What Characteristics of Orthopaedic Surgery Residency Programs Are Associated With Increased Percentage of Matched Women Residents?

backgroundWomen are underrepresented in the field of orthopaedics, and growth of the proportion of women is lagging behind all other medical specialties. Improvement begins with recruiting more women residents; however, few data exist regarding the factors that may attract women applicants to orthopaedic training programs. QUESTIONS/PURPOSES: In the 2020 to 2023 match cycles: (1) Was there a relationship between the percentage of women who matched into orthopaedic residency programs and the percentage of women residents or the percentage of women faculty in a given program? (2) What other program attributes were associated with an increased percentage of matched women applicants? (3) How did these trends change prior to and after the COVID-19 pandemic?

methodsInternet searches were used to identify orthopaedic surgery residency programs and obtain program-specific information including match data, resident and faculty rosters, fellowship offerings, and parental leave policies. NIH research funding rank of the institution, United States News and World Report (USNWR) ranking of the orthopaedic department, and Doximity program rank were determined using public data. A total of 175 programs were included in the 2020 match cycle, 197 in 2021, 201 in 2022, and 202 in 2023. Pearson correlations and Wilcoxon rank sums were used to evaluate the association between various program attributes and matched women applicants. Mixed-effects logistic regression was performed to determine ORs for matching women residents based on independent variables of interest.

resultsA positive relationship was found between women faculty and women residents matched, as an increasing percentage of women faculty were associated with a modestly increasing percentage of matched women residents (r = 0.19, p < 0.001). The same relationship was found with current women residents, in that a greater percentage of women residents correlated modestly with a greater percentage of women matched (r = 0.22, p < 0.001). Additionally, as independent variables, a higher percentage of women faculty and current women residents separately suggested increased odds of matching women residents (faculty OR 1.28 [95% confidence interval (CI) 1.14 to 1.44], residents OR 1.21 [95% CI 1.11 to 1.32]). Other program attributes associated with an increased percentage of matched women residents included number of fellowship offerings and ranking in Doximity, USNWR, and NIH funding. An increasing number of fellowship offerings was associated with an increasing percentage of women matched (r = 0.32, p < 0.001), and as an independent variable, more fellowship offerings suggested slightly increased odds of matching women residents (OR 1.14 [95% CI 1.08 to 1.19]). There was a higher percentage of matched women residents in programs with a top-40 ranking in Doximity (top-40 median 25%, not top-40 median 17%; p = 0.004), USNWR (top-40 median 29%, not top-40 median 20%; p = 0.02), or NIH funding (top-40 median 33%, not top-40 median 17%; p < 0.001) in 2023. The percentage of matched women residents changed from pre- to post-COVID-19 pandemic. Of the programs that had match data available, 24% (204 of 838) of matched applicants were women in 2023, an increase from 20% in 2020. In all, 34% (55 of 164) of these programs did not match a woman resident in the 2023 cycle, a decrease from 2020 (44%). The odds of matching women residents slightly increased with time while holding percentage of women faculty, percentage of women residents, and number of fellowship offerings constant (time effect in each respective model: faculty OR 1.13 [95% CI 1.04 to 1.22], resident OR 1.10 [95% CI 1.02 to 1.19], fellowship OR 1.11 [95% CI 1.03 to 1.19]).

conclusionGiven that programs with greater presence of women faculty and women residents are associated with higher percentages of matched women applicants, training institutions should focus their efforts on recruiting women orthopaedic surgeons to their staff, with the goal of subsequently increasing their representation of women residents. Additionally, given our data on fellowship offerings and program rankings, programs can work to expand the resources available at their institution, including fellowships and research funding. Overall, our data suggest that women who apply to orthopaedic residencies are in a strong position, requiring programs to compete for them, with well-rounded, diverse, and highly ranked programs having greater success. CLINICAL RELEVANCE: This is a new and positive shift for the field of orthopaedic surgery toward gender parity. Future studies should look further into the effect of different parental leave policies on matching women residents and factors that draw women to certain orthopaedic subspecialties.