Orthopedic surgery remains the least diverse surgical specialty in the U.S., according to a new study published in PLOS One.
The study, published Sept. 15, tracked 18,542 residency applicants from 2007 to 2019. Researchers found that while women’s share of orthopedic applicants grew from 11.8% to 19.3% over the study period, the specialty still trailed six specialties on both gender and racial representation.
African American and Asian applicant shares declined over the same stretch, even as orthopedic surgery leadership has pushed diversity initiatives for the past decade.
Here are 10 things to know from the study, based on data from the Association of American Medical Colleges’ Electronic Residency Application Service.
- Women made up just 14.9% of orthopedic surgery applicants over the 12-year study period, rising from 11.8% to 19.3% — a 63.6% increase. Even with that growth, orthopedic surgery had the lowest female representation of any surgical specialty studied.
- From 2015 to 2019, female applicants made up 16.8% of orthopedic applicants versus 36.5% in general surgery, 33.7% in otolaryngology, 33% in plastic surgery, 26.7% in urology, 26.4% in vascular surgery and 21.7% in neurosurgery.
- The percentage of female orthopedic applicants was much lower than the female share of medical school graduates, which is about 46%.
- Black, Indigenous and People of Color (BIPOC) applicants made up 28.2% of orthopedic applicants overall, growing by about 0.44 percentage points a year on average, though the yearly share fluctuated rather than climbing steadily. Vascular surgery (58%), general surgery (57.3%), neurosurgery (55.3%), plastic surgery (45.2%), otolaryngology (42.8%) and urology (42%) all outpaced orthopedics’ 32.6% share of BIPOC applicants from 2015 to 2019.
- Asian orthopedic applicants fell about 0.23 percentage points per year, and African American orthopedic applicants fell about 0.17 points per year — running counter to the field’s stated diversity goals.
- Hispanic and Latino representation in orthopedics is about 7%, making it the one group that tracked roughly in line with medical school graduates (about 8%) and comparable to other surgical specialties.
- Nearly 20% of orthopedic residency programs had exclusively male trainees, and 39.5% had zero BIPOC trainees.
- The applicant pipeline mirrors current workforce numbers rather than outpacing them — female orthopedic residents sit at 14.4% to 18% annually and female faculty at just 17.9% of programs, suggesting applicant-level gains haven’t translated into faster downstream change.
- The study cites bias in the interview process as a contributing factor for the lack of diversity. Prior research found 61% of women applicants were asked about family planning versus 8% of men, 33% were asked about children versus 4% of men, and 24% faced marital-status questions versus 7% of men.
- Separate research cited in the study found match rate disparities that compound the pipeline problem: White applicants matched at 63.4%, Hispanic applicants at 54.2%, Asian applicants at 54.1% and African American applicants at 39.5%.
Note: This data reflects residency applicants from 2007 to 2019; researchers excluded COVID-era data to avoid pandemic-related distortion in application patterns. The study collected gender as a binary category during this period, so the data does not capture nonbinary or additional gender identities. Racial and ethnic categories are self-reported and applicants could select more than one, which researchers noted could affect precise counts, though not the overall trend.
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