Diversifying Orthopaedics One Female Joint Surgeon at a Time

According to a recent survey, only 6.5 percent of orthopaedic surgeons are women. That's a slight improvement from 2010, when only four percent were women, but it still stands in stark contrast to a landscape in which there are now more women in medical school than men.

The unique physical nature of orthopaedic surgery has often been cited as one of the main deterrents to female medical students. But it's an outdated notion, says Cara A. Cipriano, MD, MSc, who is the Chief of Orthopaedic Oncology at Penn Medicine and the only female joint replacement surgeon in the department.

"All of medicine used to be male-dominated. So the question is why orthopaedics hasn't evolved when virtually every other specialty has," she says. "There are stereotypes that have continued to be reinforced long after they've been dispelled in many other fields. Can the work be physically challenging at times? Yes. But all of it can be done by women. In addition, a lot of it is subspecialty-specific and greatly alleviated by technology. So, it comes down to culture."

It's a culture that Penn Orthopaedics is committed to reshaping. L. Scott Levin, MD, FACS, FAOA, Chair of Orthopaedic Surgery at Penn Medicine, has made expanding diversity within the department a priority during his tenure. "Over the last 10 years we have continuously evolved a department culture that champions diversity at every level, which has made us stronger," he says. "Our department has one of the highest percentages of women orthopaedic residents in the country (30 percent), and the demographics of our faculty increasingly reflect the diverse community that we care for every day." Dr. Levin is also an active supporter of the Perry Initiative, a career exploration program for females in high school who are interested in pursuing careers in orthopaedic surgery, engineering or both.

Dr. Cipriano has partnered with the growing list of female orthopaedic faculty, including Kristy Weber, MD, in this pursuit of further diversification. Director of the Penn Sarcoma Program and Vice-Chair of Faculty Affairs, Dr. Weber served as the first female president of the American Academy of Orthopaedic Surgeons from 2019 through 2020 and is the current president of the International Orthopaedic Diversity Alliance (IODA).

How does diversity benefit healthcare?

Mounting research indicates that a diverse and inclusive workforce leads to better decision-making and outcomes and spurs innovation at greater rates.

In healthcare, studies show that patients tend to be more satisfied with their care when they relate more to their provider. "There are a number of studies that show that patient satisfaction is higher for female patients who are operated on by female surgeons," Dr. Cipriano says. Recent surgical outcomes data supports this notion as well.

"You could go see an orthopaedic surgeon who is a different gender or different ethnic background and still have a great outcome," said Mary O'Connor, MD, former chair of the American Academy of Orthopaedic Surgeons Diversity Advisory Board. "But some patients prefer a doctor who looks like them and feel they can trust such an individual to a greater degree. And trust is essential for patients to be compliant with treatment recommendations."

The beginning of a paradigm shift

Dr. Cipriano was recruited to Penn in September 2021 because of her acumen as an orthopaedic oncologist and joint surgeon, as well as her leadership in medical education. But she has quickly taken on a leading role in transforming the department's gender profile.

"For better or worse, I've always had a bit of a trailblazer mentality. If someone says I can't do something, it's going to be the first thing I take on," Dr. Cipriano says. "That's not to say everyone told me I couldn't do this. Rather, there were expectations that my interest would lie elsewhere."

Much of her work on this front revolves around recalibrating expectations. She's very involved in recruiting prospective residents to the orthopaedics department and selecting them. "Along with others, I review all of the applications of the women residents and help determine which get interviews. From there, I'll reach out to them, as needed, to answer any questions they may have," Dr. Cipriano says. "We want our women candidates to feel supported as they move through the review process."

In late January, she spent three consecutive days, including a weekend, interviewing candidates. Earlier in the month, Dr. Cipriano and other female physicians in the department hosted a series of virtual forums for women and sexual/gender minority (SGM) candidates. The discussions were intended to be an informal opportunity to meet, raise questions, and discuss issues relevant to the group.

"Above all, we wanted to engage them," Dr. Cipriano says. "Penn, our leadership, and our department as a whole are very supportive of its women and SGM surgeons. About a third of our residents are women, which is double the national average. There are enough of us that we're not seen as tokens; instead, we are positioned as leaders in the department. So we want our applicants to see that they'd be entering a progressive and supportive environment."

When you're a minority to the degree that women orthopaedic surgeons are, a support system can make an appreciable difference in your experience. Dr. Cipriano says she enjoys being part of a nationwide network of women orthopaedic surgeons that she's fostered during the course of her career. She's also committed to building such a network for others. For example, she's leading the mentorship program for the Women In Arthroplasty Committee of the American Association of Hip and Knee Surgeons.

But Dr. Cipriano hopes to have even more of an impact earlier on in the education and training process. Prospective residents, after all, have already decided to go into orthopaedics. As the department's Director of Undergraduate Medical Education, Dr. Cipriano is actively working to undo the dated stereotypes that continue to put off female medical students.

"I want them to see that all those preconceived notions about the identity of an orthopaedic surgeon no longer apply," she says. "Women and other minorities are not only welcome, but also needed in our field."

In addition to working directly with students, Dr. Cipriano does research with a focus on equity in the field of orthopaedics. Her recent study on medical student perceptions of orthopaedics, funded by a grant from the American Medical Association, demonstrates how preconceived notions about the field are perpetuated, and how they discourage under-represented groups from considering orthopaedic careers. "This is something we need to actively work to overcome if we want to increase diversity," she says.

Her publications have also drawn attention to the fact the women are more limited in terms of receiving awards and invitations to speak at national conferences. "Awards and invited talks are the currency of an academic career," she says. "It's important that women have these opportunities for the sake of their own career advancement, as well as to show aspiring female surgeons and the community in general that their contributions are valued. Other identities that are non-stereotypical in orthopaedics, such as racial/ethnic and sexual/gender minorities, are also critical to support, though more challenging to study."