Analysis of Factors Related to the Sex Diversity of Orthopaedic Residency Programs in the United States

Background: Women are underrepresented as applicants to and trainees of orthopaedic surgery residencies. Factors that attract women to or deter them from orthopaedic surgery have been previously published; however, there has been no analysis of the programs that train high percentages of female residents and the factors that differentiate them from programs that have low percentages of women. The purpose of this study was to identify and compare these factors between programs with high and low percentages of female residents. Methods: Information on each orthopaedic surgery residency program listed in the American Medical Association (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was collected utilizing residency program web sites, an online survey distributed to residency program coordinators, and a follow-up telephone survey. These included data on resident and faculty demographic characteristics and residency program curriculum structure. The prevalence of factors in programs with the highest percentages of female residents was compared with those with lower percentages. Results: Data were obtained from 143 (97.3%) of 147 programs, with 3,406 residents identified. Only 485 residents (14.2%) were female. Programs with more female residents had more female faculty members per program (p = 0.001), a higher percentage of faculty who were female (p < 0.001), more female associate professors (p < 0.001), more women in leadership positions (p < 0.001), and a higher prevalence of women's sports medicine programs (p = 0.03); were more commonly listed in the Top 40 for National Institutes of Health (NIH) funding (p = 0.03) and U.S. News & World Report rankings (p = 0.02); and were more likely to offer a research year (p = 0.045). Conclusions: There are greater percentages of female residents at orthopaedic residency programs with more female faculty members, more women in leadership positions, a women's sports medicine program, and the option to do a research year. Departmental and national leaders may consider these factors when efforts are undertaken to enhance the recruitment of female applicants and improve female interest in orthopaedic surgery as a specialty.