October 2000 Bulletin


Write to The Editor, AAOS Bulletin, 6300 North River Road, Rosemont, Ill. 60018-4262


The article "Road to diversity tough, but possible" (Bulletin, June 2000) was indeed a timely one. The Academy is to be congratulated for raising these issues and hopefully making a commitment for our orthopaedic society to broaden the appeal and enhance the recruitment of individuals into our specialty from diverse backgrounds. However, I am disappointed in the manner in which the Diversity Committee obtained the data, as well as the form in which it was reported. The data, as stated, was obtained from residents surveyed during the OIT exams held in 1999.

The return rate was 85 percent. Would it not have been possible to obtain a more accurate survey by soliciting departments directly through their departmental chairmen or their chiefs of residency training programs? Of more concern, however, was the tabulation of global numbers of minority residents in each program and the implication that some of these programs are indeed at the forefront of recruiting minorities and women. When one considers the size of these programs, however, the number of minorities or women is certainly not as impressive as one would be lead to believe.

For instance, in looking at the six programs mentioned with the largest number of minority residents, actual minority representation as a percent of their total number of residents would present a different picture. Granted, Howard University and the University of Puerto Rico understandably have the greatest percentages of African Americans and Hispanics, respectively. However, the number of minorities as a percentage of the number of residents in the four other "leading" programs would be the following: Harvard at 44 percent; University of Southern California, 37 percent; Case Western, 44 percent; and NYU Joint Diseases, 29 percent.

Two other California programs, on the other hand, which were not mentioned would stand out. They are the University of California at San Diego (50 percent), and the University of California at San Francisco (48 percent). In fact, looking at our program as of this date, we currently have 50 percent of our 28 residents (PGY 1-5) considered minorities by your criteria, four of whom are female. Six of our 22 faculty members are female whom, as Dr. Ries and Dr. Hu pointed out in your article, are wonderful role models helping us in our recruitment of women to orthopaedic surgery.

Before any of us rest on our laurels, however, I would hasten to add that if we remove Asian Americans from your statistics as "an underrepresented minority" (the state of California does not consider them underrepresented), the demographics would be even more troublesome. In that case (percent minorities excluding Asian Americans), the statistics would be the following: Harvard, 17 percent; Case Western, 13 percent; NYU, 6 percent; USC, 25 percent; and University of California at San Francisco, 17 percent (current academic year 25 percent).

I do feel that it is important to bring this to your attention in that with the recent passage of Proposition 209 in California, underrepresented minorities seeking orthopaedics as a specialty may feel that California training programs are, therefore, not as user-friendly and that better opportunities may lie elsewhere. As you can see from your data, nothing could be farther from the truth. California in the next two to three years will be the first state in the union where Caucasian non-Hispanics will be in the minority. Striving to reflect the demographics of our state and country, as we seek diversity in our specialty, is both appropriate and necessary. Indeed, we as a profession have a long way to go. I trust the Academy leadership will make this a high priority."

David S. Bradford, MD
Professor and Chairman
Department of Orthopaedic Surgery
University of California, San Francisco

Responding to the letter by David S. Bradford, MD, regarding the survey data on minorities and women in orthopaedics (Bulletin June 2000). As chairman of the Diversity Committee, I am close to these survey activities, which we completed with the cooperation of the AAOS research department. For your information, we have done two surveys of the OITE test takers, one in 1997 and one in 1999, and we did do a survey in 1999 directly to the program chairs, as you suggested.

Use of the OITE group is a good way to obtain data because it’s a large group of residents and individuals can self-describe their particular minorities. We did want to see if polling the residency program chairs directly would yield better or different data, however. We recognized that this might be a harder survey and that some program chairs might not like to give out this type of data for a variety of reasons. We wanted to make compliance as easy as possible, at least for this first try.

The response rate on the survey to the program chairs was 80 percent; 130 programs out of 162 responded, and this was after several attempts to bring in the surveys.

You will note on the survey to program chairs that we included the following disclaimer:

"No information on your individual residency program will be distributed or published. This is strictly confidential. Data will be combined for regional comparisons and a national composite. In the future, we may publish this information, in the aggregate, in the Academy Bulletin or display it in an exhibit at the Annual Meeting".

We added this disclaimer because we thought that it would help us to obtain a greater number of responses. If we dig into our files I think we do have the denominators you are speaking of, but we promised we would not present the data in that way.

I think that the points you make in your letter to the editor of the Bulletin are good ones and we certainly do want to provide accurate and helpful data on the number of women and minorities in orthopaedic residency programs. We do want to congratulate those programs making great strides in the admission of women and minorities and encourage others to do the same. Some of our Bulletin articles have done this already. And, at the same time, we want to avoid openly insulting or embarrassing those programs with few women and minorities.

We have made a start in the direction of collecting and disseminating diversity-related data, but have a way to go. As leaders like you respond boldly and openly and supportively to questions about diversity, it moves everyone in the orthopaedic community further along in reaching the goals of the Diversity Committee.

The Diversity Committee plans to do another survey in 2001 and I would welcome your input on how we can do this differently and more effectively.

Finally, on a personal note, I am really thrilled to know of your commitment to these issues and very appreciative of the time you have taken to express your concerns.

Augustus A. White, III, MD, PhD
Chairman, Diversity Committee

Healthy People 2010 (a program of the Department of Health and Human Services and Office of Public Health and Science) is designed to achieve two overarching goals: Goal 1: Increase quality and years of healthy life, and Goal 2: Eliminate health disparities. It is encouraging to see that the Academy is supportive of these goals in increasing access to quality medical care in this country.

The article in the June 2000 edition of the Bulletin entitled "Road to diversity tough, but possible", examined the attitudes of orthopaedic chairmen towards the problems in diversity in orthopaedic training.

It is noteworthy that the survey done by the AAOS Diversity Committee had a return rate of 85 percent. It is also very encouraging to know that there was a positive attitude taken by the majority of the department chairmen to ensure that a diverse group of orthopaedic surgeons are trained. This is a way to make sure that access to care will be increased to patients, and to eliminate health care disparities.

The article entitled "Doctors coached on cultural competency" (June 2000 Bulletin) reaffirms that cultural competency not only leads to better outcomes and increases the quality of life, but also is good economics. It is encouraging to see health care planners and managers are taking this attitude.

Congratulations to the Bulletin on these excellent reports.

Raymond O. Pierce Jr., MD
Indianapolis, Ind.

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