Gender trends in orthopedic surgical residency programs in Canada over 20 years.

Background: Gender disparities exist in several surgical specialties, particularly in orthopedic surgery. The purpose of this study was to determine the current trends in gender diversity among orthopedic surgical residents in Canada over the last 20 years.

Methods: We analyzed gender distribution data for orthopedic trainees from the Canadian Resident Matching Service (CaRMS) for 2013-2022 and the Canadian Post-MD Education Registry for 2000-2022 using linear and quadratic regressions.

Results: More male (4.7%) than female medical students (1.9%) applied to an orthopedics program (p < 0.001). The proportion of male applicants entering CaRMS who applied to orthopedics followed a quadratic (U-shaped) distribution over time (p = 0.01). The proportion of female applicants remained unchanged from 2013 to 2022 (p > 0.9). However, for matching results, among the applicants who applied to orthopedic surgery, there was no gender effect (men 56.1% matched, women 50.3% matched; p = 0.3). The proportion of residency spots offered to female applicants remained at around 30%, without significant changes over time (p = 0.1). The number of female orthopedic graduates increased linearly from 2000 to 2021 (p < 0.001), projected to reach gender equalization (at 50%) by 2060. Female residents experienced higher attrition in residency (3.4%) than male residents (2.1%; p = 0.05), and this gender difference is decreasing over time (p = 0.03).

Conclusion: Over 2 decades, women have shown consistently lower rates of application to orthopedic surgery programs than their male colleagues. Women who matched experienced higher attrition rates than men, although this appears to be improving over time.