Value-based Healthcare: The Business Case for Sponsorship of Women in High-value Orthopaedic Surgery

Helping women achieve their professional potential in orthopaedic surgery is an important pillar of gender-based advocacy that not only benefits women but also adds value to the overall healthcare system—which helps all of us, and the patients whom we serve.

Where mentorship fails to bolster women into leadership, sponsorship can be an effective mechanism at increasing women’s visibility in orthopaedic surgery. Orthopaedic practices, and specifically academic training centers, have an opportunity to develop sponsorship curricula and promote a culture of individualized career advancement through senior faculty champions. Sponsorship is defined as an episodic, reciprocal relationship focused on specific opportunities, where senior members of a professional community leverage their influence to promote protégés in their career [2]. This differs from mentorship, wherein professional development, skill-building, and goal-setting through regular discussions with a mentor who offers guidance and advice are the primary aims of the protégé.

The goals of sponsorship are more well-defined: increasing early-career visibility through high-impact roles and purposeful opportunities with institutional leaders and changemakers (Table 1). Over the past two decades, the business community has rapidly adopted the concept of sponsorship for developing talent among women and underrepresented minorities whose contributions may be systematically underrecognized by unconscious bias and professional networks dominated by men. Sponsors and protégés must make important, mutual commitments of trust, risk-taking, and professional prioritization. To help trainees climb the career ladder, sponsors must have substantial organizational influence and an ability to advocate for junior colleagues regarding competitive assignments, leadership opportunities, and committee appointments. While effective mentorship leads to professional shaping to attain career goals, successful sponsorship delivers on the objectives of increased compensation, career advancement, and professional satisfaction.

Table 1.

A comparison of the characteristics and target outcomes of mentorship and sponsorship

	Description	Senior role	Deliverables	Desired outcomes
Mentorship	Relationship centers on personal and professional development, particularly related to skill-building and goal setting [7].	A guide who provides feedback and expertise; a mentor’s impact does not depend on his/her rank or position within an institution [2].	Protégé skill attainment and professional development.	Sustained professional relationship for personalized advice, support, and guidance in shaping career trajectory.
Sponsorship	Relationship centers on increasing professional visibility through advocacy for leadership roles, raises, and executive opportunities [1].	Sponsor must have significant organizational influence and an ability and willingness to advocate for trainees [2].	Protégé career satisfaction through promotion for junior faculty, acquisition of leadership positions, and appointments to editorial boards and research committees.	Career advancement in the form of increased compensation, promotion, high-visibility assignments, appointments within national societies, and enterprise executive committees.

Recruitment, retention, and promotion of women in orthopaedic surgery requires deliberate opportunity structures. In the post #MeToo era, where mentors who are men are at times shying away from even “opening the door” for women to enter orthopaedics, a formal “seat at the table” through sponsorship is necessary. While institutionalized equal opportunity policy informs the context in which women can lead, personalized and reciprocal relationships between seniors and protégés will be the critical next step in promoting women’s career advancement.

The morphology of sponsorship in orthopaedics varies; protégés can be tasked with leading research grants, invited to speak at society conferences and panels, or be connected personally with department chairs or educational leaders. Sponsorship by influential leaders invites women trainees and early career surgeons to the table, providing them fair access to the levers of organizational authority, which in turn, advances the field for other women surgeons and patients alike.

Equity Drives Value Creation

While increasing the number of women in surgical leadership has not always been viewed as an enterprise social responsibility, it should quickly become a strategic priority for many health systems as it is incentivized by a strong business case. Sponsoring women to achieve leadership roles in orthopaedic surgery creates value by driving return on workforce investments, protecting against attrition, and fulfilling patient expectations of a diverse clinical and surgical care team. The clearest mechanism for value creation through sponsorship is by cultivating excellence within healthcare organizations. Investment in early-career women surgeons directly feeds back into institutional innovation and growth. When institutions do not systematically invest in a workforce with diverse perspectives, they perpetuate a stagnant business model that excludes ideation and innovation from underinvested talent [8]. Moreover, there are robust associations between diversity within the healthcare workforce and demonstrably improved clinical outcomes [6]. Additionally, diverse teams performed better in the competencies of innovation, team communications, and risk assessment [5].

Beyond enhancing human capital assets, sponsorship protects against attrition. We believe interpersonal relationships that increase tangible pathways to promotion, compensation, and recognition help retain women at critical attrition junctures, such as postpartum and during the transition from assistant to associate professor. Research [5] suggests that women in orthopaedics are also more likely than men to experience burnout, the sequalae of which include decreased effectiveness and productivity, increased employee turnover, and greater likelihood of medical errors. At a time when physician burnout is estimated to cost USD 7600 per doctor annually, health systems have a vested interest in protecting against lost productivity and potential attrition [3].

Finally, institutions that sponsor women in orthopaedic surgery are well positioned to go to market as patient-centered care providers. By promoting a diverse set of surgeons who fulfill patient expectations, sponsorship of women creates care team leaders who not only attract new patient segments, but also create a safe and culturally competent space for women patients to receive care. A preferences survey of musculoskeletal patients found that while the majority of patients did not demonstrate gender-based preference when selecting an orthopaedic surgeon, 14.5% of patients preferred women surgeons whereas only 1.6% of patients preferred men. In addition, the preference of women patients for a woman provider was stronger than was the preference of men for a doctor who also was a man [4]. Taken together, orthopaedic practices have a three-fold opportunity to create value by investing in talent, curbing surgeon burnout, and differentiating as diverse employers in the marketplace.

Designing Effective Sponsorship Models

Effectively integrating sponsorship within an organization’s workplace culture requires intentional redesign of many upstream processes such as recruiting, hiring, and professional development. Sponsorship begins with fostering a robust pipeline of women medical trainees with an interest in surgery and orthopaedics. While pipeline development will not in and of itself accelerate the field of orthopaedics toward gender parity, it will positively influence the next stage of recruitment: hiring. Hiring policies focused on inclusive résumé review must be supplemented by unconscious bias training and multistakeholder candidate selection. At this stage, organizations that have successfully implemented sponsorship models will achieve greater success in attracting and hiring diverse and underrepresented applicants.

The introduction of effective mentors at the beginning of a woman’s career sets the stage for future sponsorship relationships, as availability of strong mentorship will prepare these professionals for higher-stakes sponsorship arrangements. Practices should leverage a new hire’s orientation to the organization to introduce that hire to a dedicated network of orthopaedic surgeons trained in effective mentorship. These mid-career and senior professionals have the opportunity to guide new surgeons through professional challenges and provide advice for navigating career-related decision-making in preparation for coaching from a sponsor.

High-performing protégés selected from this mentorship network can be accelerated to leadership via talent investment, marked by the entrance of purposefully aligned sponsors. Investment looks like sponsor-led affinity groups organized around acquiring surgical skills as well as securing research and grants [7]. In this phase of career development, women surgeons work to become established in the practice by developing a strong track record of performance and contribution. For strong performers, well-placed sponsors can influence compensation discussions and pave the way to leadership positions. Sponsorship relationships are executed most successfully when sponsors and protégés are matched based on shared goals and mutual buy-in [1]. An example might include pairing a trainee for whom scholarly activity and medical education are of paramount career importance with an educational leader in the department of orthopaedic surgery.

Sponsors should focus on advocating for women whom the enterprise has already invested in; this accelerator can place women protégés in impactful and career-defining roles. By nominating protégés for leadership positions or steering committees, sponsors stake their professional reputation on the outcomes of select women surgeons who have been shaped through continuous influence from the enterprise talent network.

The sponsorship journey culminates in achieving tenure, senior rank, or executive positioning within the organization. The transition to leadership can be further facilitated by influences beyond individualized sponsorship relationships such as formal leadership training or executive coaching. Together, these focused efforts can cement managerial insights in women with deep domain expertise in orthopaedic surgery. Sponsors “hand the baton” to their successors, who have been supported and trained to lead departments or practices. The power of longitudinal investment in the form of effective mentorship to sponsorship equips women surgeons from the earliest career stages, where deliberate skill development and opportunity creation can harness the value of enabling career success for women professionals.