Abstract
Objectives:
The purpose of this study was to conduct a cross-sectional analysis on the diversity of academic sports medicine surgeons in the United States. We aimed to determine if the gender and race of sports medicine surgeons correlated with attainment of academic rank, leadership, and practice setting.
Methods:
Surgeons were identified using the American Orthopaedic Society for Sports Medicine (AOSSM) membership database, including individuals who had completed fellowship training and are practicing in academia. Demographic data (age and race), academic rank, leadership positions held, years in practice, practice setting (urban vs. rural), and work address were obtained from the AOSSM membership directory and publicly available profession profiles. Practice setting was defined as urban (population greater than 250,000) or rural (population less than 250,000). National area deprivation index (ADI) decile of work addresses as a measure of socioeconomic deprivation was subsequently calculated. Surgeons without a work address in the U.S. or who were still undergoing residency or fellowship training were excluded.
ADI scores were evaluated with linear regression, while years in practice were evaluated with negative binomial regression to account for the skew in distribution. Practice setting and leadership status were assessed using logistic regression. Academic rank was evaluated using ordered logistic regression.
No institutional review board approval was required for this survey study.
Results:
Of the 554 surgeons who met the inclusion criteria, 86.28% were male and 13.72% were female. 82.67% were white, 11.19% were Asian, 4.69% were black, and 1.44% were Hispanic. 82.13% of surgeons held an academic rank. Of those who did, 0.54% were instructors, 31.95% were assistant professors, 22.02% were associate professors, and 27.62% were professors. Under half of the surgeons included did not have at least one leadership position (43.68%). Over half of the surgeons evaluated practiced in an urban setting (57.94%). The average ADI of work addresses was 35.64%. The average years in practice following the completion of the highest level of training was 13.9 years.
Statistical analysis revealed that neither gender nor race significantly impacted the attainment of academic rank, leadership status, or whether they practiced in an area of higher or lower ADI. It was found that males had a higher probability of practicing in locations that had a higher ADI by an average of 5.71 points, however, this was not statistically significant (36.43 vs. 30.74, P = 0.072). Additionally, male surgeons were found to have a higher probability of practicing in a rural setting compared to their female counterparts (44.40 vs. 27.40, P = 0.002). Black and Hispanic surgeons had a 14.26% lower probability of practicing in a rural setting than their white counterparts, although this was not significant (-29.94, 1.41, P = 0.074). Race did not have a significant impact on the ADI of where surgeons practiced. Analysis further revealed that male surgeons on average had more years in practice compared to their female counterparts by 4.16 years (14.46 vs. 10.30, P < 0.001). Asian surgeons on average had 4.58 years less experience than their white counterparts (-7.02, -2.14, P<0.001).
Conclusions:
The study reveals that academic orthopaedic sports medicine is still largely lacking in diversity. The analysis demonstrates that female surgeons continue to be underrepresented despite recent increases in females entering the field of orthopaedic surgery. White and Asian surgeons are overrepresented while black and Hispanic surgeons continue to be underrepresented. Despite female, black, and Hispanic individuals being underrepresented in orthopaedic sports medicine, this study’s analysis found that there was no correlation between a surgeon’s gender and their attainment of any level of academic rank. Further analysis is needed to elucidate the reasons behind this phenomenon. While there was no statistically significant difference in ADI scores between genders and races, these results, and findings that male surgeons are more likely to practice in rural areas, suggest that there may be confounding factors influencing the practice setting based on gender or race. Additional studies are needed to understand the opportunities and factors influencing a physician’s decisions to enter urban or rural practice. Overall, the results suggest that there are still opportunities to increase the rates of female, black, and Hispanic individuals entering the field of orthopaedic sports medicine. Increasing diversity within academic orthopaedic sports medicine may also provide a more diverse pool of instructors and encourage more female and minority physicians to enter the field in a virtuous cycle. Such action is much needed as the population of patients in the U.S. continues to become more heterogenous, warranting a pool of physicians that must become equally diverse to meet its needs.
