach used by Kuo et al.12 in a study to determine the diversity of the American Association of Endocrine Surgeons and used by Singleton et al.11 to determine the diversity of Pediatric Orthopaedic Society of North America. Race/ethnicity was broken into Caucasian, Asian, African American, HLSA, and Middle Eastern.
Statistical Analysis
The statistical analysis for this study was modeled after the study by Singleton et al.11 Results were described using descriptive statistics of measure of frequency to characterize both membership and leadership. The measure of frequency used was percentages to indicate how often an “event” occurred throughout time. The results percentages were used to compare individual quantities against the whole to provide a representative number in terms of the frequency of a specific characteristic.
Results
Demographic trends for AANA and AOSSM leadership positions and committee members are shown in Tables 1 and 2, respectively. Between 2010 to 2020, there was a decrease in the percentage of Caucasians on AANA committees: 166 of 191 (87%) in 2010, 175 of 216 (81%) in 2015, and 125 of 186 (67%) in 2020. The number of Asian committee members was similar in 2010 (13/191 [7%]) and 2015 (13/216 [6%]), but increased to 17/186 (10%) in 2020. HLSA committee members increased from 5/191 (3%) in 2010 to 11/216 (5%) in 2015 and to 11/186 (6%) in 2020. African American committee members increased from 2/191 (1%) in both 2010 and 2015 (2/216, 1%) to 5/186 (3%) in 2020. There was a large increase in the percentage of Middle Eastern committee members from 5/191 (3%) in 2010 to 15/216 (7%) in 2015 and to 28/186 (15%) in 2020. The board of directors showed the greatest change in makeup from 14/14 and 12/12 (100%) Caucasian members in 2010 and 2015 to 11/12 (92%) in 2020. The board of directors Asian representation increased from 0% (0/6) in 2010 to 1/12 (8%) in 2020. The presidential line, officers, and board liaisons can be found in Table 1.
Table 1.
AANA Demographic Categories
| Demographic Category | 2010 | 2015 | 2020 |
|---|---|---|---|
| Board of directors | |||
| Caucasian | 14/14 (100%) | 12/12 (100%) | 11/12 (92%) |
| Asian | 0/14 (0%) | 0/12 (0%) | 1/12 (8%) |
| HLSA | 0/14 (0%) | 0/12 (0%) | 0/12 (0%) |
| African American | 0/14 (0%) | 0/12 (0%) | 0/12 (0%) |
| Middle Eastern | 0/14 (0%) | 0/12 (0%) | 0/12 (0%) |
| Presidential line | |||
| Caucasian | 4/5 (80%) | 5/5 (100%) | 5/5 (100%) |
| Asian | 1/5 (10%) | 0/5 (0%) | 0/5 (0%) |
| HLSA | 0/5 (0%) | 0/5 (0%) | 0/5 (0%) |
| African American | 0/5 (0%) | 0/5 (0%) | 0/5 (0%) |
| Officers | |||
| Caucasian | 2/2 (100%) | 2/2 (100%) | 2/2 (100%) |
| Asian | 0/2 (0%) | 0/2 (0%) | 0/2 (0%) |
| HLSA | 0/2 (0%) | 0/2 (0%) | 0/2 (0%) |
| African American | 0/2 (0%) | 0/2 (0%) | 0/2 (0%) |
| Middle Eastern | 0/2 (0%) | 0/2 (0%) | 0/2 (0%) |
| Committee chairs | |||
| Caucasian | 19/19 (100%) | 17/18 (94%) | 12/14 (86%) |
| Asian | 0/19 (0%) | 1/18 (6%) | 1/14 (7%) |
| HLSA | 0/19 (0%) | 0/18 (0%) | 1/14 (7%) |
| African American | 0/19 (0%) | 0/18 (0%) | 0/14 (0%) |
| Middle Eastern | 0/19 (0%) | 0/18 (0%) | 0/14 (0%) |
| Board liaisons | |||
| Caucasian | 4/4 (100%) | 3/4 (75%) | |
| Asian | 0/4 (0%) | 0/4 (0%) | |
| HLSA | 0/4 (0%) | 0/4 (0%) | |
| African American | 0/4 (0%) | 0/4 (0%) | |
| Middle Eastern | 0/4 (0%) | 1/4 (25%) | |
| Committee members | |||
| Caucasian | 166/191 (87%) | 175/216 (81%) | 125/186 (67%) |
| Asian | 131/191 (7%) | 13/216 (6%) | 17/186 (10%) |
| HLSA | 5/191 (3%) | 11/216 (5%) | 11/186 (6%) |
| African American | 2/191 (1%) | 2/216 (1%) | 5/186 (3%) |
| Middle Eastern | 5/191 (3%) | 15/216 (7%) | 128/186 (5%) |
HLSA, Hispanic/Latin/South American.
Table 2.
AOSSM Demographic Categories
| Demographic Category | 2010 | 2015 | 2020 |
|---|---|---|---|
| Council of delegates | |||
| Caucasian | 16/18 (89%) | 29/31 (94%) | 35/43 (81%) |
| Asian | 1/18 (6%) | 0/31 (0%) | 4/43 (10%) |
| HLSA | 0/18 (0%) | 0/31 (0%) | 1/43 (2%) |
| African American | 1/18 (6%) | 1/31 (3%) | 0/43 (0%) |
| Middle Eastern | 0/18 (0%) | 1/31 (3%) | 3/43 (7%) |
| Council of delegates executives | |||
| Caucasian | 5/5 (100%) | 5/5 (100%) | 6/6 (100%) |
| Asian | 0/5 (0%) | 0/5 (0%) | 0/6 (0%) |
| HLSA | 0/5 (0%) | 0/5 (0%) | 0/6 (0%) |
| African American | 0/5 (0%) | 0/5 (0%) | 0/6 (0%) |
| Board of directors | |||
| Caucasian | 13/13 (100%) | ||
| Asian | 0/13 (0%) | ||
| HLSA | 0/13 (0%) | ||
| African American | 0/13 (0%) | ||
| Committee members | |||
| Caucasian | 73/79 (92%) | 60/63 (95%) | 62/81 (77%) |
| Asian | 4/79 (5%) | 0/63 (0%) | 6/81 (7%) |
| HLSA | 0/79 (0%) | 0/63 (0%) | 1/81 (1%) |
| African American | 0/79 (0%) | 0/63 (0%) | 7/81 (9%) |
| Middle Eastern | 2/79 (3%) | 3/63 (5%) | 5/81 (6%) |
HLSA, Hispanic/Latin/South American.
Demographic trends for AOSSM were similar to those of AANA. AOSSM committee members showed a decrease in Caucasian representation from 73/79 (92%) in 2010 to 60/63 (95%) in 2015 and to 62/81 (77%) in 2020. Asian representation varied depending on the year, with 4/79 (5%) in 2010, 0/63 (0%) in 2015, and 6/81 (7%) in 2020. African American membership of AOSSM had the largest increase, from 0% in both 2010 and 2015 to 7/81 (9%) in 2020. The Middle Eastern population slowly increased over each period, with 2/79 (3%) in 2010, 3/63 (5%) in 2015, and 5/81 (6%) in 2020. HLSA remained the least-represented group, comprising 0% in both 2010 and 2015 and only 1/81 (1%) in 2020. Data for the AOSSM board of directors was only available for 2020 and was comprised of 13/13 (100%) Caucasians. The council of delegates executives were 100% Caucasian from 2010–2020. Last, the council of delegates as a whole showed relative improvement in diversity throughout the time periods summarized in Table 2.
Gender was classified for all AANA and AOSSM committee members for 3 years: 2010, 2015, and 2020 (Tables 3 and 4). Within AANA, men comprised 181/191 (95%) of the committee members in 2010, 205/216 (95%) in 2015, and 166/186 (89%) in 2020. The percentage of female committee members increased from 10/191 (5%) in 2010 and 11/215 (5%) in 2015, to 20/186 (11%) in 2020. The board of directors gender makeup went from 14/14 (100%) males in 2010 and 12/12 (100%) males in 2015, to 11/12 (92%) males and 1/12 (8%) females in 2020. All five members of the presidential line (100%) were male in both 2010 and 2020. The gender of committee chairs showed the most change over the 3 years, with female committee chairs increasing from 1 of 19 (5%) in 2010, 0 of 16 (0%) in 2015, to 3 of 14 (21%) in 2020. Women comprised 2 of 6 (33%) board liaisons in 2015, as compared to 0 of 4 (0%) in 2020. No data were available for 2010.
Table 3.
Gender Makeup of AANA
| Demographic Category | 2010 | 2015 | 2020 |
|---|---|---|---|
| Board of directors | |||
| Male | 14/14 (100%) | 12/12 (100%) | 11/12 (92%) |
| Female | 0/14 (0%) | 0/12 (0%) | 1/12 (8%) |
| Presidential line | |||
| Male | 5/5 (100%) | 5/5 (100%) | 5/5 (100%) |
| Female | 0/5 (0%) | 0/5 (0%) | 0/5 (0%) |
| Officers | |||
| Male | 2/2 (100%) | 2/2 (100%) | 2/2 (100%) |
| Female | 0/2 (0%) | 0/0 (0%) | 0/2 (0%) |
| Committee chairs | |||
| Male | 8/9 (95%) | 15/15 (100%) | 11/14 (79%) |
| Female | 1/9 (5%) | 0/15 (0%) | 3/14 (21%) |
| Board liaisons | |||
| Male | 4/6 (67%) | 4/4 (100%) | |
| Female | 2/6 (33%) | 0/4 (0%) | |
| Committee members | |||
| Male | 181/191 (95%) | 205/216 (95%) | 166/186 (89%) |
| Female | 10/191 (5%) | 11/216 (5%) | 20/186 11% |
Table 4.
Gender Makeup of AOSSM
| Demographic Category | 2010 | 2015 | 2020 |
|---|---|---|---|
| Council of delegates | |||
| Male | 18/18 (100%) | 30/31 (97%) | 41/43 (95%) |
| Female | 0/18 (0%) | 1/31 (3%) | 2/43 (5%) |
| Council of delegates executives | |||
| Male | 3/5 (60%) | 4/5 (80%) | 5/6 (83%) |
| Female | 2/5 (40%) | 1/5 (20%) | 1/6 (17%) |
| Board of directors | |||
| Male | 11/12 (92%) | ||
| Female | 1/12 (8%) | ||
| Committee member | |||
| Male | 73/79 (92%) | 58/63 (92%) | 70/81 (86%) |
| Female | 6/79 (8%) | 5/63 (8%) | 11/81 (14%) |
Within AOSSM, men comprised 73 of 79 (92%) committee members in 2010, 58 of 63 (92%) in 2015, and 70 of 81 (86%) in 2020. The percentage of female committee members increased from 6 of 79 (8%) in 2010, and 5 of 63 (8%) in 2015, to 11 of81 (14%) in 2020. The Board of Directors gender makeup was only available for 2020 and included 11 of 12 (92%) males and 1 (8%) female. The Council of Delegate Executives showed a decreasing trend in gender diversity, with 3 of 5 (60%) males and 2 of 5 (40%) females in 2010, 4 of 5 (80%) males and 1 (20%) female in 2015, and 5 of 6 (83%) males and 1 (17%) female for 2020. The gender makeup of the council of delegates showed slow, progressive change over the years, with female representation increasing from 0 of 18 (0%) in 2010 and 1 of 31 (3%) in 2015 to 2 of 43 (5%) in 2020. The gender makeup of AOSSM is represented in Table 2.
Discussion
This study demonstrates an overall improvement in both gender and racial diversity in leadership positions within AANA and AOSSM between 2010 to 2020. Between 2010 to 2020, there was a decrease in the percentage of Caucasians on AANA committees: 166 of 191 (87%) in 2010, 175 of 216 (81%) in 2015, and 125 of 186 (67%) in 2020. Likewise, AOSSM committee members showed a decrease in Caucasian representation from 73/79 (92%) in 2010, 60/63 (95%) in 2015 to 62/81 (77%) in 2020. AANA showed that the percentage of female committee members increased from 10/191 (5%) in 2010 to 20/186 (11%) in 2020. Similarly, the percentage of female committee members in AOSSM increased from 6/79 (8%) in 2010 to 11/81 (14%) in 2020. Although there have been efforts to increase diversity within each organization, there is much room for improvement.
The racial diversity among committee members for both AANA and AOSSM showed a decline in Caucasian representation, with an increase in membership representation in all other groups, including Asian, African American, HLSA, and Middle Eastern. The AANA board of directors had the largest change in racial diversity, with an increase in Asian and Middle Eastern representation; however, the presidential line showed no change, with Caucasians serving in all positions in 2020. Within AOSSM, the percentage of Caucasians on the council of delegates decreased from 2010 to 2020, whereas there was an increase in Asian and Middle Eastern representation; however, executive leadership positions in the council of delegates remained 100% Caucasian. AANA board of directors data was only available for 2020 and was composed of 13/13 (100%) Caucasians. A similar study was performed for a regional vascular surgery society, and the authors demonstrated that over a 30-year period, Caucasian males made up 89.4% of all officers and 94.2% of all senior positions.13 All ethnic minorities and women were nominated and elected for 10.5% of all positions and 5.7% of senior officer positions. This study was done to show the efforts to recruit and include more diversity in leadership positions.14 In addition, a vascular surgical society projected that between 2012 to 2021, the presidents have been 87% Caucasian, followed by Asian (6%), African American (4%), and HLSA (3%).13
The gender breakdown of other leadership categories for both AANA and AOSSM, such as officers, remained the same throughout 2010 to 2020 or showed varying degrees of representation from 2010 to 2020. This gender representation is consistent within other orthopaedic societies such as the Canadian Orthopaedic Association (COA). COA showed an increasing trend in female committee representation from 2% in 2014 up to 17% in 2018. There was a slow increase and then a plateau in female leadership positions in COA from 13% in 2014 to 15% in 2018.15
Although there has been an increase in diversity within orthopaedics, studies have shown the improvements to be minimal over the past several years.16,17 Current statistics from AAMC show that women comprise approximately 50% of medical students, and minorities make up slightly less than 50% of matriculating medical school students.18,19 These statistics indicate that orthopaedics as a specialty is not keeping up with current levels of representation in medicine. A previous study by Okike et al.20 described that the total minority representation in orthopaedic surgery fellows and residents averaged 20.2% from the years 2001 to 2008, this included 11.7% Asians or Asian-Americans, 4.0% African Americans, and 3.8% Hispanics. After review, the authors believed that this was an improvement compared to years prior with regard to representation of minorities among orthopaedic residents and fellows.21 A more recent study demonstrated that among all residents from 2009 to 2019 the total minority representation in orthopaedics was 25.5%, which was lower than any other surgical specialty.8,18 The authors found that the predominance of Caucasians within orthopaedics persists, and the ethnic makeup of residents has not changed appreciably.3,8,18 Similarly, a study performed by Meadows et al.21 examined the diversity of medical faculty and leadership by specialty in 2019 to 2020. The authors found that orthopaedic surgery program directors were 79.5% Caucasian and 20.5% were minorities in 2020. Despite no significant differences in minority representation among program directors in the 4 surgical subspecialties analyzed (P > .05 for all), orthopaedic surgery had a significantly lower percentage of minority program directors at 20.5% compared with the 4 nonsurgical specialties (P < .01 for all).22 Additionally, an analysis of diversity among chairpersons in 2019 revealed that orthopaedic surgery chairs were 87.7% Caucasian and 12.3% were minorities. With respect to changes in female representation among chairpersons, the analysis of orthopaedic surgery chairpersons showed a significant increase between 2007 and 2019 from 0.0% to 4.1% (5/122).7 The results show that there is a slow but increasing diversity. This change is important for creating strong foundations and allowing organizations to maximize their membership talents and skills.
The American Academy of Orthopaedic Surgeons census found that women constituted 2.7% of orthopaedic surgeons who were working full or part time in 2000 and rose to 6.6% in 2016.13, 19,23 Similarly a study by Poon et al.18 that demonstrated that female representation in orthopaedics increased from 10.9% to 14.4% between 2006 and 2015. In addition to a survey of 152 orthopaedic residency programs, Poon et al. reported that the percentage of women in orthopaedic residency had nearly doubled since 1995.18 However, a study performed by O’Reilly et al.5 looked into female representation as team physicians and orthopaedic surgeons and found that women represented 112/879 of all team physicians and 30/443 of orthopaedic surgeons, showing that more than half of males were team physicians and orthopaedic surgeons. Our study demonstrated that female representation in committee membership increased from 5% to 11% in AANA and from 8% to 14% in AOSSM between 2010 to 2020. Although the statistics show an effort in improvement in the gender makeup of orthopaedic surgery, there are still barriers affecting female orthopaedic surgeons. It is important to incorporate and increase female orthopaedic surgery clinical experience and facilitate mentorships in medical school that promote and encourage gender diversity.
Racial and ethnic minorities face many barriers and challenges that impact the current demographics of orthopaedic surgery residents and practicing surgeons.24,25 For example, there is a lack of mentors who are racially or ethnically concordant and who provide a welcoming and inclusive atmosphere to future medical professional including those in orthopaedic surgery. Therefore medical students and residents who are URiM may find it difficult to seek advice on how to successfully navigate a career in orthopaedic surgery. Another barrier faced by URiM medical students, residents, and faculty is unconscious bias or situational stereotypical threat, meaning that under-represented minorities may have an added burden or have negative views through a stereotypical lens.19 The AANA and AOSSM mission statements focus on quality of care, integrity, transparency, and innovation, with goals and committees based on diversification. In addition, AANA had a diversity and inclusion task force from 2020 to 2021 that throughout the year came out with initiatives including diversity research award, diversity keynote lectures, introduction to orthopaedic course for women and under-represented minorities, and advisor appointment to provide oversight on all diversity-related initiatives/issues. Similarly, AOSSM has a diversity task force. The Diversity Task Force is charged with helping the society achieve its overall mission by facilitating diversity and inclusion in surgeon education for the purpose of securing the highest level of patient-centric care for athletes of all colors, genders, ages, religious affiliations, sexual orientations, and abilities. Assessing the demographic makeup of individual organizations will lead to a more transparent understanding of how to better encompass a more diverse and beneficial forum of surgeons for the population at large. Additionally, minority physicians have been shown to be more likely to work in underserved areas, thus providing much needed access to care for minority patients and reducing healthcare disparities.13
Limitations
There are several limitations to this study. Determination of surgeon gender was based on a picture or listed on the organization website, followed by an in-depth google search. Gender cannot be determined solely with this information and does not take into account individuals who identify as nonbinary or do not identify as that specific gender. For the purpose of this study, gender was simplified to male and female, although gender encompasses more than just this binary definition. Race/ethnicity was also determined via pictures available through the organization website, Google search, or employee website; however, this is limited in that individuals may not identify with that specific race. In addition, minorities and under-represented individuals may face specific barriers that prelude their involvement in different committees or positions. Several members participated in more than 1 committee; therefore they were counted multiple times to give a true representation of each committee.
Conclusion
There has been a progressive trend toward increasing diversity in both committee membership and leadership positions in AANA and AOSSM from 2010 to 2020. Within AANA, there has been a decrease in the Caucasian representation from 87% in 2010 to 67% in 2020 and an increase in the female representation from 5% in 2010 to 11% in 2020. AOSSM demonstrated a similar trend with Caucasian representation decreasing from 92% in 2010 to 77% in 2020 in addition to female percentage increasing from 8% in 2010 to 14% in 2020. Although there has been an increase in representation of minority and female orthopaedic surgeons within both societies, there is still room for more diversity and inclusion within committee membership and leadership. It is important to progress toward the understanding of the changes that need to be made and work to implement open the field of orthopaedic sports medicine.
Footnotes
The authors report the following potential conflict of interest or source of funding: A.L.G. reports personal fees from the American Orthopaedic Foot and Ankle Society, Ruth Jackson Orthopaedic Society, and SpeakUp Ortho. M.K.M. reports personal fees from Arthrex, Inc., AAOS, American Journal of Sports Medicine Electronic Media, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy, Arthroscopy Association of North America, International Society of Arthoscopy, Knee Surgery Surgery, and Orthopaedic Sports Medicine, Ortho Info, Ruth Jackson Orthopaedic Society, and The Forum. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Supplementary Data
References
- 1.Smith C., Turner S. Deloitte University; 2015. The radical transformation of diversity and inclusion: The millennial influence. [Google Scholar]
- 2.Whitelaw K. Defining diversity: Beyond race and gender. NPR. Available at: https://www.npr.org/templates/story/story.php?storyId=122327104. Published January 13, 2010. Accessed July 16, 2017.
- 3.Ramirez R.N., Franklin C.C. Racial diversity in orthopedic surgery. Orthop Clin North Am. 2019;50:337–344. doi: 10.1016/j.ocl.2019.03.010. [DOI] [PubMed] [Google Scholar]
- 4.Yoo A., George B.P., Auinger P., Strawderman E., Paul D.A. Representation of women and underrepresented groups in US academic medicine by specialty. JAMA Netw Open. 2021;4(8) doi: 10.1001/jamanetworkopen.2021.23512. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.O'Reilly O.C., Day M.A., Cates W.T., Baron J.E., Glass N.A., Westermann R.W. Female team physician representation in professional and collegiate athletics. Am J Sports Med. 2020;48:739–743. doi: 10.1177/0363546519897039. [DOI] [PubMed] [Google Scholar]
- 6.Kamalapathy P., Moore A., Brockmeier S., Diduch D. Status quo: Trends in diversity and unique traits among orthopaedic sports medicine fellowship directors. J Am Acad Orthop Surg. 2022;30:36–43. doi: 10.5435/JAAOS-D-21-00211. [DOI] [PubMed] [Google Scholar]
- 7.Schiller N.C., Sama A.J., Spielman A.F., et al. Trends in leadership at orthopaedic surgery sports medicine fellowships. World J Orthop. 2021;12:412–422. doi: 10.5312/wjo.v12.i6.412. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Day M.A., Owens J.M., Caldwell L.S. Breaking barriers: A brief overview of diversity in orthopedic surgery. Iowa Orthop J. 2019;39:1–5. [PMC free article] [PubMed] [Google Scholar]
- 9.Lattanza L.L., Meszaros-Dearolf L., O'Connor M.I., et al. The Perry Initiative's Medical Student Outreach Program recruits women into orthopaedic residency. Clin Orthop Relat Res. 2016;474:1962–1966. doi: 10.1007/s11999-016-4908-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Mason B., Ross W.A.J., Jr., Bradford L. Nth dimensions evolution, impact, and recommendations for equity practices in orthopaedics. J Am Acad Orthop Surg. 2022;30:350–357. doi: 10.5435/JAAOS-D-21-01189. [DOI] [PubMed] [Google Scholar]
- 11.Singleton I.M., Poon S.C., Bisht R.U., Vij N., Lucio F., Belthur M.V. Diversity and inclusion in an orthopaedic surgical society: A longitudinal study. J Pediatr Orthop. 2021;41(7):e489–e493. doi: 10.1097/BPO.0000000000001851. [DOI] [PubMed] [Google Scholar]
- 12.Kuo L.E., Parangi S., Cho N.L. Diversity and inclusion in a surgical society: A longitudinal investigation. Surgery. 2019;165:808–813. doi: 10.1016/j.surg.2018.10.027. [DOI] [PubMed] [Google Scholar]
- 13.Satiani B., Vaccaro P.S., Go M.R. Diversity in membership and leadership positions in a regional vascular society. J Vasc Surg. 2010;51(4 Suppl):47S–52S. doi: 10.1016/j.jvs.2009.09.063. [DOI] [PubMed] [Google Scholar]
- 14.Morris-Wiseman L.F., Cañez C., Romero Arenas M.A., Hsu C.H., Nfonsam V.N. Race, gender, and international medical graduates: Leadership trends in academic surgical societies. J Surg Res. 2022;270:430–436. doi: 10.1016/j.jss.2021.09.043. [DOI] [PubMed] [Google Scholar]
- 15.Hiemstra L.A., Wittman T., Mulpuri K., Vezina C., Kerslake S. Dissecting disparity: Improvements towards gender parity in leadership and on the podium within the Canadian Orthopaedic Association. J ISAKOS. 2019;4:227–232. [Google Scholar]
- 16.Harrington M.A., Rankin E.A., Ladd A.L., Mason B.S. The orthopaedic workforce is not as diverse as the population it serves: Where are the minorities and the women?: AOA critical issues symposium. J Bone Joint Surg Am. 2019;101(8):e31. doi: 10.2106/JBJS.18.01010. [DOI] [PubMed] [Google Scholar]
- 17.Stanford F.C. The importance of diversity and inclusion in the healthcare workforce. J Natl Med Assoc. 2020;112:247–249. doi: 10.1016/j.jnma.2020.03.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Poon S., Kiridly D., Brown L., et al. Evaluation of sex, ethnic, and racial diversity across US ACGME–Accredited orthopedic subspecialty fellowship programs. Orthopedics. 2018;41:282–288. doi: 10.3928/01477447-20180828-03. [DOI] [PubMed] [Google Scholar]
- 19.Zuckerman J.D. What's important: Diversity in orthopaedic surgery. J Bone Joint Surg Am. 2018;100:1351–1352. doi: 10.2106/JBJS.18.00517. [DOI] [PubMed] [Google Scholar]
- 20.Okike K., Utuk M.E., White A.A. Racial and ethnic diversity in orthopaedic surgery residency programs. J Bone Joint Surg Am. 2011;93(18):e107. doi: 10.2106/JBJS.K.00108. [DOI] [PubMed] [Google Scholar]
- 21.Meadows A.M., Skinner M.M., Faraj M.T., et al. Racial, ethnic, and gender diversity in academic orthopaedic surgery leadership. J Bone Joint Surg Am. 2022;104:1157–1165. doi: 10.2106/JBJS.21.01236. [DOI] [PubMed] [Google Scholar]
- 22.Figure 13. percentage of U.S. Medical School graduates by Race/ethnicity (alone), academic year 2018-2019. https://www.aamc.org/data-reports/workforce/interactive-data/figure-13-percentage-us-medical-school-graduates-race/ethnicity-alone-academic-year-2018-2019 Available at: Accessed August 12, 2022.
- 23.Erkmen C.P., Ortmeyer K.A., Pelletier G.J., Preventza O., Cooke D.T. An approach to diversity and inclusion in cardiothoracic surgery. Ann Thorac Surg. 2021;111:747–752. doi: 10.1016/j.athoracsur.2020.10.056. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Bulatao R.A., Anderson N.B., National Research Council (US) Panel on Race, Ethnicity, and Health in Later Life, eds . National Academies Press; Washington, DC: 2004. Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda. [PubMed] [Google Scholar]
- 25.Adelani M.A., Harrington M.A., Montgomery C.O. The distribution of underrepresented minorities in U.S. orthopaedic surgery residency programs. J Bone Joint Surg Am. 2019;101(18):e96. doi: 10.2106/JBJS.18.00879. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.