Editor’s Note: This account challenges us to ask questions about the “culture” of orthopaedic surgery and to work incrementally for definitive change.
From 1937 when Ruth Jackson, MD became the first woman board-certified in orthopaedic surgery and admitted into the American Academy of Orthopaedic Surgeons until 2019 when a woman became the first female president of the AAOS, women have advanced in the field of orthopaedic surgery. As of 2022, 7.4% of practicing orthopaedic surgeons were female. 16% of orthopaedic residents were women. Despite these gains, many feel the “culture within the profession of orthopaedic surgery” has progressed slowly.
What is “culture?” It refers to knowledge, hierarchies, traditions, beliefs, attitudes, values, and way of life. There are different cultures in different fields of medicine. There are cultures of belonging and there are cultures of ‘fitting in’. How does this apply to the field of orthopaedic surgery?
As orthopaedists, we share an ever-growing collective knowledge. We have organized ourselves into workplace and professional hierarchies. We have traditions, beliefs, attitudes and values which vary among individuals in our field. We occupy a privileged place in society. The way of life we are allowed to lead is based on work volume, quality, & income.
If someone is considering pursuing a career as an orthopaedic surgeon, what questions should we advise them to ask?
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How rigid is the organizational orthopaedic hierarchy? What happens if someone steps out of the traditional chain of command?
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Is there a forum where difficult topics can be discussed as it affects patient care & our careers?
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Is there openness to minorities (anyone not in the majority culture) entering the field & ascending into positions of leadership?
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Are differences of opinion tolerated & even encouraged?
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Are leaders chosen based on merit & competence or on friendships, social interactions, politics and pedigree?
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Are new colleagues viewed as assets or competitors?
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Is work-life integration promoted?
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Is there a confidential resource where ethical violations or personal mistreatment by peers or someone in the hierarchy can be reported? Will fair action be taken?
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Is there a force within the profession that strives for “better”?
I have personally experienced or have been told of women who have been “crushed” for trying to do the right thing when it went against the prevailing winds in the department or practice. I know of whistle-blowers who have been left damaged. I have witnessed respected leaders in our field avoid taking a stand to support another colleague presumably out of fear of becoming unpopular. I have had colleagues who have been subject to mistreatment, support the perpetrator out of fear of reprisal.
To usher in a new generation of leaders who can help mold the culture into one that is more equitable, ethical, inclusive, and fair, we must teach them the skillsets they will need. We want them first to survive, then thrive and finally, take the reins to lead. We need to advise them about when speaking up is most effective and not self-damaging. Within our current culture, that is usually not during residency or fellowship training. Battles must be chosen carefully. We can’t right every wrong while we are in training or early in career, but we can remember them for later. If we truly want to push the needle, we must ascend the leadership ladder to make changes. Sometimes we need to live in the current culture, succeed, and then speak out when we have a credible voice that will not be dismissed. Small changes can be lasting changes. We must all do what we can.