Chair David S Pisetsky MD PhDProfessor of Medicine and ImmunologyChief of Rheumatology and ImmunologyDuke University Medical CenterDurham, NC

Guests Alison P Toth MDDirector, Women's Sports Medicine ProgramAssistant Professor, Orthopaedic SurgeryDuke University Medical CenterDurham, NC

Thomas P Sculco MDSurgeon-in-Chief and Korein-Wilson Professor of Orthopaedic SurgeryHospital for Special SurgeryChairman of the Department of Orthopaedic Surgery and Professor of Orthopaedic SurgeryWeill Medical College of Cornell UniversityNew York, NY

Women in orthopedic surgery

We have a problem

• The percentage of women entering medical school has increased from 11.1% in 1970 to 47.8% in 2001

• The percentage of women in orthopedics has increased from 0.6% in 1970 to 9.0% in 2001

• Orthopedic residencies have the lowest percentage of women compared with all other primary surgical specialties• Only thoracic surgery, a field entered secondarily

after the completion of general surgical training, has a lower percentage

Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480.

Alison P Toth MD

Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480.

Alison P Toth MD

We have a problem—0.6%

• The percentage of all female residents who choose an orthopedic residency is 0.6%, a number that has not changed over the past twenty years

Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480.

Alison P Toth MD

We have a recruiting problem

• Orthopedic surgery has not had the same success in recruiting female trainees that other surgical fields have had

• There appears to be a leveling of the recruitment rate over the past two decades, indicating that the higher numbers of women entering medicine will not be sufficient to improve gender representation in orthopedic surgery training

Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480.

Alison P Toth MD

Barriers to recruiting women for orthopedic surgery

• Leadership• Chairman, faculty

• Nature of the field• Physical

– Strength– Appeal of power tools, carpentry

• Lifestyle– Less concerning with resident work-hour

restrictions– Trauma call

• Lack of mentoring• Male mentoring/role models• Female role models lacking

– Practicing orthopedic surgeons (2.3%)

Alison P Toth MD

Recruiting women into orthopedics at Cornell

• Introduce women to orthopedics early in their career

• Provide first-year students with a textbook in musculoskeletal disease

• Funding 10 research fellowships for medical students, at least half of them going to women

• Feature our women faculty in interactions with students

• Involve female faculty in the resident selection process

Thomas Sculco MD

A female dimension to orthopedics

• Women tend to be gentler with soft tissue

• Have excellent psychomotor skills

• Increase the level of discourse in the OR

• More empathetic with their patients

Thomas Sculco MD

Dr Toth’s success story…

• First encounter with orthopedic surgeons was as an athlete—very common among future surgeons

• Very encouraging surgeons—excellent mentors

• Worked in that same clinic every summer and was repeatedly taken to the OR

Alison P Toth MD

Early active recruitment is important

Dr Toth’s success story…

• As a former athlete, no issues of strength or lifting

• Did not encounter any obstacles along the way—always treated equally

• Attitude of not having a chip on the shoulder

Alison P Toth MD

Different genders, different skills

• Mere generalization: fine techniques are better accomplished by women—hand, foot and ankle surgery, microvascular etc

• From experience, dexterity is superior in a woman—less aggressive handling of the tissue

Thomas Sculco MD

Different genders, different skills:Intrinsic or acquired?

• Traditionally, girls would sew and boys preferred woodworking

• Will the evolving gender roles affect the differences in skills?

• Although women are more oriented towards the crafts, within a year of residency they gain comfort and confidence

David Pisetsky MD PhD

Thomas Sculco MD

Young Alison tinkering with cars

• Last of three girls

• Was taught what a boy would have been taught:

• Building fences

• Tinkering with cars

– Was not intimidated when first taken to the OR due to this experience

Alison P Toth MD

Early exposure is primary—would imply major society changes

Women in the locker room culture

• Women getting pregnant, delivering, and breast-feeding are alien topics to the locker room culture in the OR

• Surgeons just have to adapt

• A lot of women with athletic backgrounds go into orthopedics

Thomas Sculco MD

Former athletes as surgeons

• 50-60% of orthopedic residents at Cornell are former athletes; 15-20% were athletes at the collegiate level

• They like the “team” approach

• Many may have been treated by team physicians and see them as role models

Thomas Sculco MD

Dr Toth on being a team physician

• Cares for 300 division 1 female athletes at Duke

• Great mentoring to get athletes interested in medicine, sports medicine in particular

• Great experience getting to know athletes at the game, not just when they come to the office injured

• Previously assisted the team physician for the New York Giants—always felt respected and appreciated

Alison P Toth MD

• Women must not only be introduced to orthopedics early, but also to the breadth of the field:

• Metabolic bone disease

• Trauma

• Sports medicine

• Hand and foot surgery

• Women can play a part in any of these subspecialties and find their niche—there is a place for everyone

Thomas Sculco MD

Two sets of skills: Hardiness vs dexterity

Climbing the academic ladder

• Dedicated women can move up the ladder

• Many women may not choose an academic career

• At Cornell, a woman is director of orthopedic research and is also team physician

• Such women are role models and more will follow

Thomas Sculco MD

What about private practice?

• May be easier, as the surgeon can select a field with less lifting, eg, foot and ankle surgery

• Private practice allows the regulation of working hours

• Option not to take call

• Work part-time

• In a trauma center, the surgeon must perform all that comes in, all the more difficult tasks

Thomas Sculco MD

Conclusions

• Early exposure

• Show women that they can succeed in the field

• Women must start looking at men as role models

• Mentoring should be gender-blind

Thomas Sculco MD

Alison P Toth MD