Orthopaedic "Person"

When I joined Orthopaedics as a trainee back in 1998, it was a male dominated specialty especially in Mumbai. One is immediately given the impression that one needs to be a macho alpha male to fit into the “orthopaedic Profile” and to survive the residency programme in one of the busiest hospitals in Mumbai. The social, cultural and unconscious biases inculcated within medical school meant that no females from my batch even considered taking up orthopaedic surgery as their specialty. There were merely a handful of female orthopaedic surgeons in the city at the time. And this is even though one of pioneers of Paediatric orthopaedic surgery in Mumbai was a female Orthopaedic surgeon, Dr Ms Perin Mullafiroze, in the 1960s.

Fast forward to 2007, I joined the Manchester residency programme. It may have been my own unconscious bias or a preconceived self-belief, but I felt like a misfit. The expectation or at least what I thought was the expectation was that of an alpha male, ex-rugby player (built like one too) with a keen interest in sports (football especially!). Most conversations in theatre did revolve around football (of course when not teaching and training!). Slowly, but surely over the 6 year period, you find your niche, start getting comfortable and confident in your own skin. Mind you, I never felt like an outsider in the region, and ethnicity-wise, Manchester was the most diverse region. There were 6 Indian/Asian trainees out of 12 trainees in the year I joined the programme, but only one female trainee out of 12!

Fast forward to 2022, I feel extremely comfortable in my own skin as a paediatric orthopaedic surgeon, but more importantly the diversity of fellows and trainees coming to work in the department would be unimaginable in 1998! The conversations in theatre don’t revolve around sports alone, but a wide range of topics including politics, films, (Marvel universe particularly), finance, and music. I now see so many female trainees in Orthopaedics. I am told Wessex region is an outlier in terms of high number of female trainees in Orthopaedics and the numbers around the country remain dismal.

One of the common misconceptions around Orthopaedics is that it is a specialty that requires a lot of physical strength. The stereotypical picture is that of a burly man in scrubs with hammer in one hand and a drill in another! However, a wise trainer had once told me that Orthopaedic surgery is not about strength, but about precision, movement and technique. If you are using strength to do something, you are not doing it right! I completely agree with that, and it has stayed with me all my life. There is perhaps only one surgery in orthopaedics that actually requires physical strength, and that is implant removal, especially a stuck intramedullary nail! But who says that women orthopaedic surgeons do not have that strength?

(Check out this video on youtube. https://www.youtube.com/watch?v=xRE3FFew9eo)

Stereotyping is not unique to orthopaedics. Popular culture and media has played a major role into our social/cultural bias into what a doctor should look like or behave. Doctor films from the 1960s, Benny Hill series, Carry on doctor have all portrayed the surgeon to be a beer guzzling sexist strong man. There was also a popular notion that GPs need to be a nurturing paternal married man wear with jackets with tweed /leather elbow patches. Of course that has thankfully changed. The "hidden curriculum" is the unofficial bias introduced very early on in medical school influencing the choice of a future medical career.

Despite changing trends and demographics globally, the recent statistics published in Bone and Joint Open shows staggering discrepancies between the number of male and female orthopaedic surgeons. As recent as 2020, females accounted for only 25% of all orthopaedic trainees and only 7% of orthopaedic consultants in UK. This figure comes in at sharp contrast to the entrants in medical school in UK, where the number of female doctors has far surpassed male doctors at 55%.

?The international Orthopaedic diversity alliance published some data recently from national orthopaedic associations worldwide and found Estonia, Sweden and Brunei to be the top three countries with most female orthopaedic surgeons. UK ranked at number 15 and India at 26!

We still have a long way to go but steps are being taken in the right direction. British Orthopaedic association currently has as its president Ms Deborah Eastwood, a strong advocate and champion for diversity in orthopaedics. BOA has already published its action plan highlighting different steps to be taken to increase diversity within its committee, programmes, conference and trainees.

The most important change, should and will come from individuals who break stereotypes, challenge the norm and provide good role models to future generations of medics.