The 'leaky pipeline' in orthopaedic surgery: why female trainees drop out?

Abstract

Background: Orthopaedic surgery remains one of the least gender-diverse medical specialties, with women making up a small fraction of practicing surgeons despite increasing female enrolment in medical schools. The "leaky pipeline" phenomenon describes the progressive loss of female trainees due to systemic barriers such as implicit bias, workplace discrimination, inequitable surgical training opportunities, and inadequate work-life balance policies. Understanding the factors contributing to female trainee attrition is essential for fostering gender equity in orthopaedic surgery.

Main body: Female orthopaedic trainees face unique challenges, including stereotypes that question their physical capability, limited access to mentorship and sponsorship, and an unsupportive workplace culture. Many report experiencing discrimination, microaggressions, and exclusion from leadership pathways. Additionally, disparities in surgical case assignments limit skill development and career advancement, further discouraging retention. Work-life balance remains a major concern, as rigid training schedules and insufficient parental leave policies force many female trainees to reconsider their career paths. These systemic barriers contribute to higher attrition rates and hinder efforts to diversify the orthopaedic workforce. To address these issues, institutions must implement targeted reforms. Formal mentorship and sponsorship programs can support female trainees in securing leadership roles and competitive fellowships. Equitable case distribution policies are necessary to ensure fair training opportunities. Institutional commitment to creating inclusive environments through bias training and zero-tolerance policies for discrimination can help improve retention. Additionally, introducing family-friendly policies, such as flexible scheduling and structured parental leave, can make orthopaedic surgery a more viable career choice for women. Early outreach initiatives should also be expanded to encourage female interest in the specialty.

Conclusion: Gender disparities in orthopaedic surgery persist due to longstanding systemic challenges. Without targeted interventions, the leaky pipeline will continue to exclude talented female surgeons, limiting diversity, innovation, and patient care. Institutional commitment to mentorship, equitable training opportunities, and supportive workplace policies is essential for retaining female trainees and achieving gender equity in orthopaedics. Addressing these barriers will ensure that success in the field is determined by skill and dedication rather than gender.