Prospective memory: an alternate explanation for choice of residency

We read with great interest the article, “Gender trends in orthopedic surgical residency programs in Canada over 20 years” by Frazer and colleagues.¹ This progress toward gender balance is encouraging, but the reasons behind who does or does not select a career in orthopedic surgery may be shifting in ways that go beyond traditional explanations.

It is often assumed that women avoid surgical specialties because they carry more caregiving responsibilities at home. Our recent small study on prospective memory (PM), conducted at the University of British Columbia and involving 26 orthopedic surgeons (7 female, 19 male), suggests that this picture is changing. Prospective memory refers to the anticipatory and organizational work of running a household, such as remembering appointments, planning schedules, and managing dependents.² Not surprisingly, female orthopedic surgeons reported significant PM demands. Strikingly, younger male surgeons also described higher PM demands than expected and often perceived themselves and their partners as sharing these responsibilities more than older generations did.³

This generational difference matters. When placed alongside Frazer and colleagues’ finding of a U-shaped curve in male applications with a notable dip around 2018, it raises the possibility that men, too, are increasingly weighing household and caregiving responsibilities when choosing specialties. Unlike men in prior generations, many younger men may expect and want to be more engaged at home. Faced with the long hours and unpredictable demands of surgical training, some may decide that orthopedic surgery is less compatible with the lifestyle expectations they have for themselves and their families.

This perspective shifts the conversation. Gender disparity in orthopedic surgery is not simply about barriers preventing women from entering; it may also reflect men making different choices because their priorities have changed. The forces influencing specialty selection are likely multifactorial, and include mentorship, culture, opportunity, and evolving social roles.

We believe that broadening the dialogue in this way could benefit everyone. By recognizing that both men and women value work–life integration, we need to consider how training and hospitals can make orthopedic surgery an attractive, sustainable career. Supporting diverse career paths and family engagement will not only strengthen equity, but may also help retain talented surgeons across genders and generations.