Abstract
Objectives:
Physician ethnic and gender diversity is known to be inextricably linked to patient outcomes, access to care and healthcare literacy in underrepresented patients. Despite this knowledge, the ethnic and gender disparities prevalent amongst physicians continue to contribute to inequalities in the American healthcare system. Recent data has demonstrated that surgeons, with orthopaedic surgeons in particular, are amongst the least diverse group of physicians. There has been an increased emphasis on promoting surgeon diversity as well as an increased emphasis on publishing literature regarding diversity. Through a systematic review of the literature regarding diversity throughout all surgical subspecialties, this study aims to determine whether this recent increased awareness has correlated to an increase in the number of publications on the matter. This study also aims to quantify the literary contributions of each surgical subspecialty and correlate this with each subspecialties respective demographic profile to identify areas that can be improved in order to continue to promote diversity.
Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to query articles from PubMed, Embase, Web of Science and the Cumulative Index to Nursing and Allied Health Literature through April 1st, 2022. The search used a combination of keywords for the constructs of surgical subspecialties, residency training and diversity. The Rayyan Intelligent Systematic Review program was then utilized by three independent reviewers to screen articles. Broad inclusion criteria was utilized to include articles that discussed either ethnic or gender diversity as it pertained to any surgical subspecialty. Articles that only discussed diversity in non-surgical medical fields or articles that only discussed diversity related to religion, age, or sexual orientation were excluded. Articles were then categorized by surgical subspecialty, type of diversity discussed (gender, ethnic or both) and level of training.
Results:
The query resulted in 1429 total articles from 4 database searches. 408 duplicate articles were found and removed. Of the remaining 1021 articles screened, 701 were excluded with the remainder of the 320 studies included in the review (Figure 1). Orthopaedic surgery was the subspecialty with the highest number of publications regarding ethnic or gender diversity (n=73), followed by general surgery (n=56) (Figure 2). A majority of articles focused solely on gender diversity (n=144) with fewer articles focusing solely on ethnic diversity (n=39). A total of 137 articles analyzed both ethnic and gender diversity. Figure 3 illustrates the number of studies about diversity published by year dating back to 1998. A total of 109 studies regarding surgical diversity were published in 2021 compared to just 22 studies during a 10 year period from 1998 to 2007 (Figure 3). Two articles were published prior to 1998 and 17 articles have been published in 2022 prior to April 1st, 2022. A total of 221 reports discussed ethnic or gender diversity at the resident level, 41 studies at the fellow level and only 20 studies at the student level.
Conclusions:
The importance of promoting diversity in surgeons cannot be overstated. Improved patient satisfaction, better patient outcomes, greater access to healthcare and more transparent patient- physician communication are but a few of the tangible benefits of having a diverse workforce. Orthopaedic surgery is the surgical subspecialty with the most publications regarding diversity amongst surgeons. While orthopaedic surgery should be commended for this, it remains one of the least ethnically and gender diverse surgical subspecialties. This review highlights the need for orthopaedic surgeons to continue to promote diversity at all training levels. Furthermore, as the recent emphasis on promoting diversity has led to a rapid increase in published studies in recent years, close attention should be paid to how the ethnic and gender landscape of the surgical workforce changes over the coming years. There were more than ten times the number of articles discussing diversity at the resident level compared to at the medical student level. Should gender and ethnic diversity remain stagnant, surgeons may need to place increased emphasis on targeting a younger demographic and continue to implement more grassroots programs that promote ethnic and gender diversity.
