CORR Insights®: How Well Represented are Women Orthopaedic Surgeons and Residents on Major Orthopaedic Editorial Boards and Publications?

Where Are We Now? Although a large majority of orthopaedic surgeons are men, more and more women are filling positions in orthopaedic surgery training programs, with approximately 13% to 14% representation in recent studies [2, 5]. The gender gap in orthopaedic surgery, as illustrated by Rynecki and colleagues [6] in the current study, has marginally decreased in research and editorial participation, mostly in first authorship roles and in junior editorial positions. For the sake of diversity, this is a positive development. However, the glass ceiling remains substantially intact. Despite increasing participation by women in orthopaedic research and in junior editorial positions, and despite the thousands of peer reviews for orthopaedic journals completed by women, no woman has occupied the editor-in-chief position at three major orthopaedic journals—Clinical Orthopaedics and Related Research® (CORR®), Journal of Bone and Joint Surgery (JBJS), or Journal of the American Orthopaedic Association (JAAOS)—in the last 20 years [6], or ever. Others have identified this lack of gender diversity in professorial and chair positions in orthopaedics as well [2]. Rynecki and colleagues [6] postulate that the younger generation has simply not yet reached an age or experience level to gain leadership positions in orthopaedic academic publishing. There may be some validity to this argument; however, the truth is likely more complex. I am of the opinion that the higher women climb in orthopaedic leadership, the more they feel the glass ceiling above their heads. Where Do We Need To Go? How can the glass ceiling be shattered? The answer to this question is straightforward—women with the skills and desire need the opportunity to lead orthopaedic journals. Women are Chief Executive Officers of major corporations [10], leaders of their countries and major international organizations [7], and Academy Award winners in film directing—a category (in)famously dominated by men [10]. But women haven’t helmed an academic orthopaedics journal? It is possible that orthopaedic journals are susceptible to blind spots when considering women for top positions—perhaps their value as potential leaders has been overlooked. There are some parallel examples, however, that can inspire change. The current editor-in-chief of the Journal of Orthopaedic Research, a publication of the Orthopaedic Research Society, is a woman. The current President of the American Academy of Orthopaedic Surgeons is the first woman ever to hold that position since the Academy was founded in 1933. There have been women Presidents of the Orthopaedic Research Society, one who is currently a Senior Editor at CORR. And although they are not published by highly male-dominated clinical specialties, some of the most prestigious medical journals in the world (Nature, British Medical Journal) have been, and are, led by women [4, 9]. These facts are inspirational. And perhaps we need more inspiration to expand gender diversity in academic orthopaedic publishing and the associated senior authorship and top editorial positions. This inspiration will only be possible if qualified women have the opportunity to be leaders. More women will need to choose orthopaedic surgery as a specialty, and the younger generation will need to advance in their careers. These are concrete steps that can be taken towards greater equity in journal leadership. Although the percentage of women on the editorial board of CORR exceeds the number of women in our specialty, as indicated by Rynecki and colleagues [6], it may be that there have not been any women applicants to the editor-chief position at JAAOS, JBJS, or CORR. The authors do not provide this information. But even if none have applied, we need to consider the possibility that women may be reluctant to apply, given the general lack of women in role-model positions, and therefore perceived little hope of success. How Do We Get There? For the glass ceiling to break, we first need to understand the reasons for its existence. Open discussion and acknowledgement of the current culture in academic orthopaedics would be the first step in understanding and addressing the lack of leadership positions held by women in our field. These discussions can start with determining anonymously the perceptions of both men and women in orthopaedic surgery regarding the demands and skills needed to lead academic journals, and the perceived ability of men and women to meet these demands. Surgeons can also be anonymously asked if they have experienced gender discrimination in the work place. In fact, an ongoing survey sponsored by the Canadian Orthopaedic Association is determining just that, with 400 responses so far [11]. Another source of information that is likely to be informative would be qualitative research (data obtained from group discussions and interviews, for example [1]) in the form of focus-group discussions designed to identify barriers to women in academic orthopaedics as they approach leadership roles. These discussions can involve both men and women, together or separate, frankly answering open-ended questions about situations where women are considered for positions in which they would be leading men and women. This type of research can be repeated in various countries and healthcare systems to determine if the current culture is pervasive or localized. It is likely that these approaches will uncover specific reasons for the current situation, such as barriers identified that women perceive when hoping to advance their careers, and misconceptions about available opportunities. Orthopaedic surgery is not alone in poor representation among women in the highest editorial positions, as other areas of medicine and science such as dermatology and environmental sciences are in a similar situation [3, 8]. However, our specialty could take these first steps to increase diversity and strengthen our speciality’s editorial leadership.

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