Patient Disparities and Provider Diversity in Orthopedic Surgery: A Complex Relationship

Abstract

Disparities in the access to, utilization of, and outcomes after orthopaedic surgery are a notable problem in the field that limits patients' ability to access the highest level of care and achieve optimal outcomes. Disparities exist based on numerous sociodemographic factors, with sex and race/ethnicity being two of the most well-studied factors linked to disparities in orthopaedic care. These disparities cross all subspecialties and tend to negatively affect women and racial/ethnic minorities. The increased recognition of the disparities in orthopaedic care has been paralleled by an increased recognition of the lack of diversity among orthopaedic surgeons. Although efforts are being made to improve the representation of women and underrepresented minorities among orthopaedic surgeons, the numbers, particularly of racial and ethnic minorities, show little improvement. The lack of gender and racial diversity among orthopaedic surgeons may be one of many factors related to the gender and racial disparities seen in orthopaedic care. Patients may prefer a provider that they can better identify with and that may affect care. Orthopaedic surgery as a specialty must continue to work to foster an inclusive environment and make concerted efforts to improve diversity through the recruitment of women and underrepresented minorities, among others, for the benefit of patients, surgeons, and the continued growth of the field as a whole. In recent years, there has been an increased recognition of the notable patient disparities in access to, utilization of, and outcomes in orthopaedic care due to various sociodemographic factors, two of the most studied being sex and race/ethnicity. Disparities are seen across all orthopaedic subspecialties, including joint arthroplasty, spinal surgery, and fracture care. At the same time, there has been a recognition of the lack of diversity among orthopaedic surgeons, including both gender and racial/ethnic diversity, among others. The topics of both patient disparities and provider diversity are vast and complex, with numerous causes and influencing factors. As orthopaedic research is only beginning to explore these topics, information remains

Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture

“…48 Increasing attention to inequities in orthopedic surgical care coincides with a greater recognition of the low awareness of health disparities and lack of diversity within this surgical subfield. [49][50][51][52] For instance, Adelani and O'Connor 52 found that only 12% of surveyed orthopedic surgeons believed patients receive different health care because of race and ethnicity. Many have attributed these prevailing beliefs to the racial and ethnic underrepresentation within orthopedic surgery.…”

“…Many have attributed these prevailing beliefs to the racial and ethnic underrepresentation within orthopedic surgery. [49][50][51][52] In 2018, 84.7% of orthopedic surgeons in the US identified as White individuals, whereas only 1.9% and 2.2% identified as Black and Hispanic individuals, respectively. 49 In the past decade, there were, on average, 4 Black and Hispanic hand surgery fellows each year, representing approximately 2% of total fellows, with a flat growth rate over this time.…”

“…[49][50][51][52] In 2018, 84.7% of orthopedic surgeons in the US identified as White individuals, whereas only 1.9% and 2.2% identified as Black and Hispanic individuals, respectively. 49 In the past decade, there were, on average, 4 Black and Hispanic hand surgery fellows each year, representing approximately 2% of total fellows, with a flat growth rate over this time. 53,54 While health inequities are complex, racial or ethnic minority patients may more readily engage with physicians who share a similar background, upbringing, or cultural identity.…”

“…53,54 While health inequities are complex, racial or ethnic minority patients may more readily engage with physicians who share a similar background, upbringing, or cultural identity. 49,54,55 Thus, enhancing diversity in these subfields, such as through participation in pipeline or summer immersion programs, 53 could play a role in more equitable patient outcomes.…”

“…Third, physician-level factors, such as implicit bias, could lessen the offering of ORIF to racial or ethnic minority patients . Increasing attention to inequities in orthopedic surgical care coincides with a greater recognition of the low awareness of health disparities and lack of diversity within this surgical subfield . For instance, Adelani and O’Connor found that only 12% of surveyed orthopedic surgeons believed patients receive different health care because of race and ethnicity.…”