Gender Differences Among Shoulder Arthroplasty Surgeons: Past, Present, and Future.

INTRODUCTION: Reducing differences in the gender representation of shoulder arthroplasty surgeons may help optimize patient care. This work aims to determine (a) the current gender distribution of surgeons performing shoulder arthroplasty, (b) how gender relates to practice patterns among shoulder arthroplasty surgeons, and (c) how gender distribution has been changing over time.

METHODS: The Medicare Provider Utilization and Payment Data for years 2012-2020 was utilized to identify orthopedic surgeons performing anatomic and reverse total shoulder arthroplasty (current procedural terminology [CPT] code 23472). The dataset provides self-reported gender, credentials, national provider identifier (NPI), annual volume for all procedures (based upon CPT) that were performed at least 11 times in the calendar year, and location for all included providers. The dataset was linked to the Medicare physician compare dataset using NPI numbers to determine hospital affiliations, year of medical school graduation, and graduating medical school. All included hospitals were queried to determine academic status (affiliated orthopedic residency or fellowship program). The American Shoulder and Elbow Surgeons (ASES) directory was reviewed to determine gender breakdown of current members.

RESULTS: The number of surgeons performing at least 11 shoulder arthroplasty annually increased from 821 (13 females; 1.6%) in 2012 to 1,840 (53/1,840 females; 2.9%; p=0.05) in 2019. One female ranked in the top 100 surgeons by shoulder arthroplasty volume in 2012 and in 2020. Female surgeons graduated more recently from medical school (mean: 2005) compared to male surgeons (mean: 1997; p<0.001). About 10% of female (10.8%, 12/111) and male surgeons (9.1%, 229/2528) practiced at hospitals with orthopedic residents (p=0.50). Female surgeons performing shoulder arthroplasty were less likely than males to perform total knee arthroplasty (29.4% versus 54.1%; p<0.001) and total hip arthroplasty (12.6% versus 34.7%; p<0.001). There were 86 female members of the ASES (6.7%; 86/1275), with a significant difference in the proportion of women in differing membership categories (p=0.017).

DISCUSSION AND CONCLUSION: A diverse cohort of high-volume shoulder replacement surgeons is integral to delivering high-quality shoulder arthroplasty. Currently, the proportion of women performing high volume shoulder replacement in the US is small, with little improvement in recent years. However, women performing shoulder arthroplasty are younger, often involved in academic practices, and the membership of the ASES is increasingly female. Continued efforts to promote orthopedics, and mentor women residents and medical students interested in shoulder surgery, may bring real change to the gender differences among shoulder replacement surgeons over the coming years.