{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:04:06Z","timestamp":1789499046598,"version":"build-2803163510"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Introduction<\/jats:title>\n Gender and racial diversity are key topics for discussion in medical education and, in particular, orthopaedic surgery. Studies have shown patient-physician concordance leads to improved healthcare outcomes. Despite this, the orthopaedic surgery workforce is amongst the least diverse. This study examined trends in gender and race amongst applicants to United States (U.S.) orthopaedic surgery programs to understand the future trajectory of the orthopaedic workforce. With an increasing emphasis on diversity, we hypothesize that gender and racial diversity among orthopaedic surgery applicants have increased.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Publicly available demographic data from the Electronic Residency Application Service (ERAS) for applicants to surgical residency programs between 2007 and 2019 were collected. Linear regression analysis by residency application year was performed for orthopaedic surgery and other surgical specialties. Z-tests were used to compare respective proportions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Over the 12-year study period, 18,542 applicants applied to U.S. orthopaedic programs. Of those, 14.9% were female and 28.2% were Black, Indigenous, or People of Color (BIPOC). The percentage of female applicants increased from 11.8% to 19.3% at a rate of 0.41% per year (R\u2009=\u20090.79). The percentage of BIPOC applicants between 2007\u20132019 ranged from 24.8 to 34.1% annually, trending upwards by 0.44% per year. Compared to other surgical specialties, orthopaedic surgery consistently demonstrated a paucity of female and BIPOC applicants. While African American and Hispanic representation in the orthopaedic surgery applicant pool were comparable to other surgical specialties (6.6% and 8.0%, respectively), Asian applicants were underrepresented at 15.4% compared to 19.3\u201322.6% for other specialties (p\u2009<\u20090.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Application to orthopaedic training programs by female and BIPOC individuals is persistently lower than in other specialties. Despite efforts to increase diversity, diversification has not accelerated signficantly. It remains important for orthopaedic residencies to continue institutional programs and grassroots efforts to encourage a diverse applicant pool.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0355417","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:14:34Z","timestamp":1789496074000},"page":"e0355417","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diversity in orthopaedic surgery residency applications\u2013Where are we?"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-0468","authenticated-orcid":true,"given":"Ameen","family":"Chaudry","sequence":"first","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Trikha","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3960-156X","authenticated-orcid":true,"given":"Thomas","family":"Olson","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Clarkson","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Ishmael","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristofer","family":"Jones","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Stavrakis","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Thompson","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Bernthal","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at University of California Los Angeles, University of California","place":["Los Angeles, California, United States of America"],"department":["UCLA Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"1","key":"pone.0355417.ref001","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.otc.2021.07.017","article-title":"The Value of Diversity, Equity, and Inclusion in Otolaryngology","volume":"55","author":"CL Francis","year":"2022","journal-title":"Otolaryngol Clin North Am"},{"issue":"4","key":"pone.0355417.ref002","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.jsurg.2020.11.013","article-title":"Diversity, Equity and Inclusion in Medicine: Why It Matters and How Do We Achieve It?","volume":"78","author":"KM Rosenkranz","year":"2021","journal-title":"Journal of Surgical Education"},{"issue":"4","key":"pone.0355417.ref003","first-page":"383","article-title":"Diversity improves performance and outcomes","volume":"111","author":"LE Gomez","year":"2019","journal-title":"J Natl Med Assoc"},{"issue":"3","key":"pone.0355417.ref004","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-089900","article-title":"Patient-surgeon racial and ethnic concordance and outcomes of older adults operated on by California licensed surgeons: an observational study","volume":"15","author":"EM Shannon","year":"2025","journal-title":"BMJ Open"},{"issue":"6","key":"pone.0355417.ref005","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.018893","article-title":"The urgent and ongoing need for diversity, inclusion, and equity in the cardiology workforce in the United States","volume":"10","author":"Q Capers","year":"2021","journal-title":"JAHA"},{"issue":"1","key":"pone.0355417.ref006","first-page":"6","article-title":"Race\/Ethnicity Concordance Between Patients and Physicians","volume":"109","author":"PA Poma","year":"2017","journal-title":"J Natl Med Assoc"},{"key":"pone.0355417.ref007","volume-title":"Disparities in patient experiences, health care processes, and outcomes: the role of patient\u2013provider racial, ethnic, and language concordance","author":"LA Cooper","year":"2004"},{"issue":"8","key":"pone.0355417.ref008","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1097\/ACM.0000000000002779","article-title":"Bridging the Gap: Holistic Review to Increase Diversity in Graduate Medical Education","volume":"94","author":"O Aibana","year":"2019","journal-title":"Acad Med"},{"issue":"11","key":"pone.0355417.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0207274","article-title":"Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties","volume":"13","author":"E Lett","year":"2018","journal-title":"PLoS One"},{"issue":"3","key":"pone.0355417.ref010","doi-asserted-by":"crossref","first-page":"223","DOI":"10.7326\/0003-4819-141-3-200408030-00013","article-title":"Diversifying the racial and ethnic composition of the physician workforce","volume":"141","author":"NR Powe","year":"2004","journal-title":"Ann Intern Med"},{"issue":"3","key":"pone.0355417.ref011","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.ocl.2019.03.010","article-title":"Racial diversity in orthopedic surgery","volume":"50","author":"RN Ramirez","year":"2019","journal-title":"Orthop Clin North Am"},{"issue":"16","key":"pone.0355417.ref012","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOS-D-18-00131","article-title":"Current trends in sex, race, and ethnic diversity in orthopaedic surgery residency","volume":"27","author":"S Poon","year":"2019","journal-title":"J Am Acad Orthop Surg"},{"key":"pone.0355417.ref013","unstructured":"AAMC. Diversity in Medicine: Facts and Figures. 2019. https:\/\/www.aamc.org\/data-reports\/workforce\/report\/diversity-medicine-facts-and-figures-2019"},{"issue":"2","key":"pone.0355417.ref014","article-title":"Geographic differences in sex and racial distributions among orthopaedic surgery residencies: programs in the South less likely to train women and minorities","volume":"3","author":"R Rajani","year":"2019","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"issue":"12","key":"pone.0355417.ref015","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.2106\/00004623-200312000-00031","article-title":"Women in surgical residency training programs","volume":"85","author":"LC Blakemore","year":"2003","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0355417.ref016","article-title":"The Importance of Diversity, Equity and Inclusion in Orthopaedic Research","author":"T Alliston","year":"2020","journal-title":"Journal of Orthopaedic Research"},{"issue":"12","key":"pone.0355417.ref017","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.18.00320","article-title":"Orthopaedic Faculty and Resident Sex Diversity Are Associated with the Orthopaedic Residency Application Rate of Female Medical Students","volume":"101","author":"K Okike","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"17","key":"pone.0355417.ref018","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.17.01291","article-title":"Women in Orthopaedic Surgery: Population Trends in Trainees and Practicing Surgeons","volume":"100","author":"CC Chambers","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"15","key":"pone.0355417.ref019","article-title":"A 5-Year Update on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States","volume":"98","author":"AE Van Heest","year":"2016","journal-title":"The Journal of Bone and Joint Surgery"},{"issue":"3","key":"pone.0355417.ref020","article-title":"Orthopaedic Surgery Faculty","volume":"5","author":"KN Shah","year":"2020","journal-title":"JB JS Open Access"},{"issue":"1","key":"pone.0355417.ref021","first-page":"1","article-title":"Gender Diversity in Orthopedic Surgery: We All Know It\u2019s Lacking, but Why?","volume":"40","author":"A Van Heest","year":"2020","journal-title":"Iowa Orthop J"},{"key":"pone.0355417.ref022","unstructured":"AAMC Faculty Roster. Association of American Medical Colleges. 2018."},{"issue":"6","key":"pone.0355417.ref023","doi-asserted-by":"crossref","first-page":"241","DOI":"10.5435\/JAAOS-D-19-00076","article-title":"Orthopaedic faculty and resident racial\/ethnic diversity is associated with the orthopaedic application rate among underrepresented minority medical students","volume":"28","author":"K Okike","year":"2020","journal-title":"J Am Acad Orthop Surg"},{"issue":"10","key":"pone.0355417.ref024","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1001\/jama.2018.10650","article-title":"Graduate medical education, 2017-2018","volume":"320","author":"SE Brotherton","year":"2018","journal-title":"JAMA"},{"key":"pone.0355417.ref025","doi-asserted-by":"crossref","first-page":"116193","DOI":"10.1016\/j.amjsurg.2025.116193","article-title":"Impact of the COVID-19 pandemic on the experiences of underrepresented-in-medicine women applicants to surgical residency","volume":"245","author":"DM Carmona Matos","year":"2025","journal-title":"Am J Surg"},{"issue":"11","key":"pone.0355417.ref026","article-title":"The Impact of the COVID-19 Pandemic on Orthopaedic Surgery Residency Applicants During the 2021 Residency Match Cycle in the United States","volume":"4","author":"NC Danford","year":"2020","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"issue":"1","key":"pone.0355417.ref027","first-page":"23","article-title":"Effects of the Covid-19 Pandemic on the Orthopaedic Surgery Residency Application Match Patterns","volume":"43","author":"AJ Sama","year":"2023","journal-title":"Iowa Orthop J"},{"issue":"8","key":"pone.0355417.ref028","doi-asserted-by":"crossref","first-page":"350","DOI":"10.5435\/JAAOS-D-21-01189","article-title":"Nth dimensions evolution, impact, and recommendations for equity practices in orthopaedics","volume":"30","author":"B Mason","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"issue":"6","key":"pone.0355417.ref029","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s12178-021-09717-4","article-title":"The Perry Initiative\u2019s Impact on Gender Diversity Within Orthopedic Education","volume":"14","author":"D Harbold","year":"2021","journal-title":"Curr Rev Musculoskelet Med"},{"key":"pone.0355417.ref030","doi-asserted-by":"crossref","unstructured":"Ko M, Ton H. The Not Underrepresented Minorities: Asian Americans, Diversity, and Admissions. Academic Medicine. 2020;95(2):184\u20139.","DOI":"10.1097\/ACM.0000000000003019"},{"issue":"2","key":"pone.0355417.ref031","article-title":"US Medical School Admissions Leaders\u2019 Experiences With Barriers to and Advancements in Diversity, Equity, and Inclusion","volume":"6","author":"M Ko","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"6","key":"pone.0355417.ref032","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1177\/0003134821991982","article-title":"Gender, Race, Age, Allopathic Degree, Board Score, and Research Experience Among Applicants Matching to General and Orthopedic Surgery Residencies, 2015-2019","volume":"88","author":"M Sutherland","year":"2022","journal-title":"The American Surgeon"},{"issue":"11","key":"pone.0355417.ref033","article-title":"Analysis of Factors Related to the Sex Diversity of Orthopaedic Residency Programs in the United States","volume":"100","author":"AD Sobel","year":"2018","journal-title":"The Journal of Bone and Joint Surgery"},{"issue":"11","key":"pone.0355417.ref034","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.K.00826","article-title":"Why Do Medical Students Choose Orthopaedics as a Career?","volume":"94","author":"AL Johnson","year":"2012","journal-title":"Journal of Bone and Joint Surgery"},{"issue":"18","key":"pone.0355417.ref035","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.18.00879","article-title":"The Distribution of Underrepresented Minorities in U.S. Orthopaedic Surgery Residency Programs","volume":"101","author":"MA Adelani","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"9","key":"pone.0355417.ref036","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1007\/s11999-016-4830-3","article-title":"Medical School Experiences Shape Women Students\u2019 Interest in Orthopaedic Surgery","volume":"474","author":"MI O\u2019Connor","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"pone.0355417.ref037","doi-asserted-by":"crossref","DOI":"10.60118\/001c.31412","article-title":"Comparative analysis of racial and gender diversity in orthopedic surgery applicants and residents from 2007 and 2019","volume":"3","author":"AC Onuoha","year":"2022","journal-title":"Journal of Orthopaedic Experience & Innovation"},{"issue":"9","key":"pone.0355417.ref038","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1007\/s11999-016-4908-y","article-title":"The Perry Initiative\u2019s Medical Student Outreach Program Recruits Women Into Orthopaedic Residency","volume":"474","author":"LL Lattanza","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"9","key":"pone.0355417.ref039","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1007\/s11999-016-4846-8","article-title":"Can a Strategic Pipeline Initiative Increase the Number of Women and Underrepresented Minorities in Orthopaedic Surgery?","volume":"474","author":"BS Mason","year":"2016","journal-title":"Clin Orthop Relat Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355417","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:14:41Z","timestamp":1789496081000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355417"}},"subtitle":[],"editor":[{"given":"Priti","family":"Chaudhary","sequence":"first","affiliation":[{"name":"AIIMS: All India Institute of Medical Sciences","place":["INDIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":39,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355417","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}