Faculty Diversity Associated With Decreased Orthopaedic Surgery Resident Attrition.

Abstract

Underrepresented minority (URM) and female orthopaedic surgical residents have an increased risk of attrition. The purpose of this study was to investigate the relationship between orthopaedic faculty demographic diversity and resident attrition. Demographic data for full-time faculty in departments or divisions of Orthopaedic Surgery at accredited medical schools in the United States and demographic and attrition data for 13,785 affiliated orthopaedic residents were sourced from the Association of American Medical Colleges. Faculty diversity was defined by the number of female and/or URM faculty at medical school affiliated with residency. The faculty per year (FPY) was calculated by dividing the total number of female and URM faculty by the number of years in residency for each resident. The average FPY across all programs was calculated to assess whether programs had above-average FPY (greater faculty diversity) or below-average FPY. This stratification was used to investigate the relationship between faculty diversity and resident attrition. Diverse faculty was defined as the aggregate of URM and female faculty. A p-value of <0.05 was considered statistically significant. Overall resident attrition was 3.2%. Female and URM residents had attrition rates of 6.2% and 6.3%, respectively. The average URM FPY for all orthopaedic surgery departments was 2.0; the average female FPY was 5.8; and the average diverse FPY was 7.5. Residents in programs with above-average female and URM FPY had a decreased risk of attrition (relative risk [RR] = 0.25, p < 0.001; RR = 0.23, p < 0.001, respectively). Programs with below-average female, URM, and diverse FPY significantly increased the risk of all resident attrition by 82% (RR = 1.82, p < 0.001), 47% (RR = 1.47, p < 0.001), and 88% (RR = 1.88, p < 0.001), respectively. Programs with increased racial and gender faculty diversity are associated with lower resident attrition, regardless of resident race or sex. Below-average faculty diversity is associated with the greatest risk of attrition among female and URM residents.