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Defining the Training Pathway for Racial, Ethnic, and Gender Diversity in the Emerging U.S. Hand Surgery Workforce.
Paul J Pottanat, MD, Jason Silvestre, MD, Colin Zieminski, MD, Charles A Daly, MD; Dane N Daley, MD
Medical University of South Carolina, Charleston, SC
INTRODUCTION: Previous studies have demonstrated a lack of diversity among orthopedic and plastic surgery subspecialities including hand surgery. The purpose of this study was to analyze trends in demographic diversity within the pathway of orthopedics and plastics hand surgery fellowship positions.
METHODS: This was a cross-sectional analysis of allopathic medical students, orthopedic surgery residents, plastic surgery residents, orthopedic hand fellows and plastics hand fellows at U.S.-accredited training programs from 2013 to 2024. Demographic data, including gender, race, and ethnicity was collected from the ACGME database and 2020 U.S. census data. Participation-to-prevalence ratios (PPRs) quantified the representation in the emerging hand surgery workforce (orthopedic and plastic surgery hand fellows) relative to allopathic medical students, orthopedic/plastic surgery residents, and the U.S. population.
RESULTS: In the orthopedic hand fellows cohort, the representation of female trainees increased over time, while the representation of white trainees and black trainees decreased over time. In the plastic hand fellows cohort, there was no change in racial, gender or ethnic representation over time. In the orthopedic hand fellows cohort, females, Black, Hispanic, AI/AN, were underrepresented, while males, Asian, and NH/PI, were overrepresented relative to the U.S. population. In the plastics hand fellows cohort, females, black, Hispanic, AI/AN, NH/PI, were underrepresented, while males and Asian were overrepresented.
CONCLUSION: The proportion of females in hand surgery fellowships has improved overtime, however, there continues to be a lack of racial minorities pursuing a career in hand surgery. Hand fellowship directors should continue to promote diversity in the emerging hand surgery workforce.
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