Summary

Orthopaedic surgery is the surgical subspecialty with the most publications regarding diversity amongst surgeons, however it remains one of the least ethnically and gender diverse surgical subspecialties.

Abstract

Introduction

Physician ethnic and gender diversity is known to be inextricably linked to patient outcomes, access to care and healthcare literacy in underrepresented patients. Despite this knowledge, the ethnic and gender disparities prevalent amongst physicians continue to contribute to inequalities in the American healthcare system. There has, however, been an increased emphasis on promoting surgeon diversity as well as an increased emphasis on publishing literature regarding diversity. Through a systematic review of the literature regarding diversity throughout all surgical subspecialties, this study aims to determine whether this recent increased awareness has correlated to an increase in the number of publications on the matter. This study also aims to quantify the literary contributions of each surgical subspecialty and correlate this with each subspecialties respective demographic profile to identify areas that can be improved in order to continue to promote diversity.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to query articles from PubMed, Embase, Web of Science and the Cumulative Index to Nursing and Allied Health Literature through March 15, 2022. The search used a combination of keywords for the constructs of surgical subspecialties, residency training and diversity. The Rayyan Intelligent Systematic Review program was then utilized by two independent reviewers to screen articles. Broad inclusion criteria of both ethnic and gender diversity within various training levels of any surgical specialty was utilized.

Results

The query resulted in 1429 total articles from 4 database searches. 408 duplicate articles were found and removed. Of the remaining 1021 articles screened, 701 were excluded with the rest of the 320 studies included in the review. Orthopaedic surgery was the subspecialty with the highest number of publications regarding ethnic or gender diversity (n=73), followed by general surgery (n=56). A majority of articles focused solely on gender diversity (n=144) with fewer articles focusing solely on ethnic diversity (n=39). 137 articles analyzed both ethnic and gender diversity. 109 studies regarding surgical diversity were published in 2021 compared to just 22 studies during a 10 year period from 1998 to 2007. Two articles were published prior to 1998 and 17 articles have been published in 2022 prior to April 1st, 2022. 221 articles discussed ethnic or gender diversity at the resident level, 41 articles at the fellow level and only 20 articles at the student level.

Conclusion

Orthopaedic surgery is the surgical subspecialty with by far the most publications regarding diversity amongst surgeons. Despite this, orthopaedic surgery remains one of the least ethnically and gender diverse surgical subspecialties. This review serves as a call to action to orthopaedic surgeons to continue to promote diversity at all training levels. Furthermore, as the recent emphasis on promoting diversity has led to an exponential increase in published studies in recent years, close attention should be paid to how the ethnic and gender landscape of the surgical workforce changes over the coming years. Should gender and ethnic diversity remain stagnant, orthopaedic surgeons may need to rethink the approach to promoting diversity.