Melanie Cole (Host): Interestingly, the gender distribution of medical schools around the country is about 50/50, according to the NIH. With orthopedic residency programs, however by contrast, are nearly 90% male. My guest today is Dr. Linda Suleiman. She's an orthopedic surgeon at Northwestern Memorial Hospital. Dr. Suleiman, traditionally as orthopedics is male dominated, what led you to pursue this specialty?

Dr. Linda Suleiman, MD (Guest): Sure. The major reason I pursued orthopedic surgery is when I was a medical student I really didn't get the sense that orthopedics was male dominated, and it's probably because I had a female mentor. I was exposed to a female orthopedic surgeon probably my first year of medical school. And so at that time, my perception of orthopedics wasn't that it was a male dominated specialty until I was a fourth year medical student actually going away and doing rotations at various hospitals where I started to look around and I was the only woman in the room. And so I think that's a major reason why women who do go into orthopedics, is because of the fact that we're exposed early to female mentors.

Host: That's a very good point. So what do you see are some of the barriers to more women practicing orthopedics? And also, do you think there's a good reason why female students aren't seeking residency programs in orthopedics? Has it been that it's sort of like this tough guy thing, bone-breaking carpenter type practice of medicine? What do you think are some of those barriers?

Dr. Suleiman: No, I think historically the perception of orthopedics is that it's a boy's club. It's a fraternity of men who are doing this carpentry like field with saws, and screws, and hammers, and I think when medical students rotate in orthopedics, and during their third year, if all the people in the room are guys, you're attracted to specialties that are like you, that act like you, that you can identify with.

And I think the first thing is that orthopedics is not a required rotation for the majority of medical schools. So it's not part of the core surgery sub-specialties to learn as a medical student. So initially, the exposure isn't there. And then when you get the chance to do it as an elective, most of the guys in your class are doing that elective because they see other guys doing that sub-specialty.

And so I think personally if we can expose all students as a required rotation, even if it's for a two-week rotation, something small within the surgery rotation, I think you'd get a more diverse plethora of applicants, especially since 50% of women are medical students.

Host: Which is true, and again, such a good point. Let's speak about some of the myths about orthopedics that might deter women from practicing it. And I mentioned the carpenter factor, or the strong bone work stuff, but also the financial inefficiency. Do you feel that on call duties for orthopedics might have made the field unappealing? Because I don't understand that women are going into pediatrics, and that's on call a lot. So do you think that some of those kinds of things are coming into play here?

Dr. Suleiman: I think that the perception is if you do surgery, you're going to have a worse lifestyle. I think that's the perception to medical students as far as in general, and I think that as a woman who saw another woman practice orthopedics who had three children, that perception of, 'You can't have kids, you can't have a family, you can't be a mom, you can't be a wife.' That whole perception went away because I saw someone doing that.

But the majority of departments and programs may not have women living the type of life they want to live, for example, and those medical students start to perceive those perceptions as reality, and that you can't have the lifestyle that you want, so they go to other specialties. But again, it's exposure and mentorship, and I'm glad we have groups like the Perry Initiative, which was named after one of the first female orthopedic surgeons to expose high school students, college students, medical students into orthopedics early so that they see that you can be one of us.

Host: That's really very interesting. Now tell us about your research on gender disparities in orthopedics. What did you look at, and what are your findings, and where does the wage gap fit into this picture?

Dr. Suleiman: Sure. My research in women orthopedics looked at population trends in trainees and practicing surgeons. So we wanted to look at the data from the AAMC back in 2005-2006 versus the data- the most recent data was 2016-2017, to look at how has our specialty grown in a decade? And when we looked at us compared to other specialties that were not doing so well like neurosurgery, like thoracic surgery, who were around the same number of kind of like 11% back in 2005. They had exponential increases, whereas we had very small increase in that number.

And so our data looked at, 'Well, what are the current number of residents?' And then from there, we wanted to look at rank. So we saw that there was a discrepancy; in women who are in orthopedic surgery, the number of department chairs. There's one orthopedic woman who's a department chair in the country. Only 8.7% of professors in orthopedic surgery were women. So even when you were in an academic setting, we didn't see the growth in rank, and I think that can come back toward as you grow in rank, will grow your financial wage.

And so I think the financial discrepancy is a completely separate topic, and I think that's not just within orthopedics, but I think that's across both medical and non-medical specialties, is that we don't do a good job of asking for what we want and what we deserve.

Host: Interesting. We certainly don't, and as women, it would seem that as breaking onto the medical scene. Dr. Suleiman, what do you want women to know about what the health systems and medical training programs can do to recruit more females to orthopedic surgery? I mean, do you want them to be in this specialty? I think it would be wonderful. There are so many women today in sports, and sports medicine, and being athletes, and youth athletes, that there's so much of a need now.

Dr. Suleiman: You know, the majority of some of the surgical sub-specialties that's within orthopedics, most of the patients are women. And to not have the same representation from the physician side, it hurts the care that we can provide to all patients. There's a level of understanding. When you diversify your work force, it leads to better and broader ideas because you see different perspectives of the same topic.

So even if your department may not necessarily be the most diverse from a gender standpoint, it's the environment, the cultural competency within that department, and the culture of the department that makes a woman feel comfortable being in that department. So I think from a departmental standpoint of recruitment, training our current faculty, training our current residents about implicit biases can change the environment in which women work.

And so that's one way I think the departmental side can recruit more women from a faculty standpoint. I think from getting more women into residency, it's exposure, and showing our medical students early on that you are welcomed into this specialty, that you will be successful in this specialty, and it's mentorship. And your mentor doesn't have to be a woman, but it's a mentor who's going to convey that message.

Host: Is there anything else you'd like to finish up with, Dr. Suleiman? I think this is such an important topic, and it can really reach across all the spectrums of medicine where there is a gender discrepancy. What would you like to summarize? What would you like the listeners to take away from the segment?

Dr. Suleiman: I think what I want for listeners to take away is don't be afraid to have a conversation early. If you see talented medical students who are women, instead of asking the question of, "Well, why would you want to do orthopedics?" We start asking the question of, "How do you think you can contribute to the field?" You know I see it so often, even when I was a medical student, when you're on rotations and the attending asks you, "Well, you want to do ortho? Why would you want to do that?" Instead of doubting our female medical students, I think we should be uplifting and supporting them when they decide, "This is what I want to do."

Host: Great idea, great information. Thank you so much. The research is so interesting and I hope that you'll come back on with us again and tell us how this is moving along, and if you think things are changing. Thank you again for joining us. This is Better Edge: A Northwestern Medicine Podcast for Physicians. For more information on the latest advances in medicine, please visit www.NM.org. That's www.NM.org. This is Melanie Cole, thanks so much for listening.