Trends in Medical Training and Leadership at Academic Orthopedic Programs

Abstract

Introduction: When deciding on which programs to rank or fellowships to enter, medical students and residents may assess the program's prestige and specialty training opportunities. This report aimed to analyze the demographics of orthopedic department chairs and program directors (PDs), focusing on the prestige of their orthopedic training and medical school. Secondary data included fellowship, higher-level education, sex, professorship, years of practice, and total published research.

Methods: We used U.S. News and Doximity to rank 192 medical schools and 200 orthopedic residency programs based on prestige rankings, respectively. We searched for the department chair, vice-chair, and PD via program websites, Council of Orthopaedic Residency Directors (CORD), Orthopedic Residency Information Network (ORIN), personal websites, LinkedIn, and Doximity. Subsequently, we searched for each individual's demographic information, education and research history, employment history, and medical school attended.

Results: We gathered data on 268 orthopedic surgeons with leadership positions at academic hospitals. Of the 268, 115 were department chairs, 15 were vice-chairs, 126 were PDs, 11 were both the chair and PD, and one was vice-chair and PD. Of the 268 physicians, 244 physicians were male (91.0%), while 22 were female (9.0%). The average residency reputation ranking overall was 59.7 ± 5.7. More specifically, for chairs, the average was 57.0 ± 8.3 (p < 0.005), and for PDs, the average was 63.6 ± 8.0 (p <0.005). There was no significant difference between chairs and PDs (p = 0.26).

Conclusion: Orthopedic leaders were found to have trained at more prestigious programs. This trend could be explained by increased research opportunities at more prestigious programs or programs attempting to increase their own reputation. 9.0% of the leaders identify as female, which is comparable to the 6.5% of practicing female orthopedic surgeons. However, this further demonstrates a need for gender equity in orthopedic surgery. Assessing trends in the training of orthopedic surgeons with leadership positions will allow a better understanding of what programs look for in the hiring process.

Keywords: chair; orthopedics; program director; ranking; residency; vice-chair; women.

Figure 1. Leadership inclusion and exclusion criteria.

Inclusion criteria were set to include physicians with permanent leadership positions with academic titles. Furthermore, to assess residency reputation ranking, only those with residency training inside the United States were included.

Figure 2. The number of Academic Orthopedic Leadership compared to Residency Reputation Ranking.

Reputation rankings were determined using Doximity. The programs under NA were former residency programs that have been closed (Letterman Army Medical Center and Fitzsimons Army Medical Center).

Figure 3. The number of Academic Orthopedic Leadership compared to Medical School Ranking Ranking.

Medical rankings were determined using the U.S. News research ranking.

Figure 4. Orthopedic Fellowship Trends

The following graph looks at the distribution of orthopedic fellowships in all orthopedics, females in orthopedics, all orthopedic chairs, vice-chairs, and PDs at academic institutions, and female orthopedic chairs, vice-chairs, and PDs at academic institutions. The data for the overall numbers for orthopedics came from the 2018 AAOS census. The data on chairs, vice-chairs, and PDs came from our own data.