June 2007 | Back to Table of Contents

Pulse

Where Women Dare to Tread

Orthopedic surgery has traditionally been dominated by men. But the times are a changin'.

Ten years ago, Gina Reese hurt her knee playing rugby. Although she didn’t need surgery, her orthopedic surgeon recommended that she wear a brace for months, lay low, and pretty much give up sports. The news was crushing. An athlete since childhood, Reese wasn’t willing to let go of her passion. So on the advice of another rugby player, she sought a second opinion from Elizabeth Arendt, M.D., vice chair of the University of Minnesota’s department of orthopedic surgery and medical director of the men’s and women’s intercollegiate athletics department. “I remember I had an entire speech prepared just to try to get her to listen to me, to get her to understand that sports were a big part of my life,” she says. “I didn’t even need it.”

Reese discovered that her medial collateral ligament injury could heal with about six to eight weeks of physical therapy and that she would not need a brace. A few months after her diagnosis in the fall of 1996, Reese, now 43, began training for the spring rugby season and the Twin Cities Marathon, which she completed in September 1997. Now retired from rugby, she is pain-free, plays ice hockey, and continues to run half-marathons and participate in triathlons. She attributes much of her recovery to seeing a female orthopedic specialist. “I felt because she was a woman, she advocated for me,” Reese says of Arendt.

Arendt, who was the first female orthopedic surgeon on staff at the University of Minnesota, empathizes with patients such as Reese, who come to her after less-than-positive clinical experiences. “The recurrent theme I hear from female patients is that I listen to them and I take their complaints and questions more seriously, particularly as it relates to their pursuit of athletics,” she says. “It doesn’t mean that all female physicians do this, and it doesn’t mean that all male physicians don’t.”

Breaking In
Even as more patients such as Reese seek out female orthopedic surgeons, and even as surgical residencies have become more family friendly with the Accreditation Council on Graduate Medical Education’s 80-hour work week and 24-hour shift-length limits, orthopedic surgery still suffers from gender imbalance. In 2006, the American Academy of Orthopaedic Surgeons (AAOS) published a report on orthopedic practice in the United States. Women comprised 3 percent of the board-certified orthopedic workforce and 6 percent of candidates or applicants for membership in 2005-2006. But the imbalance may be shifting. Between 1998 and 2001, the percentage of female orthopedic residents increased slightly, from 7.6 percent to 9.8 percent, according to an AAOS survey. In 2005, 11 percent of residents in orthopedic surgery were women, according to a September 2006 article in the Journal of the American Medical Association.

Women's Work Female orthopedic surgeons are contributing to their specialty in a number of ways. For example, after her own clinical observations revealed differences in how male and female athletes obtained anterior cruciate ligament (ACL) injuries, Elizabeth Arendt, M.D., vice chair of the University of Minnesota’s department of orthopedic surgery and medical director for intercollegiate athletics, scrutinized five years of data from the National College Athletic Association’s Injury Surveillance System on ACL injuries in men and women in college soccer and basketball programs. The results, published in 1995, revealed that men’s ACL injuries were primarily the result of contact, while women’s were not. “A contributing factor is the greater quadriceps strength and relative weakness of hamstring muscles found in most female athletes,” says Aimee Klapach, M.D., an orthopedic surgeon with Sports and Orthopaedics Specialists in Edina. “This means that there is a huge window of opportunity for prevention programs for female athletes—working on hamstring strengthening as well as core strengthening—to avoid ACL injuries.” Last year, when Klapach and partner Daniel Buss, M.D., saw that the protective slings used to stabilize dislocated shoulders were ill-fitting for their female patients, they designed a new one that could accommodate the female form more effectively. Shortly thereafter, Klapach and colleague Lisa Wasserman, M.D., another orthopedic surgeon, established Sports and Orthopaedics Specialists’ Women’s Orthopaedic Center, which was launched in April and emphasizes the unique aspects of musculoskeletal health in women.—J.M.

The number of women in Minnesota’s orthopedics residency programs may be small, but their percentages are at or above the national averages. According to data compiled by the University of Minnesota’s department of orthopedics for the 2006-2007 academic year, three of seven first-year residents, one of eight second-year residents, three of eight third-year residents, one of five fourth-year residents, and two of six senior residents are women. But in 2007, only one of the 107 women graduating from the University of Minnesota Medical School was matched with a residency program in orthopedic surgery. Six of the 50 orthopedic surgery residents at Mayo Clinic are women, as are two members of the cohort of 10 that will begin this summer. None of Mayo Medical School’s 2007 graduates are pursuing orthopedics.

One reason the specialty has traditionally failed to attract women is the perception that it’s physically demanding. Surgeons had to rely on their strength to cut through bones and insert pins. They had to be able to lift patients to position them for procedures. “In the old days, before we had a lot of power tools and instruments in the OR, orthopedic surgery was an extremely physically demanding field, and, unfortunately, a lot of advisors still think it’s that way,” says Kim Templeton, M.D., associate professor of orthopedic surgery at the University of Kansas Medical Center. Templeton is working with the AAOS and the Ruth Jackson Orthopedic Society to try to increase the number of women in the profession. “We’re trying to get the message out that there are different ways of doing things besides with just brute strength.”

Julie Switzer, M.D., an assistant professor of orthopedic surgery at the University of Minnesota and director of geriatric trauma at Regions Hospital in St. Paul, has become skilled at finding better ways to do her work. Five-feet, 4-inches tall, she frequently takes Level I trauma calls for fractures and other serious injuries. Says Switzer: “You can either use brute strength or you can figure out the problem and use adequate anesthesia and sedation [so you aren’t fighting the patient’s muscle forces] or use biomechanical principles more precisely.”

Moving toward Change
Templeton knows that there are a number of reasons why attracting more women to orthopedic surgery is important. “First, it’s the right thing to do. Second, if women are interested, they should feel like they are welcome in the field,” she says. “The third is somewhat self-serving: If you are not making the field attractive to half of the medical student population, by definition, you are limiting the people who are applying to your program, and eventually, that is going to affect the quality of the specialty.”

One way to encourage women is to mentor them. “One issue that we have in medical schools is that there aren’t a lot of female faculty in orthopedic training programs and so the students aren’t seeing women out there as role models,” Templeton says.

The Ruth Jackson Orthopedic Society, which was created in 1983 as a support and networking group for female orthopedic surgeons, has a mentoring initiative and works with the AAOS, which also has a diversity/mentoring program. The society provides scholarships to female medical students who want to attend its conferences and meet women who are having success in the field. Says Templeton, a past president and current board member: “It gives them the opportunity to meet a group of great women who are orthopedic surgeons—all of whom have lives outside of their practice—so that they can get a sense for what it’s like to work within the field.” Several University of Minnesota students have received mentoring or scholarships through the Ruth Jackson Society.

During her 22 years as an orthopedic surgeon, Arendt has seen orthopedic practice open up to women. When she was applying for residencies in 1979, she recalls how the specialty “was almost trying not to attract women.” During two interviews, she was asked how she thought she could hold up to the rigors of the field and what would happen if she got pregnant.

But times and attitudes have changed. When she became the first female surgeon at the university to have a child, she orchestrated her own pregnancy leave. Later, she and Ann Van Heest, M.D., another orthopedic surgeon at the university, developed maternity, paternity, and adoption leave policies for the orthopedics residency program.

Such policies have caught the attention of medical students. “Female students have an extraordinary interest in orthopedics in our medical school,” Arendt says. “I am sure that in part it is due to the exposure that women have here—the role models that I hope that we have made for them.”—Jeanne Mettner