Orthopedic surgery has the smallest proportion of female physicians among any medical specialty. Women account for only 7 percent of orthopedic surgeons with approximately 14 percent of orthopedic residents, but a shift is slowly occurring within the field.

The orthopedic surgery residency program at Baylor College of Medicine continues to break barriers within the specialty with about 30 percent of its residents identifying as female, which has allowed for unique experiences for the all-woman team of trainees at Texas Children’s Hospital.

The team of female residents consists of four women who are typically underrepresented in medicine: Dr. Monique Chambers (fourth-year resident), Dr. Christina Alvara (third-year resident), Dr. Olivia A. Barron (second-year resident) and Dr. Fatima Mubarak (first-year resident). The team was also rounded out by two female orthopedic pediatric fellows: Drs. Rachel Silverstein and Jessica McGraw. The team is led by Dr. Nicole Montgomery, assistant professor of orthopedic surgery at Baylor, resident coordinator and assistant program director at Texas Children’s.

Dr. Monique Chambers, Dr. Fatimah Mubarak, Dr. Nicole Montgomery, Dr. Olivia Barron and Dr. Christina Alvara are members of the Orthopedic Surgery Residency at Baylor College of Medicine.

“This group at Baylor is a rarity – a rarity to have the number of women and minorities – and it’s something that needs to be celebrated. They are the future face of orthopedics,” said Dr. Dorothy Beauvais, assistant professor of orthopedic surgery at Baylor and Texas Children’s.

The culture of orthopedics is typically depicted through male athletes who are white. While patients have been mainly exposed to a white male-dominated group of orthopedic specialists, they will slowly see a shift in representation.

“Now that we have more women expanding the field, we’re seeing a domino effect of being able to inspire more women to enter (it), to reach out to more students who are female and break down those stereotypes,” Barron said. “Just because we use drills and tools that have been historically associated as ‘man tools,’ (it) doesn’t mean that women can’t step into the operating room and do the same thing.”

While the American Academy of Orthopaedic Surgeons aims to be more intentional about recruiting diverse surgeons, the field still has strides to make. When white women or people of color apply to residencies and see a program filled with all white men, they may feel unwelcome.

“They face difficulty finding someone to take interest in them. When we can relate to others, we build a relationship. The more diverse the specialty becomes, the more we can attract others and relate to them,” Beauvais said. “Many medical students are also deterred from surgery because of the physical demands of the specialty.”

The necessary physicality can be an obstacle, but Alvara said she was able to adjust and has derived better results in training. Being assertive is an ongoing skill to be learned, she added, but it’s one that makes tasks easier and more approachable.

Alvara, who identifies as Hispanic, is the only person in her family in medicine. She explains that while her family’s health literacy is poor, she slowly found people to be role models for her in orthopedics. Her situation can be isolating, but she grew to be brave enough to ask for other perspectives and gain allies.

“The understanding that diversity does not equal watering down the specialty, whether that is female-based, geographical or racial. Part of the conversation is getting people to understand the beauty of being a woman of color, the difference it makes, and the importance of that perspective at the table with some of our white male colleagues,” Chambers said.

The pediatric team’s residents expressed gratitude for having women to follow and relate to throughout their residency. Mubarak explained that her interest in orthopedic surgery began because she worked with an African-American surgeon. An important factor in her decision to apply was seeing other women of color excelling in orthopedic surgery.

Mubarak wears a hijab and knew she might face prejudice within the field. She recalled the guidance from her fellow, Rachel Silverstein, who reassured her that she was welcome and her decision to join orthopedic surgery was the right one.

“When you walk into a room and there’s a surprised look of doubt on a patient’s face that you’re the orthopedic surgeon, you have to prove that a woman is just as capable in this field, a minority is capable in this field. We break down that perception,” Beauvais said.

Programs that lack diversity must be open and willing to express the importance of having a diverse team and training staff. There are barriers at every level to there must be a concerted effort to recruit minorities and promote their efforts from the top down, said Chambers.

“Recruitment efforts are one thing, but retention and inclusion once you get there are completely different. That’s the area that needs more attention, effort and support,” Chambers said.

Facing microaggressions in orthopedics is common and a consistent feeling of needing to prove oneself is tiresome. While joining a male-dominated field can feel isolating, the women are grateful to be among a residency program that looks different than orthopedic teams of the past.

Chambers said support can come from anyone — whether they look like you or not.

“A lot of where I am today is because of allyship from white male pioneers who supported me,” Chambers said. “Even if you don’t have people that look like you around, (you should) maintain your sense of self-identity and pride and take that courageous leap of faith to show them why you are valuable and why you belong. Allyship is critical and can open doors that some would never knock on or be invited to have a seat at the table.”

The women in the Baylor orthopedic team developed a sense of bravery and courage in order to pursue something they love. Beauvais encourages women to do what they want without letting appearances deter them.

“At the end of the day, I will always be who I am, and there is no specialty where those challenges wouldn’t exist, so I might as well do the one thing that I love to do,” Mubarak said.

By Homa Shalchi