Trailblazing Female Orthopaedic Department Chairs Offer Wisdom for Next Generation of Women in Leadership

Medicine has made great strides in gender representation over the past decade; however, the underrepresentation of women is more pronounced at higher levels of training and leadership. Although there have been advances in the field of orthopaedic surgery, underrepresentation persists. In 2019, women constituted 15.4 percent of orthopaedic surgery residents, 19.9 percent of faculty, and 9 percent of program directors. The 2023–2024 academic year marked the first time that the number of orthopaedic surgery department chairs who were women hit double digits, a significant increase from one in 2015–2016 (Fig. 1).

The scarcity of female department chairs may reflect existing barriers to women’s advancement in the field of orthopaedic surgery. Previous studies have surveyed female department chairs in other specialties. Building on those studies, the authors conducted a survey-based inquiry to draw on the experiences of the 10 female orthopaedic surgery department chairs as of summer 2023, nine permanent and one interim (Fig. 2). The aim was to explore past experiences and current perspectives of these trailblazing women and to provide a personal touch of advice for aspiring female orthopaedic surgeon leaders. The following is a summary of the survey results.

Average overall job satisfaction was rated 8.9 out of 10. Satisfaction was driven by purpose and fulfillment to affect organizational changes and create a positive impact across all levels of the department. The top motivation to become chair was the desire to lead and build the department. Prior leadership experiences within the hospital emerged as the most helpful experiences for preparing for a chair position. The most common previously held leadership positions among current chairs were vice chair (90 percent) and division chief (70 percent). Therefore, obtaining leadership experience and seeking mentorship were ranked as the top advice for aspiring female surgeons, and current chairs are eager to empower the next generation of women leaders in orthopaedic surgery.

Some survey participants also highlighted the value of developing institutional knowledge across domains, such as human capital, operations, and finances. Additionally, the presence of gender biases was identified as a major obstacle to leadership. Respondents wrestled with aggressions, perceptions of competence, and challenges to their abilities from colleagues or superiors. As a result, they felt their authority was often undermined, and greater efforts were required for recognition and institutional support.

Lastly, the respondents advised development of leadership skills, whether through formal coaching, leadership courses and resources, or education (i.e., obtaining an MBA degree). Respondents also underscored the importance of advocacy and authenticity in leadership. Leadership roles are challenging but can cultivate personal growth by refining awareness of personal strengths and weaknesses and overcoming self-doubt. Authenticity lies at the core of their leadership philosophy and involves advocating for themselves with confidence. These themes are reflected in selected quotes from respondents, summarized below.

• “I feel more like I have a wider sphere of influence than I did before. I feel that I am using a completely different skill set than I do as a surgeon, and it is both challenging and rewarding.”
• “Don’t be afraid to ‘stretch’ yourself. It is a big role but has many rewards. You will never be absolutely ready for the role. Embrace the challenge.”

Mentorship and support

• “I was surprised by how satisfying the creative aspects of the job are in leading department initiatives, and helping and mentoring faculty, and in working in the health system.”
• “I have also benefited from mentors and sponsors who were not afraid of my being a woman.”
• “Hang out with women chairs and get advice. I think we are all ready, willing, and able to mentor more women for these roles.”

Authenticity in leadership

• “Follow your passion, stay true to yourself and your style, find your mantra as a leader. Mine is, ‘How do I help you become your best you?’ for all of the people in my department.”
• “Learn the selective ‘yes’—the things you should say yes to that advance your career or put you on the map. Say something of value at each important meeting. Be brave and be heard.”

Serving as a department chair demands not only clinical expertise but also leadership skills to shape future policies and practices at the broader departmental and institutional levels. For women in particular, the journey to this prestigious position is often complicated by existing biases, institutional barriers, personal sacrifices, and a lack of female representation in leadership. Nonetheless, the survey found that current chairs depicted their leadership roles as a journey of personal growth, marked by embracing both the challenges and incredible rewards derived from their roles.

Female representation in leadership is essential to creating a robust pipeline of future female leaders by establishing mechanisms for mentorship and inspiration. At every level of training, the impact of increasing representation is tangible. For example, match rates were higher than the proportion of female residents among attendees of Perry Initiative’s outreach programs, and residency programs with greater female representation in faculty and leadership had a larger number of female residents in orthopaedic surgery. Consequently, increasing female representation at the leadership level is an imperative and strategic goal to sustainably grow the presence of women in orthopaedic surgery.

Joyce En-Hua Wang is an MD/MBA candidate at Georgetown University School of Medicine and an aspiring orthopaedic surgeon.

Christen M. Russo, MD, is an associate professor of orthopaedic surgery at Columbia University Irving Medical Center and the immediate past president of the Ruth Jackson Orthopaedic Society.

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