A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Clin Orthop Relat Res. 2021 Jun 1;479(6):1179-1189. doi: 10.1097/CORR.0000000000001724.
Although previous studies have evaluated how the proportion of women in orthopaedic surgery has changed over time, these analyses have been limited by small sample sizes, have primarily used data on residents, and have not included information on growth across subspecialties and geographic regions.
QUESTION/PURPOSE: We used the National Provider Identifier registry to ask: How have the (1) overall, (2) regional, and (3) subspecialty percentages of women among all currently practicing orthopaedic providers changed over time in the United States?
The National Provider Identifier Registry of the Centers for Medicare and Medicaid Services (CMS) was queried for all active providers with taxonomy codes pertaining to orthopaedic subspecialties as of April 2020. Women orthopaedic surgeons were identified among all physicians with subspecialty taxonomy codes. As all providers are required to provide a gender when applying for an NPI, all providers with queried taxonomy codes additionally had gender classification. Our final cohort consisted of 31,296 practicing orthopaedic surgeons, of whom 8% (2363 of 31,296) were women. A total of 11,714 (37%) surgeons possessed taxonomy codes corresponding with a specific orthopaedic subspecialty. A univariate linear regression analysis was used to analyze trends in the annual proportions of women who are active orthopaedic surgeons based on NPI enumeration dates. Specifically, annual proportions were defined using cross-sections of the NPI registry on December 31 of each year. Linear regression was similarly used to evaluate changes in the annual proportion of women orthopaedic surgeons across United States Census regions and divisions, as well as orthopaedic subspecialties. The national growth rate was then projected forward to determine the year at which the representation of women orthopaedic surgeons would achieve parity with the proportion of all women physicians (36.3% or 340,018 of 936,254, as determined by the 2019 American Medical Association Physician Masterfile) and the proportion of all women in the United States (50.8% or 166,650,550 of 328,239,523 as determined by 2019 American Community Survey from the United States Census Bureau). Gender parity projections along with corresponding 95% confidence intervals were calculated using the Holt-Winters forecasting algorithm. The proportions of women physicians and women in the United States were assumed to remain fixed at 2019 values of 36.3% and 50.8%, respectively.
There was a national increase in the proportion of women orthopaedic surgeons between 2010 and 2019 (r2 = 0.98; p < 0.001) at a compound annual growth rate of 2%. Specifically, the national proportion of orthopaedic surgeons who were women increased from 6% (1670 of 26,186) to 8% (2350 of 30,647). Assuming constant growth at this rate following 2019, the time to achieve gender parity with the overall medical profession (that is, to achieve 36.3% women in orthopaedic surgery) is projected to be 217 years, or by the year 2236. Likewise, the time to achieve gender parity with the overall US population (which is 50.8% women) is projected to be 326 years, or by the year 2354. During our study period, there were increases in the proportion of women orthopaedic surgeons across US Census regions. The lowest growth was in the West (17%) and the South (19%). Similar growth was demonstrated across census divisions. In each orthopaedic subspecialty, we found increases in the proportion of women surgeons throughout the study period. Adult reconstruction (0%) and spine surgery (1%) had the lowest growth.
We calculate that at the current rate of change, it will take more than 200 years for orthopaedic surgery to achieve gender parity with the overall medical profession. Although some regions and subspecialties have grown at comparably higher rates, collectively, there has been minimal growth across all domains.
Given this meager growth, we believe that substantive changes must be made across all levels of orthopaedic education and leadership to steepen the current curve. These include mandating that all medical school curricula include dedicated exposure to orthopaedic surgery to increase the number of women coming through the orthopaedic pipeline. Additionally, we believe the Accreditation Council for Graduate Medical Education and individual programs should require specific benchmarks for the proportion of orthopaedic faculty and fellowship program directors, as well as for the proportion of incoming trainees, who are women. Furthermore, we believe there should be a national effort led by American Academy of Orthopaedic Surgeons and orthopaedic subspecialty societies to foster the academic development of women in orthopaedic surgery while recruiting more women into leadership positions. Future analyses should evaluate the efficacy of diversity efforts among other surgical specialties that have achieved or made greater strides toward gender parity, as well as how these programs can be implemented into orthopaedic surgery.
尽管之前的研究评估了整形外科手术中女性比例随时间的变化，但这些分析受到样本量小、主要使用居民数据以及不包括跨专业和地理区域增长信息的限制。
问题/目的：我们使用国家提供者标识符注册表询问：在美国，（1）总体而言，（2）区域，（3）女性在所有目前执业的整形外科医生中的比例随时间如何变化？
美国医疗保险和医疗补助服务中心（CMS）的国家提供者标识符注册表查询了截至 2020 年 4 月所有具有整形外科专业分类代码的活跃提供者。在具有专业分类代码的所有医生中确定了女性整形外科医生。由于所有提供者在申请 NPI 时都必须提供性别，因此所有具有查询分类代码的提供者都有性别分类。我们的最终队列包括 31296 名执业整形外科医生，其中 8%（2363 名/31296 名）为女性。共有 11714 名（37%）外科医生拥有与特定整形外科专业相对应的分类代码。使用单变量线性回归分析来分析基于 NPI 计数日期的活跃整形外科医生的年度女性比例趋势。具体来说，每年的比例是通过每年 12 月 31 日的 NPI 注册表的横断面定义的。线性回归同样用于评估美国人口普查区域和分区以及整形外科专业中女性整形外科医生的年度比例变化。然后预测全国增长率，以确定女性整形外科医生的代表性将达到与所有女性医生（根据 2019 年美国医学协会医师主文件确定为 36.3%或 340,018 名/936,254 名）和美国所有女性（根据 2019 年美国社区调查确定为 50.8%或 166,650,550 名/328,239,523 名）的比例相等的年份。使用 Holt-Winters 预测算法计算性别均等的预测值以及相应的 95%置信区间。假设女性医生和美国女性的比例分别保持在 2019 年的 36.3%和 50.8%，分别为 2019 年的值。
2010 年至 2019 年期间，女性整形外科医生的比例在全国范围内有所增加（r2 = 0.98；p <0.001），复合年增长率为 2%。具体来说，女性整形外科医生的全国比例从 6%（1670 名/26186 名）增加到 8%（2350 名/30647 名）。假设按照这一速度持续增长，那么与整个医学领域（即整形外科中达到 36.3%的女性）实现性别均等的时间预计为 217 年，即到 2236 年。同样，与美国总人口（占 50.8%的女性）实现性别均等的时间预计为 326 年，即到 2354 年。在我们的研究期间，美国人口普查区域的女性整形外科医生比例有所增加。西部（17%）和南部（19%）的增长最低。在每个人口普查分区都观察到类似的增长。在每个整形外科专业中，我们在整个研究期间都发现了女性外科医生比例的增加。成人重建（0%）和脊柱外科（1%）的增长最低。
我们计算出，按照目前的变化速度，整形外科要达到与整个医学领域的性别均等还需要 200 多年的时间。尽管一些地区和专业的增长速度相对较高，但总体而言，所有领域的增长都微不足道。
鉴于这种微不足道的增长，我们认为必须在所有层面的整形外科教育和领导中进行实质性的变革，以加深当前的曲线。这包括要求所有医学院校课程都包含专门的整形外科课程，以增加通过整形外科管道的女性人数。此外，我们认为，研究生医学教育认证委员会和各个项目应该要求整形外科教师和奖学金项目主任的比例，以及新学员的比例，具体规定为女性。此外，我们认为应该由美国骨科医师学会和骨科专业协会领导一项全国性的努力，在招募更多女性进入领导层的同时，促进女性在骨科手术中的学术发展。未来的分析应该评估在其他已经实现或在性别均等方面取得更大进展的外科专业中多样性工作的效果，以及这些计划如何在骨科手术中实施。
