Residency Match Rates in Orthopaedic Surgery Based on Sex, Under-Represented in Medicine Status, and Degree Type : JBJS Open Access

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AOA Critical Issues in Education

Residency Match Rates in Orthopaedic Surgery Based on Sex, Under-Represented in Medicine Status, and Degree Type

White, Peter B. DO, MS1; Giordano, Joshua R. DO1; Chen, Matthiew BS1; Bitterman, Adam D. DO1,2; Oni, Julius K. MD3; Zacchilli, Michael MD1,4; Poon, Selina C. MD, MPH, MS, FAOA5; Cohn, Randy M. MD1,6,a

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JBJS Open Access 8(1):e22.00143, January-March 2023. | DOI: 10.2106/JBJS.OA.22.00143
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Orthopaedic surgery is well recognized as one of the most competitive1 and least diverse medical specialties2–4. Numerous studies have highlighted the under-representation of women and racial/ethnic minorities in orthopaedics5–8. Over the past few decades, there has been some increase in the percentage of women and minorities in orthopaedic surgery9,10, albeit both groups are still well below their representation in medicine and the general public.

In June 2020, the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) completed their transition to a single accreditation system for all residency programs11. Although the goal was to create nationwide standards for graduate medical education, the transition to a single accreditation system and unified residency match was not without criticism, especially regarding residency selection12,13. Critics of the single accreditation entity were largely concerned that osteopathic physicians would be more likely to match into primary care specialties and less would enter competitive surgical subspecialties compared with their allopathic counterparts13–16.

Therefore, the purpose of this study was to compare recent application rates and match rates for traditionally under-represented groups within orthopaedic surgery such as female candidates and racial and ethnic minorities under-represented in medicine (URiM) as well as among osteopathic physicians.


A retrospective study was performed to determine application and match rates for those applying into orthopaedic surgery during the 2017 through 2021 application cycles. Data before 2017 were unavailable. Application data were collected from the Electronic Residency Application Service (ERAS) annual report released by the American Association of Medical Colleges (AAMC)17. Data collected included sex, URiM status, and degree type for US medical school graduates (MD vs. DO). Data were not available by double variables, such as URiM male and female. All data collected by this system are self-reported by the applicants during their residency applications. For the analysis of sex, applicants with unknown sex (n = 1) were excluded, leaving 7,902 included for evaluation.

Regarding race/ethnicity, applicants in the latter 2 years (2020 and 2021) of the study period were allowed to select 1 or more races/ethnicities in the ERAS application, vs. only 1 in the initial 3 years of the study period. Applicants listed with unknown (n = 449) or other (n = 285) race were excluded, leaving 7,350 applicants for evaluation. Categorization of URiM status was based on the AAMC's definition of “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” This includes the following ERAS categories: Black or African American, Hispanic, Latino, or of Spanish Origin; American Indian or Alaskan Native; and Native Hawaiian or other Pacific Islander18.

For degree type, only applicants from a US medical school were included in the study, resulting in 1,240 international medical graduates being excluded, leaving 6,663 applicants available for study. To determine the demographic characteristics of current residents, a separate database, the Orthopaedic Residency Information Network (ORIN), was queried in June 2022. This was performed to identify current orthopaedic surgery residents throughout the United States, corresponding to those residents who largely applied during the 2017-2021 application cycles. This database is managed by the Council of Orthopaedic Residency Directors committee of the American Orthopaedic Association, relies on the self-reporting by residency programs, and was created to provide information to prospective orthopaedic surgery applicants19. At the time of query, 171 residency programs were listed. Sex was identified for 155 programs (90.6%) for a total of 3,574 residents. URiM and degree type were listed for 143 (83.6%) and 125 (73%) programs, respectively.

Statistics were performed with STATA 14.0. Descriptive statistics for all categorical variables included counts and proportions. Statistical testing performed included chi-square tests for all categorical variables, and Pearson's correlation was performed for sex, URiM status, and degree type over time. Statistical significance was defined as p < 0.05.



Across the study period, there were a total of 7,902 applicants, of which 6,454 (82%) were identified as male and 1,448 (18%) were female. From 2017 to 2021, there were increasing trends in the total number of applicants (r = 0.91, p = 0.037) as well as the number of both male and female candidates applying into orthopaedic surgery (r = 0.90, p = 0.039; and r = 0.90, p = 0.039, respectively). Of the 3,574 residents identified in the ORIN database, 688 (19%) were female and 2,886 (81%) were male. There was no significant difference in the application rate when the 2 databases were compared with the match rate based on sex (p = 0.249, Table I).

TABLE I - Percentage of Applicants and Residents in Orthopaedic Surgery Based on Sex
Male Female
Applicants 81.7% 18.3%
Residents 80.7% 19.3%
p = 0.24


Race/ethnicity was reported by 7,374 applicants, including 6,043 non-URiM and 1,331 URiM candidates (18% URiM, Table II). There was an increase in the number of URiM and non-URiM applicants during the study period (r = 0.92; p = 0.026; and r = 0.93; p = 0.023, respectively). There were 3,345 residents with reported race/ethnicity, with 2,714 residents not URiM and 631 URiM residents (19% URiM, p = 0.156, Table II).

TABLE II - Percentage of Applicants and Residents in Orthopaedic Surgery Based on Race/Ethnicity*
Applicants 81.9% 18.1%
Residents 81.1% 18.9%
p = 0.16
*URiM = under-represented in medicine.


A total of 6,663 allopathic and osteopathic applicants from US medical schools were identified, including 5,641 allopathic and 1,022 osteopathic candidates (15% osteopathic, Table III). During the study period, there was a significant increase in the number of DO applicants (r = 0.88; p = 0.047). There were 2,856 residents identified who graduated from US medical schools, 2,521 with an MD degree and 335 with a DO degree (12% osteopathic, p < 0.002, Table III).

TABLE III - Percentage of Applicants and Residents in Orthopaedic Surgery Based on Degree Type
Applicants 84.7% 15.3%
Residents 88.3% 11.7%
p = 0.002


This study sought to examine the application and match rates among various under-represented demographics within the field of orthopaedic surgery. From 2017 to 2021, we found that match rates for female and racial and ethnic minorities URiM candidates are reflective of their application rates. However, we found that osteopathic applicants in orthopaedic surgery have a lower match rate than their allopathic counterparts.

Our analysis found that match rates of female candidates are reflective of their application rates. However, just 19% of orthopaedic surgery residents were female. This is higher compared with a previous study that demonstrated only 14% female residents during the 2016-2017 academic year9. Although there has been an increase in female residents in the orthopaedic community, female candidates still make up a considerable minority of orthopaedic residents. A previous study showed a compound annual growth rate of just 2% in the proportion of practicing female orthopaedic surgeons from 2010 to 201920. Assuming that growth continued at this rate, they estimated that it would take 217 years to achieve gender parity (36% women in orthopaedic surgery). Thus, although match rates of female candidates are currently reflective of their application rates, the number of female residents pursuing orthopaedic surgery is far less than male residents. With increased early exposure in medical education with programs such as the Perry Initiative and improved female mentorship through the Ruth Jackson Orthopaedic Society and other organizations, the orthopaedic community can improve on the proportion of female candidates pursuing careers within orthopaedic surgery21–23.

Our data found that match rates of URiM candidates are reflective of their application rates as well; however, just 18.9% of residents are URiM and just 18.1% of applicants are URiM. Previous studies have examined this lack of diversity in race/ethnicity among orthopaedic residency programs. A study by Poon et al. found applicants from Asian, Black, Hispanic, or other race groups had lower odds of admission into residency compared with White applicants10. Another study found that 61% of minority applicants were accepted into an orthopaedic residency vs. 73% of White applicants24. Although this does conflict with our data, we did confirm the continued need for increased URiM representation within orthopaedic surgery applicants and residents. Previous studies have identified a lack of minority faculty and many other potential barriers to recruiting Black and minority applicants25,26. To further improve diversity in orthopaedic surgery, efforts should focus on early exposure in medical education and improved mentorship with programs such as the Nth Dimension and the J. Robert Gladden Orthopaedic Society23,25. In addition, programs must take a proactive approach to create a safe and fair working environment for URiM residents25.

We found a significant difference in the match rates of osteopathic applicants compared with their allopathic counterparts, with osteopathic students significantly less likely to match into orthopaedic surgery residency. To the best of our knowledge, this is the first study to examine and compare match rates between osteopathic and allopathic applicants in orthopaedic surgery residency training. One previous study looked at the effect of the single accreditation system on DO medical student match rates in surgical subspecialties27. From 2018 to 2020, they found a decrease of 3% in the total number of matched spots for DO applicants. In addition, they found that only 51.7% of DO applicants matched compared with 67.7% of MD applicants in competitive surgical specialties. This study coupled with our present study may suggest that there is an element of selection bias against DO applicants. This is also consistent with the findings of the National Ranking Matching Program's program director survey from the first 2 years after the merger of the AOA and ACGME in a single graduate medical education accreditation system. In 2021, 53% of programs would seldomly or never interview a US DO fourth year applicant compared with 9% for US MD fourth year seniors28. In 2022, this trend worsened with 63% for programs now indicating that they would seldomly or never interview a US DO fourth year applicant vs. 16% for US MD fourth year applicants29. As medical school accreditation status was ranked the fifth most important education and academic characteristic for a program director when determining who to interview in 2021, this may suggest the increasing value going forward and possible increasing selection bias. Another plausible explanation is that recent studies have highlighted the importance of away rotations at matching into orthopaedic surgery and there being a discord in opportunities and fees among DO and MD applicants applying for residency, leading to a difference in application and match rates30–36. Further studies are needed to elucidate the etiology and nature of this selection bias.

This study is not without limitations. ORIN is self-reported, and thus gender, race/ethnicity, and degree data may not exactly match ERAS data. Second, at the time the ORIN database was queried, approximately 80% of all residents nationally were accounted for in the database. The residents who are unaccounted for may bias the results, especially in the race/ethnicity and degree categories, which were slightly less accounted for in ORIN than sex. In addition, it is assumed that all current residents in June 2022 (when ORIN was queried) applied to orthopaedic surgery residency in the 2017-2021 application cycles. This may not exactly be the case for a small number of residents on a 6-year track, those who took a leave of absence, or those who left their residency program and thus are not included in the ORIN database. Given how ERAS and ORIN data are presented, we are unable to differentiate application or residency characteristics in those applicants/residents who fall under more than 1 minority category. Fourth, during the study period, the single accreditation system finalized its merger among residency programs with all traditionally ACGME and AOA programs being unified under a single system. Although this may confound the findings, ORIN has been reported to be the most reliable publicly accessible database for reporting the degree types of current residents37. Longer term studies are needed to validate the results of this study. Finally, we did not control for characteristics that have been previously associated with matching in orthopaedic surgery, such as Alpha Omega Alpha status, US Medical Licensing Exam scores, publications, and volunteer experience10. Future studies should attempt to control for these variables in looking at differences in orthopaedic surgery match rates. However, given the lack of availability of National Residency Match Program data, this type of research is inherently difficult.


In recent years, there has been a significant and necessary push to increase diversity in the field of orthopaedic surgery. From 2017 to 2021, match rates of female and URiM candidates are reflective of their application rates. Osteopathic applicants in orthopaedic surgery have lower match rates than their allopathic counterparts.


1. Trikha R, Keswani A, Ishmael CR, Greig D, Kelley BV, Bernthal NM. Current trends in orthopaedic surgery residency applications and match rates. J Bone Joint Surg Am. 2020;102(6):e24.
2. Poon S, Kiridly D, Mutawakkil M, Wendolowski S, Gecelter R, Kline M, Lane LB. Current trends in sex, race, and ethnic diversity in orthopaedic surgery residency. J Am Acad Orthop Surg. 2019;27(16):e725-33.
3. Day CS, Lage DE, Ahn CS. Diversity based on race, ethnicity, and sex between academic orthopaedic surgery and other specialties: a comparative study. J Bone Joint Surg Am. 2010;92(13):2328-35.
4. Emery SE; Carousel Presidents. Diversity in orthopaedic surgery: international perspectives: AOA critical issues. J Bone Joint Surg Am. 2019;101(21):e113.
5. Simon MA. Racial, ethnic, and gender diversity and the resident operative experience. How can the Academic Orthopaedic Society shape the future of orthopaedic surgery? Clin Orthop Relat Res. 1999;(360):253-9.
6. Blakemore LC, Hall JM, Biermann JS. Women in surgical residency training programs. J Bone Joint Surg Am. 2003;85(12):2477-80.
7. O'Keefe RJ. Embracing differences to improve success: American Orthopaedic Association Presidential Address, Boston, Massachusetts, June 23, 2017: AOA critical issues. J Bone Joint Surg Am. 2019;101(9):e37. Erratum in: J Bone Joint Surg Am. 2019 Jun 19;101(12):e60.
8. Harrington M. Why isn't the orthopaedic workforce as diverse as the population it serves? Where are the minorities and women? Symposium session at the Annual Meeting of the American Orthopaedic Association; Jun 27-30, 2018; Boston, MA.
9. Chambers CC, Ihnow SB, Monroe EJ, Suleiman LI. Women in orthopaedic surgery: population trends in trainees and practicing surgeons. J Bone Joint Surg Am. 2018;100(17):e116.
10. Poon SC, Nellans K, Gorroochurn P, Chahine NO. Race, but not gender, is associated with admissions into orthopaedic residency programs. Clin Orthop Relat Res. 2022;480(8):1441-9. Erratum in: Clin Orthop Relat Res. 2022 Aug 1;480(8):1627.
11. Accreditation Council for Graduate Medical Education. History of the Transition to a Single GME Accreditation System. Available at: Accessed December 1, 2022.
12. Aiyer A, Sankar V, Summers S, Rush A III, Kaplan JRM, Varacallo M, Marsh JL, Levine WN. Unifying the orthopaedic surgery residency application process under a single accreditation system: a primer. J Am Acad Orthop Surg. 2020;28(7):263-7.
13. Cummings M. The single accreditation system: risks to the osteopathic profession. Acad Med. 2021;96(8):1108-14.
14. Fugazzi L, Cummings M. The AOA/ACGME single accreditation system and its immediate and future impact on family medicine. Fam Med. 2022;54(2):91-6.
15. Beckman JJ, Speicher MR. Characteristics of ACGME residency programs that select osteopathic medical graduates. J Grad Med Educ. 2020;12(4):435-40. Erratum in: J Grad Med Educ. 2021 Feb;13(1):139.
16. Kortz MW, Vegas A, Moore SP, McCray E, Mureb MC, Bernstein JE, May J, Bishop B, Frydenlund M, Dobson JR. National resident matching program performance among US MD and DO seniors in the early single accreditation graduate medical education era. Cureus. 2021;13(8):e17319.
17. AAMC. ERAS Statistics. Available at: Accessed December 1, 2022.
18. AAMC. Unique Populations. Available at: Accessed December 1, 2022.
19. American Orthopaedic Association. AOA/CORD Orthopaedic Residency Information Network (ORIN). Available at: Accessed December 1, 2022.
20. Acuña AJ, Sato EH, Jella TK, Samuel LT, Jeong SH, Chen AF, Kamath AF. How long will it take to reach gender parity in orthopaedic surgery in the United States? An analysis of the National Provider Identifier Registry. Clin Orthop Relat Res. 2021;479(6):1179-89.
21. Scerpella TA, Spiker AM, Lee CA, Mulcahey MK, Carnes ML. Next steps: advocating for women in orthopaedic surgery. J Am Acad Orthop Surg. 2022;30(8):377-86.
22. Mulcahey MK, Waterman BR, Hart R, Daniels AH. The role of mentoring in the development of successful orthopaedic surgeons. J Am Acad Orthop Surg. 2018;26(13):463-71.
23. Lamanna DL, Chen AF, Dyer GSM, Johnson AE, McCarthy CJ. Diversity and inclusion in orthopaedic surgery from medical school to practice: AOA critical issues. J Bone Joint Surg Am. 2022;104(18):e80.
24. Poon S, Nellans K, Rothman A, Crabb RAL, Wendolowski SF, Kiridly D, Gecelter R, Gorroochurn P, Chahine NO. Underrepresented minority applicants are competitive for orthopaedic surgery residency programs, but enter residency at lower rates. J Am Acad Orthop Surg. 2019;27(21):e957-68.
25. Ode GE, Bradford L, Ross WA Jr, Carson EW, Brooks JT. Achieving a diverse, equitable, and inclusive environment for the black orthopaedic surgeon: part 1: barriers to successful recruitment of black applicants. J Bone Joint Surg Am. 2021;103(3):e9.
26. McDonald TC, Drake LC, Replogle WH, Graves ML, Brooks JT. Barriers to increasing diversity in orthopaedics: the residency program perspective. JB JS Open Access. 2020;5(2):e0007.
27. Etheart I, Krise SM, Burns JB, Conrad-Schnetz K. The effect of single accreditation on medical student match rates in surgical specialties. Cureus. 2021;13(4):e14301.
28. Results of the 2021 NRMP Program Director Survey. NRMP. (n.d.). Available at: Accessed January 8, 2023.
29. Results of the 2022 NRMP Program Director Survey. NRMP. (n.d.). Available at: Accessed January 8, 2023.
30. Camp CL, Sousa PL, Hanssen AD, Karam MD, Haidukewych GJ, Oakes DA, Turner NS. The cost of getting into orthopedic residency: analysis of applicant demographics, expenditures, and the value of away rotations. J Surg Educ. 2016;73(5):886-91.
31. O'Donnell SW, Drolet BC, Brower JP, LaPorte D, Eberson CP. Orthopaedic surgery residency: perspectives of applicants and program directors on medical student away rotations. J Am Acad Orthop Surg. 2017;25(1):61-8.
32. Brueggeman DA, Via GG, Froehle AW, Krishnamurthy AB. Virtual interviews in the era of COVID-19: expectations and perceptions of orthopaedic surgery residency candidates and program directors. JB JS Open Access. 2021;6(3):e21.00034. Erratum in: JB JS Open Access. 2021 Aug 20;6(3).
33. Holderread BM, Han A, Mand DS, Liu J, Harris JD, Liberman SR. Effects of COVID-19 on geographical trends in the orthopaedic surgery residency match. JB JS Open Access. 2022;7(3):e21.00107.
34. White PB, Henry JP, Partan MJ, Choy K, Hogge CA, Katsigiorgis G, Bitterman AD, Cohn RM. Differences in fourth-year orthopaedic away rotation opportunities and fees among osteopathic and allopathic medical students 1 year after the implementation of the single accreditation system. JB JS Open Access. 2022;7(3):e22.00057.
35. Chen AF, Secrist ES, Scannell BP, Patt JC. Matching in orthopaedic surgery. J Am Acad Orthop Surg. 2020;28(4):135-44.
36. Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della Valle CJ, Zuckerman JD. An analysis of orthopaedic residency selection criteria. Bull Hosp Jt Dis. 2002;61(1-2):49-57.
37. Bernstein SL, Wei C, Gu A, Fufa D, Levine WN. Evaluating databases with orthopaedic surgery residency program information. J Am Acad Orthop Surg. 2022;30(24):1177-83.

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