Diversity in medicine

Avant media

Sunday, 8 January 2023

Female surgeon

When Dr Jennifer Green started out as a trainee and was considering orthopaedics as a specialty, there weren’t any female orthopaedic surgeons in Sydney.

“I never really thought much about it at the time,” Dr Green reminisces. “I knew I wanted to go into orthopaedics, and that’s what I did. It wasn’t until many years later that I looked back and realised there was a very tiny trickle of women following in our footsteps."

In the two decades since, orthopaedics in Australia has come a long way, even though there is still much work to be done. It wasn’t until November 2022 that the Australian Orthopaedic Association (AOA) Orthopaedic Women’s Link (OWL) representative on the board of the AOA was given the right to vote.

Women only make up 5% of orthopaedic surgeons in Australia, despite more than 50% of those going to medical school are women. Australia is well behind Canada and Malaysia who have more than 10% female representation in orthopaedics1.

“For so many years, women have been isolated from each other and are much less embedded in orthopaedic networks. It is not until recently that we developed a strong network through using a group app to connect.”

Leading by example

Earlier this year Dr Green, a Canberra based orthopaedic hand and wrist surgeon, was the recipient of the Australian Medical Association’s first-ever Diversity in Medicine Award, commended on her work in promoting diversity, equity and inclusion in orthopaedics.

As the former chair of the AOA’s Orthopaedic Women’s Link (2018-20), Dr Green’s main role was to drive the AOA diversity strategy. During this time, she founded the International Orthopaedic Diversity Alliance (IODA), a non-profit organisation of more than 1,000 members worldwide connecting to champion diversity, equity and inclusion in orthopaedics.

Unconscious bias

Despite the lack of visible female representation in her specialty, Dr Green says she did not suffer any discrimination or setbacks. “It’s an ‘unconscious bias’, rather than discrimination,” says Dr Green. “Historically, when joint replacements all had to be done by hand, there was a reason why tall, strong males were the dominant members of the orthopaedic fraternity We have had power tools for more than 50 years which mean strength is not a priority and there are also many more sub-specialities to choose from. However, despite these significant changes, the gender diversity of the orthopaedic workforce has remained very low and we now understand the many barriers to diversity and the strategies that are most successful to overcome them.”

One significant barrier is the ‘hidden curriculum’ at medical school, where long-held stereotypes are shared with students by medical faculty, such as ‘orthopaedics is a boys’ club’, which deters women from choosing orthopaedics.

“The most effective tool we have established at AOA to combat this is a workshop program called ‘A glimpse into the life of orthopaedics’. These include a ‘hands-on’ workshop with the opportunity to use drills and plates, practice arthroscopy and apply plaster casts. At these workshops, half of the facilitators are male colleagues who are allies for gender diversity. It sends a very powerful message that women are welcome in orthopaedics.”

Fight for equality

While encouraging and supporting diverse students to enter orthopaedics is one tactic, Dr Green knows the fight for inclusion begins from the top down. “We created a charter we’re inviting every national orthopaedic association to sign, stating they will commit to a diversity strategy and strive to include minorities,” explains Dr Green.

Dr Green says studies show that if you have more diversity in your organisation, you attract the top talent, you make better decisions and you are more innovative.

“People think diversity is something nice to have but not really relevant,” says Dr Green. “But if you don’t have a diverse work force, your patients will suffer. Evidence shows there are profound healthcare inequities. A study in Canada a male with severe osteoarthritis in their knee was 22 times more likely to be offered a knee replacement than a woman2. There are worse outcomes if parents don’t have English as a first language. LGBTQI patients also face barriers because we have so few LGBTQI surgeons in orthopaedics. People that present as gender diverse get lower access to care.”

Balancing act

Despite having a full-time practice in addition to her advocacy work, Dr Green still finds time for her husband, two teenage daughters, and dogs. She says it is also key to be proactive in finding time for her own interests and to look after her own physical and mental health.

“I haven’t always been good at this, you need to be really deliberate about it,” says Dr Green. “It is challenging and I know plenty of people who have struggled, and we are all trying to do better.”

1. Hiemstra, Laurie A. et al. 'Experiences of Canadian female orthopaedic surgeons in the workplace: defining the barriers to gender equity'. J Bone Joint Surg Am. 2022 Aug 17; 104(16):1455-1461.

2. Borkhoff, Cornelia M. et al. 'The effect of patients' sex on physicians' recommendations for total knee arthroplasty'. Canadian Medical Association Journal. 2008 Mar 11; 178(6): 681–687.

This article was first published in Connect magazine issue no. 19.

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