Hispanic Representation and Academic Productivity in Orthopaedic Surgery in the United States: A Comparative Analysis

Abstract

Purpose:

Hispanics represent 19.5% of the US population but remain underrepresented in orthopaedic surgery. This study evaluates the academic productivity and scholarly output of Hispanic faculty across accredited US orthopaedic residency programs.

Methods:

Faculty members were identified from orthopaedic residency programs in the AAMC ERAS 2024 directory. Academic rank and years in practice were collected. Hispanic identity was approximated by cross-referencing surnames with Hispanic surname lists. Scholarly productivity was assessed using the h-index and citation counts.

Results:

Of the identified faculty members, 2.4% had Hispanic surnames. These faculty had fewer years in practice (17.4 vs. 18.6, P = 0.1) and were unlikely to be associate or full professors (40.5% vs. 51.4%, P = 0.007). The mean h-index and citation counts were 17.3% and 24.8% lower, respectively, for those with Hispanic versus non-Hispanic surnames (P = 0.05 and P = 0.14). Younger faculty (11 to 25 years in practice) with Hispanic surnames seem to have academic parity, with similar or higher h-index and citation counts than their non-Hispanic counterparts. A correlation between years in practice and academic output was observed only among faculty with non-Hispanic surnames.

Conclusion:

While Hispanic faculty remain underrepresented, showing lower academic productivity than their non-Hispanic counterparts, younger faculty (11 to 25 years of practice) show comparable or higher metrics. This improvement among younger Hispanic faculty may signal the early influence of diversity initiatives.

Hispanics in orthopaedic surgery are underrepresented in the United States, accounting for only 2.2% of the entire orthopaedic surgery workforce in 2018.¹ Although this number has increased from 1.8% in 2012,² it is in stark contrast with the fact that Hispanics represent 19.5% of the entire US population (https://www.census.gov/quickfacts/fact/table/US/PST045222). The underrepresentation of Hispanic physicians in orthopaedic surgery is likely multifactorial but has been partially attributed to fewer mentorship opportunities and limited early exposure to the field,³ although several efforts have emerged to broaden access to the field through pipeline programs and early engagement opportunities.^4,5

Academic productivity is often considered an objective metric of the influence an individual has in their professional field. While there is no perfect metric for evaluating academic productivity, the “h-index,” a metric introduced by Dr. Jorge Hirsch that attempts to quantify both productivity (quantity) and citation impact (quality) of a scientist's body of work,⁶ has been widely considered as a reliable tool to measure it.^7-14 The “h-index” has been studied in various medical and surgical specialties, with higher h-indices showing strong correlations with academic promotion and National Institutes of Health (NIH) awards.^11,14 The “h-index” is calculated as the highest number of publications an individual has produced (h) that have been cited at least (h) times. Therefore, an author who has had 20 of their articles cited at least 20 times each will have an h-index of 20, regardless of the total number of publications or citations.

To our knowledge, there is limited or no information available regarding the representation and academic productivity and contributions to the overall orthopaedic scientific literature by Hispanic orthopaedic faculty members in academic medical centers across the United States. The aim of this study was to identify Hispanic orthopaedic faculty members in academic medical centers in the United States and to analyze their academic productivity indicators, compared with those of non-Hispanic faculty. We hypothesize that Hispanic orthopaedic faculty members in academic medical centers in the United States, although underrepresented, are just as academically productive as their non-Hispanic counterparts.

Methods

We identified all academic institutions with an orthopaedic surgery residency program participating in the Association of American Medical Colleges (AAMC) 2024 Orthopaedic Residency match by searching through the AAMC Electronic Residency Application Service (ERAS) directory. The official website for each of the orthopaedic surgery residency programs listed on the 2024 AAMC ERAS directory was searched, and a list of all the faculty members for each program was compiled. The faculty members' names, academic rank (instructor, assistant professor, associate professor, and professor), and years in practice were identified, when available, from each program membership directory. The sex of the faculty member was identified by their pronoun usage from their faculty biography. Orthopaedic faculty members were also independently searched using public websites (i.e., US News Health, Healthgrades, Doximity, and Castle Connolly) to identify the year of residency completion. Years in practice were calculated as the number of years since graduating residency or fellowship (if completed). Only faculty members who had completed an orthopaedic surgery residency program were included in the analysis. We excluded orthopaedic faculty members who had completed a residency program other than orthopaedic surgery (i.e., family medicine, physical medicine and rehabilitation, plastic surgery, etc.).

After the compilation of orthopaedic surgery faculty members and their respective academic institutions, we proceeded to obtain data on each faculty members' research productivity by searching Scopus (https://www.scopus.com/freelookup/form/author.uri), a scientific abstract and citation database. Using the last name, first name, middle name, and academic institution for each of the previously identified orthopaedic faculty members, the Scopus database was searched to obtain their respective h-index and citation counts.

Determination of Hispanic surname origin for the included orthopaedic faculty members was performed by cross-referencing the faculty members' surnames with a unique list of Hispanic surnames from the Word and Perkins (1996) list of Spanish surnames,¹⁵ which accounted for the most frequently occurring Hispanic surnames from the 1990 US Census. In addition, a list of surnames of Hispanic origin was obtained from Name Census, a website that aggregates US demographic information from a variety of sources, including the Bureau of the Census, the Library of Congress, and the Social Security Administration (https://namecensus.com/last-names/common-hispanic-surnames). Overall, a total of 926 Hispanic surnames were collected, with 639 of them coming from the Word and Perkins list and 287 from the Name Census list. This final list of 926 Hispanic surnames served as the reference list to identify Hispanic orthopaedic faculty member surname origin.

Statistical analysis was conducted using the STATA program (Stata Corporation, College Station, TX). A Student t test or a Fisher exact test, as appropriate, was used to compare differences between the groups, using a two-tailed 0.05 level of significance. A Pearson product-moment coefficient of correlation (r) was used to analyze associations between variables.

Results

A total of 210 orthopaedic surgery residency programs were listed in the AAMC ERAS directory. Of the 210, 27 were not included in the study because of the absence of an official website listing their respective faculty members. As a result, the study included 183 (87%) of the orthopaedic surgery programs listed in the AAMC ERAS directory, with 4888 orthopaedic surgery faculty members representing 42 states, 1 US territory, and the District of Columbia. The distribution by region is summarized in Table 1. According to the AAMC ERAS directory, the institutions included were classified as university hospitals (54.4%), community hospitals (13.74%), university affiliated (31.32%), and military hospitals (0.55%). Of the 4888 orthopaedic surgery faculty included, 590 (12.7%) were female and 4298 (87.9%) were male. Years-in-practice data were available for 4792 (96.4%) of the included orthopaedic faculty members. The orthopaedic faculty members included in the study have been in practice for a mean of 18.8 years (range: 1-77; SD: 11.7 years). Academic rank data were available for 3450 (70.6%) of the included orthopaedic faculty members. Of those, there were 114 instructors (3.3%), 1581 assistant professors (45.8%), 870 associate professors (25.2%) and 886 professors (25.7%).

Table 1.

Stratification of Orthopaedic Surgeon Faculty From Participating Residency Programs Into 42 US, 1 US Territory, and One District

Region	Orthopaedic Surgery Residency Programs	Faculty with Surnames Identified as Hispanic	Faculty with Surnames not identified as Hispanic	Academic Rank				Years in Practice (Avg)	h-Index (Avg)	Citation Counts (Avg)
				Instructor	Assistant Professor	Associate Professor	Professor
Midwest	67	26	1731	10 (0.9%)	563 (51.8%)	240 (22.1%)	274 (25.2%)	18.55	11.97	1334.46
Northeast	48	30	1272	21 (2.2%)	464 (48.5%)	262 (27.4%)	209 (21.9%)	20.26	12.48	1300.33
Pacific	20	7	445	1 (0.3%)	114 (31.9%)	106 (29.7%)	136 (38.1%)	18.81	15.72	1893.59
Southeast	40	43	1089	21 (2.7%)	330 (42.2%)	215 (27.5%)	216 (27.6%)	18.09	12.57	1275.61
West	8	10	317	61 (20.4%)	117 (39.1%)	62 (20.7%)	59 (19.7%)	17.26	12.32	1156.61

Puerto Rico (PR) is included in the Southeast region. Only faculty members with available academic ranks are represented in the academic rank distribution.

Of the 4888 orthopaedic faculty members included, 116 (2.4%) were identified as having a Hispanic surname. Of the 116 faculty members whose surnames were identified as Hispanic, 17 (14.7%) were female and 99 (85.3%) were male. The 116 orthopaedic faculty members whose surnames were identified as Hispanic were located in 27 states, one US territory, and the District of Columbia. Of the 116, 58 (50%) were in four states and one US territory: NY (12.93%), PR (12.7%), FL (11.21%), TX (7.76%), and IL (6.03%). Years-in-practice data were available for 108 (93.1%) of the orthopaedic faculty members whose surnames were identified as Hispanic. The orthopaedic faculty members whose surnames were identified as Hispanic have been in practice for a mean of 17.4 years (range, 2-60; SD: 11.1 years), compared with a mean of 18.6 years (range, 1-77; SD: 11.7 years) for those whose surnames were not identified as Hispanic (P = 0.1). Academic rank data were available for 89 (76.7%) of the orthopaedic faculty members whose surnames were identified as Hispanic. Of those, there were 6 instructors (6.7%), 47 assistant professors (52.8%), 25 associate professors (28.1%), and 11 professors (12.4%). A rank of associate or full professor has been achieved by 40.5% of faculty members whose surnames were identified as Hispanic, compared with 51.4% for those whose surnames were not identified as Hispanic (P = 0.007).

The mean h-index for all orthopaedic faculty members included in the study was 12.6 (range, 0-153; SD: 14.2). Female faculty members had a mean h-index that was 37.9% (8.2; range: 1-56; SD: 8.6) lower than that of male faculty members (13.2; range, 0-153; SD: 14.7) (P < 0.00001). Orthopaedic faculty members whose surnames were identified as Hispanic had a mean h-index that was 17.3% lower (10.5; range, 0-84; SD: 13.2) than that of those whose surnames were not identified as Hispanic (12.7; range, 0-153; SD: 14.2) (P = 0.05). Female faculty members whose surnames were identified as Hispanic had a mean h-index that was 29.6% (7.6, range, 1-33; SD: 8.3) lower than that of male faculty members whose surnames were also identified as Hispanic (11.0; range, 0-84; SD: 13.9) (P = 0.17). When considering rank, the h-index was lower for faculty members whose surnames were identified as Hispanic at each of the academic ranks analyzed, with larger differences at the professor level (23% lower, P = 0.13) (Figure 1). When considering years in practice, the h-index seemed to be similar or even higher for faculty members whose surnames were identified as Hispanic and who had between 11 and 25 years in practice, but it was markedly lower for those with more than 25 years in practice (Figure 2). The mean number of citations for all orthopaedic faculty members included was 1351.5 (range, 0-61,181; SD: 3325.4). Orthopaedic faculty members whose surnames were identified as Hispanic had a mean citation count that was 24.8% lower (1022.1; range, 0-24,744; SD: 2858.2) than that of those whose surnames were not identified as Hispanic (1359.4; range, 0-61,181; SD: 3335.6) (P = 0.14). When considering rank, the citation count was lower for faculty members whose surnames were identified as Hispanic at each of the academic ranks analyzed, with larger differences at the professor level (20% lower, P = 0.32) (Figure 3). When considering years in practice, the citation count seemed to be higher for faculty members whose surnames were identified as Hispanic and who had between 11 and 25 years in practice, but it was markedly lower for those with more than 25 years in practice (Figure 4).

Figure 1.

Graph demonstrating h-index by academic rank. The h-index was lower for faculty members whose surnames were identified as Hispanic at each of the academic ranks analyzed, with the larger differences at the professor level (23% lower, P = 0.13).

Figure 2.

Graph demonstrating h-index by years in practice. Younger faculty (11 to 25 years in practice) with Hispanic surnames seem to have academic parity, with similar or higher h-index than their non-Hispanic counterparts.

Figure 3.

Graph demonstrating citation counts by academic rank. The citation count was lower for faculty members whose surnames were identified as Hispanic at each of the academic ranks analyzed, with the larger differences at the professor level (20% lower, P = 0.32).

Figure 4.

Graph demonstrating citation counts by years in practice. Younger faculty (11 to 25 years in practice) with Hispanic surnames seem to have academic parity, with similar or higher citation counts than their non-Hispanic counterparts.

For orthopaedic faculty members whose surnames were identified as Hispanic, there was minimal to no correlation between years in practice and h-index and citation counts (r = 0.10, P = 0.29 and r = 0.11, P = 0.25, respectively). However, years in practice and h-index and citation counts were correlated for those whose surnames were not identified as Hispanic (r = 0.33, P < 0.0001 and r = 0.28, P < 0.0001, respectively).

Discussion

The results of our study suggest that 2.4% of orthopaedic faculty members in accredited residency programs in the United States have a surname that can be identified as Hispanic. This is consistent with the Orthopaedic Surgeon Census conducted by the AAOS,^1,2 reporting that Hispanic orthopaedic surgeons represented 1.8% of practicing surgeons in 2012 and 2.2% in 2018. Our results also suggest that the academic contributions of orthopaedic faculty members from accredited residency programs in the United States whose surnames were identified as Hispanic are still lagging behind those of members whose surnames were not identified as Hispanic. Furthermore, when stratified by sex, female faculty whose surnames were identified as Hispanic had a 29.6% lower mean h-index compared with Hispanic faculty. While this difference did not reach statistical significance likely because of limited sample size, this intersectional trend suggests that Hispanic women in academic orthopaedics may face overlapping structural barriers related to both sex and ethnicity. Overall, orthopaedic faculty members whose surnames were identified as Hispanic had mean h-index and citation counts that were 17.3% and 24.8% lower than those of faculty whose surnames were not identified as Hispanic.

Early engagement organizations, such as the American Association of Latino Orthopaedic Surgeons (AALOS), the J. Robert Gladden Society, and Perry Initiative, have played a role in recent efforts to diversify the field of orthopaedic surgery.^16,17 It is interesting to see that almost 8% of all orthopaedic residents in the United States are of Hispanic origin,⁵ a population that is growing at a faster rate than the overall orthopaedic workforce. The results of this study suggest that younger orthopaedic faculty members whose surnames were identified as Hispanic, especially those who have been in practice for between 11 and 25 years, have similar or even higher h-index and citation counts than those whose surnames were not identified as Hispanic. Significant differences in h-index and citation counts were found among those orthopaedic faculty members who had been in practice for over 25 years, with those whose surnames were identified as Hispanic having markedly lower counts, suggesting a decreased focus on academic productivity in the older generation of Hispanic-origin surgeons. It is important to note that there are several potential confounding factors that may influence these outcomes, which were not included in our analysis. For example, institutional research funding levels (i.e., NIH funding at the faculty member's institution) may markedly affect publication output and citation metrics. In addition, differences in primary academic tracks (e.g., clinician-educator versus research-focused appointments) may lead to variability in expected scholarly productivity. Future studies should explore these dimensions to determine whether the observed disparities are due to systemic barriers, differential role expectations, or other institutional factors, and to identify effective strategies for promoting equity in orthopaedic surgery faculty development.

It seems that Hispanic representation in academic medical centers in the United States remains disproportionately low compared with the Hispanic population in the United States. Interestingly, 50% of those faculty members whose surnames were identified as Hispanic in this study practice orthopaedics in only four states and one US territory. The remaining 50% practice in 23 states and the District of Columbia. We were unable to identify orthopaedic faculty members with Hispanic surnames in 23 of the 52 states/territory/district (DC and Puerto Rico included). Although the number of Hispanic orthopaedic surgeons has been increasing over the past few years, it is possible that a study like ours may not reflect that growth because it is likely that only a fraction of them practices in an academic environment.

Although orthopaedic faculty members whose surnames were identified as Hispanic seem to have spent a similar number of years in practice as those whose names were not identified as Hispanic, they also seem to have achieved higher professorial ranks in lower proportions, with only 40% of them achieving the rank of associate or full professor, compared with 51% of those whose surnames were not identified as Hispanic. As representation increases in medical schools and residencies, we should expect senior-level positions to demonstrate similar growth in the future. These findings highlight the need for targeted support and mentorship for underrepresented groups, including Hispanics.

This study has several limitations. Orthopaedic faculty members were identified as having a Hispanic surname by comparing their surnames with two sources: the Word and Perkins (1996) list of Spanish surnames¹⁵ and a list of common Hispanic surnames from Name Census (https://namecensus.com/last-names/common-hispanic-surnames), which compiles US demographic data from sources such as the Census Bureau, the Library of Congress, and the Social Security Administration. Despite efforts to use reliable and verified data, some Hispanic surnames may have been omitted, potentially leading to an underestimation of Hispanic author representation. This limitation is particularly relevant for individuals of mixed heritage whose surnames may not appear on these lists, leading to Type I errors. In addition, Type II errors may occur when surname-based identification misclassifies individuals who have changed their surname because of marriage or those from countries such as the Philippines, where Hispanic surnames are common but may not reflect Hispanic identity. These factors could result in either overestimation or underestimation of Hispanic representation. In addition, the method of identification of Hispanic orthopaedic surgeons used in this study assumes that someone with a Hispanic surname identifies with the Hispanic culture when it might not be the case, while, at the same time, likely eliminates surgeons with a Hispanic perspective who lack Hispanic surnames but who are equally representative of the Hispanic community. However, the fact that the rate of Hispanic representation described in our study matches the one described by the Orthopaedic Surgeon Census conducted by the AAOS^1,2 is reassuring.

To our knowledge, this is the first study analyzing representation and academic productivity of Hispanic orthopaedic faculty in the United States. Hispanic faculty remain underrepresented and demonstrate, overall, lower academic productivity indicators than non-Hispanic peers. This may reflect the historical lack of institutional support, barriers to early-career research funding, and limited access to mentorship and professional networks faced by underrepresented minorities in academic medicine. By contrast, it seems that younger Hispanic orthopaedic faculty members, especially those who have been in practice for between 11 and 25 years, have achieved academic parity, with similar or higher h-index and citation counts than their non-Hispanic counterparts. This improvement among younger Hispanic faculty may signal the early effect of diversity initiatives. Thus, as Hispanic representation grows in medical training, focused support and mentorship will be essential to fostering equitable academic achievement and leadership in orthopaedic surgery. While this analysis is limited to US academic orthopaedic programs, our methodology and insights may inform similar efforts in identifying disparities to develop strategies in support of equity for faculty development and academic promotion.