Chair Versus Chairman: Does Orthopaedics Use the Gendered Term More Than Other Specialties?

Abstract

Background Orthopaedics is the least gender-diverse medical specialty. Research suggests that the use of gendered language can contribute to workforce disparity and that gender-neutral language supports the inclusion and advancement of women, but the degree to which gender-neutral language is used by academic departments in what typically is a department’s highest position (department chair) has not been characterized. Questions/purposes (1) Is the proportion of department websites that use the term chairman (as opposed to chair) greater in orthopaedics than in five other surgical and medical specialties? (2) Are departments led by chairs who are women less likely to use “chairman” than those led by men, and does this vary by specialty? Methods Seven hundred fourteen official websites of orthopaedic, neurosurgery, general surgery, internal medicine, pediatrics, and obstetrics and gynecology departments affiliated with 129 allopathic medical schools were screened. Any use of the term chairman on title pages, welcome messages, and faculty profile pages was identified using a Boyer-Moore string-search algorithm and terms were classified based on their location on the site. The overall use of the term chairman was compared by specialty and gender of the chair. Results Sixty percent of orthopaedic department websites (71 of 119) used the term chairman at least once, a proportion higher than that of pediatrics (36% [46 of 128]; OR 0.38; 95% CI, 0.23 to 0.63; p < 0.001), internal medicine (31% [38 of 122]; OR 0.030; 95% CI, 0.18 to 0.53; p < 0.001), and obstetrics and gynecology (29% [37 of 126]; OR 0.28; 95% CI, 0.17 to 0.48; p < 0.001), but no different than that of neurosurgery (57% [54 of 94]; OR 0.91; 95% CI, 0.52 to 1.6; p = 0.74) and general surgery (55% [69 of 125]; OR 0.83; 95% CI, 0.50 to 1.4; p = 0.48). Across disciplines, departments whose chairs were women were much less likely to use the term chairman than departments whose chairs were men (14% [17 of 122] versus 50% [297 of 592]; OR 0.16; 95% CI, 0.09 to 0.28; p < 0.001). Conclusions The frequent use of the term chairman in orthopaedics, coupled with the preference of women to use the term chair, suggests considerable room for growth in the use of gender-equal language in orthopaedics. Clinical Relevance Our current efforts to increase the number of women in orthopaedics may be undermined by gendered language, which can create and reinforce gendered culture in the field. Electing to use gender-neutral leadership titles, while a relatively small step in the pursuit of a more gender-equal environment, presents an immediate and no-cost way to support a more inclusive culture and counteract unconscious gender bias. Future studies should explore the individual attitudes of chairs regarding the use of gendered titles and identify additional ways in which biases may manifest; for example, the use of gendered language in interpersonal communications and the presence of unconscious bias in leadership evaluations. Continued efforts to understand implicit bias in orthopaedics can guide actionable strategies for counteracting gendered stereotypes of the specialty, in turn aiding initiatives to recruit and promote women in the field.

Women in academic surgery over the last four decades

“…Interestingly, tradition and departmental culture may also propagate gender stereotypes that women do not “belong” in these surgical specialties. A study of gendered language on departmental websites showed orthopaedics and neurosurgery departments were more likely to use gendered language (such as “chairman”) compared to more gender neutral language (such as “chair”) [ 17 ]. Similar to what is seen in other specialties, female surgeons take on more childcare and domestic responsibilities at home [ 18 ].…”

Is There Gender Disparity in Orthopedic Surgery Resident Research Productivity?

“…Although female editors and authors are increasing in major orthopedic journals [13], female senior authors consistently publish less than would be expected based on their representation, compared with male orthopedic surgeons [2,6]. While recent literature suggests the representation of female authorship has been improving among the major orthopedic surgery journals, persistent disparities in research productivity by female orthopedic surgeons still exist [7,9,10,11,12,15]. This has implications for career advancement and may continue to enable gender disparity in the field [5].…”

“…In the United States, 16.7% of active orthopedic surgery residents are female, the lowest among all medical subspecialties in the country [1]. Among the reasons attributed to the dearth of female representation: implicit bias, limited mentorship, perceptions that too much strength is required, few women in leadership positions, and a lack of collegiality [8,10,12,16]. Although female editors and authors are increasing in major orthopedic journals [13], female senior authors consistently publish less than would be expected based on their representation, compared with male orthopedic surgeons [2,6].…”

Reply to the Letter to the Editor: Medical School Experiences Shape Women Students’ Interest in Orthopaedic Surgery

“…I thank the authors for reiterating how we are simply not doing enough. Each of us has the ability to support diversity, even with actions as simply as our language [5]. I continue to reach out to colleagues who use the term “chairman” and request they use the gender-inclusive term, “chair.” To date, I have only received supportive responses.…”