PDF(Pubmed)
Abstract：
Introduction The gender disparity in orthopaedic surgery is well-established. According to our analysis, only 7.4% of practicing orthopaedic surgeons in the US are female in 2022. While there are several theories attempting to explain this gender gap, our eight years of data show that limited female representation is a self-perpetuating cycle as areas without female representation almost never improve in that regard. It appears that existing female mentorship is critical to the growth of a female orthopaedic presence in an area. In the present work, we aim to describe how gender diversity in orthopaedic surgery differs across the country, how this diversity is changing over time, and how surgeon gender diversity may be affected by the sociodemographic characteristics making up the counties where orthopaedic surgery is practiced. Methods A retrospective study was conducted using publicly available National Provider Identifier (NPI) data from 2015 to 2022. Orthopaedic surgeons and their genders were identified using the Provider Type and Gender data elements associated with an individual NPI. Rural-urban and metro characters were defined using the USDA Economic Research Reserve\'s rural-urban continuum codes. Python was used for database building and data cleaning. GeoDa, a statistical map-based graphing software, was used to plot and assess demographic, geographic, and socioeconomic trends. Trends in gender diversity from 2015 to 2019 were analyzed for each individual year as well as the time period as an aggregate. Cluster analysis was performed to assess complex spatial patterns of variables that could not be condensed linearly or logarithmically. Moran\'s I was used to measure the similarity of a Federal Information Processing System (FIPS) area code to its neighbors. Within the clustering analysis, spatial clusters were broken down into four groups of spatial outliers (High-High, High-Low, Low-High, and Low-Low) referencing a given area\'s relationship with its neighbors. Factorial ANOVA between each of the four cluster types was performed using the variables provided in the article to identify significant demographic variables within the cluster analysis. Results There are relative hotspots of gender diversity in the Northwest, Northeast, and Southwest with relative coldspots in the Midwest and Southern US. In counties that are considered gender diversity hotspots, the total population of orthopaedic surgeons increases by 0.94 each year while the population of female orthopaedic surgeons increases by 0.2, suggesting that in areas with high gender diversity, 4.7 male orthopaedic surgeons are joining practices for every 1.0 female. In areas with low gender diversity, the population of orthopaedic surgeons increases by 0.11 surgeons each year while the slope for an increase in female orthopaedic surgeons is 0. Conclusions Orthopaedic surgery lags behind other male-dominated surgical specialties in gender parity. Our analysis demonstrates that certain areas of the country including the Northwest, Northeast, and Arizona have improved gender diversity compared to the rest of the country. We also see that the rate of increase of female orthopaedic surgeons in the past seven years is highest in areas with more preexisting female orthopaedic surgeons, suggesting the importance of a \"trailblazer\" phenomenon in recruiting female surgeons.
摘要：
介绍骨科手术中的性别差异是公认的。根据我们的分析,2022年，美国只有7.4%的骨科医生是女性。虽然有几种理论试图解释这种性别差距，我们八年的数据表明，女性代表性有限是一个自我延续的周期，因为没有女性代表性的地区在这方面几乎从未改善过。看来，现有的女性指导对于某个地区女性骨科的成长至关重要。在目前的工作中,我们的目的是描述骨科手术中的性别多样性在全国各地的差异，这种多样性是如何随着时间的推移而变化的，以及外科医生性别多样性如何受到骨科手术所在县的社会人口统计学特征的影响。方法使用2015年至2022年公开的国家提供者标识符（NPI）数据进行回顾性研究。使用与单个NPI相关的提供者类型和性别数据元素确定了骨科医生及其性别。使用美国农业部经济研究储备的城乡连续体代码定义了城乡和地铁特征。Python用于数据库构建和数据清理。GeoDa,基于统计图的绘图软件，被用来绘制和评估人口统计，地理,和社会经济趋势。对2015年至2019年的性别多样性趋势进行了分析。进行聚类分析以评估无法线性或对数浓缩的变量的复杂空间模式。Moran的I被用来衡量联邦信息处理系统（FIPS）区号与其邻居的相似性。在聚类分析中，空间聚类被分解为四组空间异常值(高-高，高-低,低-高,和低-低)引用给定区域与其邻居的关系。使用本文中提供的变量进行四种聚类类型中的每一种之间的阶乘方差分析，以识别聚类分析中的重要人口统计学变量。结果西北地区存在性别多样性的相对热点,东北,和西南部，在美国中西部和南部有相对寒冷的地方。在被认为是性别多样性热点的县，骨科医生的总人口每年增加0.94，而女性骨科医生的人口增加0.2，这表明在性别多样性高的地区，4.7名男性整形外科医生每1.0名女性加入实践。在性别多样性低的地区，整形外科医生的人数每年增加0.11名，而女性整形外科医生的增加斜率为0。结论骨科手术在性别均等方面落后于其他男性主导的外科专业。我们的分析表明，包括西北地区在内的某些地区，东北,与全国其他地区相比，亚利桑那州的性别多样性有所改善。我们还看到，在过去七年中，女性骨科医生的增长率在女性骨科医生较多的地区最高，这表明“开拓者”现象在招募女性外科医生中的重要性。
