Trends in Orthopaedic Surgery Workforce Diversity: Analyzing Changes Over Time

Abstract

Introduction: There are many reasons why orthopaedic surgeons move or change careers. We asked the questions: (1) What is the geographic distribution of orthopaedic surgeons with respect to age, sex, and race and ethnicity? (2) How has our workforce changed over time with regard to these factors? (3) Are there any patterns or trends detected regarding policy or regulatory events that coincide with these differences?

Methods: The American Academy of Orthopaedic Surgeons surveys over 30,000 members, collecting data on demographics, age, race sex, and practice statistics. We calculated geographic distributions and evaluated these differences over time-potential influences from malpractice suits or tort reform were investigated.

Results: Overall surgeon density increased over time. The largest negative changes were noted in District of Columbia, Wyoming, and North Dakota and positive changes in Colorado, South Dakota, and West Virginia. Age across all states increased (mean 1.7 years). Number of female surgeons increased in most states (4.6% to 5.7%). Number of African Americans increased from 1.6% to 1.8%, Hispanic/LatinX from 1.8% to 2.2%, Asian from 5.5% to 6.7%, and multiracial from 0.8% to 1.2%. No change was noted in the percentage of Native American surgeons.

Discussion: Surgeon density increased from 2012 to 2018; the cause for this change was not evident. Small increases in surgeon population, female surgeons, and in some underrepresented minorities were seen.

Figure 1

Heatmaps of orthopaedic surgeon density from 2012 to 2018. Blue states are more dense, and white states are less dense. The numbers represent number of orthopaedic surgeons per 100,000 people population.

Figure 2

Map showing change of density over time from 2012 to 2018, with green representing increase and red loss of density. The numbers represent number of orthopaedic surgeons per 100,000 people population.

Figure 3

Map showing difference in age of orthopaedic surgeons from 2012 to 2018. All orthopaedic surgeons had increased in age. In 2012, the BLS (Bureau of Labor Statistics) median employed age was 42.2 years; in 2018, it was 42.2 years also, suggesting there was no increase in national employed age; however, the average orthopaedic surgeon age has increased, representing an aging workforce compared with the national workforce.

Figure 4

Female heatmap. These density maps represent the percentage change from 2012 to 2018 with green representing an increase in percentage and red representing a decrease in percentage of overall orthopaedic surgeons. This survey was conducted with approximately 29,000 members, 1,700 female and 27,300 male.

Figure 5

Male heatmap. These density maps represent the percentage change from 2012 to 2018 with green representing an increase in percentage and red representing a decrease in percentage of overall orthopaedic surgeons.

Figure 6

Map showing the 2018 Census of percentage of female orthopaedic surgeons. This is from the AAOS Census of 1781 orthopaedic surgeons who identified as female. States with the highest percentage were Vermont (13.3%), Maine (11.9%), and District of Columbia (11.3%).

Figure 7

Graph based on survey response, which was approximately 20% of responses compared with the over 30,000 AAOS surgeon membership. Percentage of Whites decreased from 88.5% to 84.7% while African Americans had minimal change from 1.6% to 1.8%, Hispanic/LatinX changed from 1.8% to 2.2%, Asian changed from 5.5% to 6.7% (Asian female surgeons had a change from 6.3 to 9.0%), Native Americans had no change from 0.3% to 0.3%, and multiracial changed from 0.8% to 1.2%.

Figure 8

Graph represents changes in surgeon race/ethnicity excluding White.