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A 5-Year Review of the Designated Leadership Positions of the American Society for Surgery of the Hand (ASSH)

Published:November 19, 2020DOI:https://doi.org/10.1016/j.jhsa.2020.09.004

      Purpose

      Despite near equal representation of women in medical schools since 2008, the percentage of women in surgical subspecialties has remained low. Hand surgery accounts for one of the highest percentages of women, at 19%. Ascension to leadership positions has not yet been fully studied among this group. Our study examined whether increased female representation translated to representation at different levels within the organization.

      Methods

      The 2014 to 2018 membership rosters were obtained from the American Society for Surgery of the Hand (ASSH) and compared by gender. Leadership and volunteer committee positions were evaluated as published in the annual ASSH Committee Reference Book. Leadership positions were defined as appointment to committee chair or Council or acceptance to the Young Leaders Program. Rates of engagement were compared for each of the leadership activities. When available, the time for advancement through various leadership positions was also analyzed by gender.

      Results

      Between 2014 and 2018, the percentage of female ASSH Active Members steadily increased from 11% to 14%. Engagement in early career activities such as committees and the Young Leaders Program also increased: committee positions from 16% to 17% and Young Leaders Program membership from 27% to 40% female representation across the same period. Relative to the overall number of eligible females in the society, women applied at a greater rate and achieved positions at an average of 2 years earlier than their male counterparts.

      Conclusions

      There is a steady increase in the percentage of women within the ASSH. Female ASSH members applied for early career leadership positions at a higher rate and achieved these positions earlier than their male counterparts. This may indicate that future women leaders are appropriately supported in the organization.

      Clinical relevance

      The ASSH has been committed to increasing gender and ethnic diversity. Early analysis demonstrates an increase in women surgeons’ participation in early career leadership activities within the society.

      Key words

      In 2017, it was reported that in the United States, women represented 20.6% of general surgeons and just 16% of plastic surgeons and 5% of orthopedic surgeons.
      • Day C.S.
      • Lage D.E.
      • Ahn C.S.
      Diversity based on race, ethnicity, and sex between academic orthopaedic surgery and other specialties: a comparative study.
      ,
      Association of American Medical Colleges
      Active Physicians by sex and specialty.
      A continued lack of diversity, misconceptions about compatibility with family life, the physical rigor required, and the lack of role models all contribute to low numbers of women surgeons in these fields.
      • Blakemore L.C.
      • Hall J.M.
      • Biermann J.S.
      Women in surgical residency training programs.
      • Okike K.
      • Utuk M.E.
      • White A.A.
      Racial and ethnic diversity in orthopaedic surgery residency programs.
      • Baldwin K.
      • Namdari S.
      • Bowers A.
      • Keenan M.A.
      • Levin L.S.
      • Ahn J.
      Factors affecting interest in orthopedics among female medical students: prospective analysis.
      An increase in gender diversity in medicine has been correlated with higher-quality medical education, greater research productivity, improved business solvency, and increased accessibility to health care resources for underserved populations.
      • Simon M.
      Racial, ethnic, and gender diversity and the resident operative experience: how can the Academic Orthopaedic Society shape the future of orthopaedic surgery?.
      ,
      • Poon S.
      • Kiridly D.
      • Mutawakkil M.
      • et al.
      Current trends in gender, race and ethnic diversity in orthopaedic surgery residency.
      To this end, there has been an increasing effort throughout surgical specialties to recruit women to these fields.
      • Pories S.E.
      • Turner P.L.
      • Greenberg C.C.
      • et al.
      Leadership in American surgery: women are rising to the top.
      ,
      • Michelassi F.
      • Maier R.V.
      • Lillemoe K.
      Leadership in American surgery—women are rising to the top.
      Despite increasing numbers of women entering surgical specialties, representation of women in leadership has lagged behind, a phenomenon described as the leaky pipeline.
      • Carr P.L.
      • Gunn C.M.
      • Kaplan S.A.
      • Raj A.
      • Freund K.M.
      Inadequate progress for women in academic medicine: findings from the National Faculty Study.
      ,
      • Emamaullee J.E.
      • Lyons M.V.
      • Berdan E.
      • Bazzarelli A.
      Women leaders in surgery: past, present, and future.
      With 19% of women, hand surgery represents one of the highest female rates among orthopedic and plastic surgery subspecialties.
      • Poon S.
      • Abzug J.
      • Caird M.
      • et al.
      A five-year review of the designated leadership positions of Pediatric Orthopaedic Society of North America: where do women stand?.
      Over recent years, there has been a steady increase in the number of women choosing hand surgery as a career, but the promotion of these individuals on a national level is less well-understood. Specialty society membership is often an important part of a surgeon’s career development. With nearly 2,000 Active Members reported in 2018, the American Society for Surgery of the Hand (ASSH) is the largest membership organization for hand surgeons. It has been committed to increasing gender and ethnic diversity, and early analysis demonstrates an increase in women surgeons’ participation in membership and national meeting activities.
      • Earp B.E.
      • Mora A.N.
      • Rozental T.D.
      Extending a hand: increasing diversity at the American Society for Surgery of the Hand.
      The goal of this study was to investigate whether the increased female representation in ASSH’s membership is reflected throughout the leadership pathway within the organization and whether differences exist in the participation patterns in leadership activities between genders.

      Materials and Methods

      Applications for volunteer committee positions in ASSH were available electronically starting in 2014. Therefore, the membership roster was obtained from ASSH and compared by gender between 2014 and 2018. Gender was a self-reported binary choice. The number of females and males engaging in volunteer committee positions and leadership positions, defined as the appointment to committee chair or acceptance to the Young Leaders Program, as published in the annual ASSH Committee Reference Book, was evaluated for the same period. Rates of engagement, determined as the number of participating individuals by gender divided by the overall number of eligible members by gender, were compared for each leadership activity. When available, the time for advancement through various leadership positions, defined as the time, in years, from becoming an Active Member to attainment of the position, was also analyzed by gender.

      Results

      Membership participation

      Active membership in ASSH increased from 1,732 in 2014 to 1,950 in 2018 (13%). In the same period, female Active Members increased from 184 to 246 (34%). Although not eligible for committee or leadership positions, candidate-level members, including both resident and fellow-level candidates, also increased over that period (Fig. 1).
      Figure thumbnail gr1
      Figure 1Percentage of female representation within the ASSH.
      The time between the completion of fellowship and becoming a Candidate Member was similar between genders (both were <1 year), as was the time between the completion of fellowship and becoming an Active Member (average, 6 years for both males and females).

      Committee participation

      Volunteer participation in a committee represents one of the first steps in professional advancement within the society. Currently, ASSH has 54 volunteer committees overall, with 29 open to volunteer applications; the remaining are determined by appointment or election. Committee gender composition roughly approximated the overall gender percentages across the organization and similarly showed an increase over the study period from 16% in 2014 to 17% in 2018.
      When participation trends were evaluated by gender, women showed higher rates of committee involvement than their male counterparts (Table 1). The time from becoming an Active Member to participation on a committee was, on average, 2 years earlier in women than in men.
      Table 1Percentage of Females at Membership Levels, by Year
      ASSH Membership Levels20142015201620172018
      Active members11%11%12%12%13%
      Candidate members20%19%21%22%24%
      Candidate fellow20%28%18%26%20%
      Candidate resident24%17%21%25%28%
      Overall14%14%15%17%17%

      Advancement to leadership

      Young Leaders Program

      Another pathway to career advancement in the society is through involvement with the Young Leaders Program. Members of ASSH who qualify for this program include individuals who are Active Members of less than 8 years. From the available application data between 2014 and 2018, there was an increase in the percentage of applications from females as well as the number of females selected for program (Table 2).
      Table 2Female Applications and Program Participation, by Year (%)
      20142015201620172018
      Young Leader applications
      Number of female applications per total applications.
      1829302621
      Young Leaders
      Number of females participating in program per all program participants.
      2727403140
      Number of female applications per total applications.
      Number of females participating in program per all program participants.
      Time from achieving Active Member status and participating in the Young Leaders Program was equal between genders, at an average of 2 years.

      Committee chair

      Advancement to higher leadership within the organization is marked by the acquisition of committee chair and Council positions. The representation of women in committee chair positions increased markedly over the study period from 6% in 2014 to 23% in 2018. When engagement patterns with respect to achieving chair positions was evaluated by gender, a lower percentage of eligible females were found to achieve chair positions earlier in the study period, but this percentage surpassed males in 2018 (Table 3).
      Table 3Involvement Rate Relative to Overall Active Members, by Gender
      ASSH Membership Involvement20142015201620172018
      Female committee members7476878669
      Female active members184198216239246
      % involvement40%38%40%36%28%
      Male committee members391368367349335
      Male active members1,5481,5851,6381,6891,704
      % involvement25%23%22%21%20%

      Council membership

      Election to Council represents the next level of leadership progression. There are 13 Council positions, and only Active Members may apply. Applications are reviewed by the Nominations Committee and elected by the membership. Each position of the Presidential Line has a 1-year term; all other Council positions, including the treasurer, have 3-year terms.
      The percentage of women relative to men varied for elected council positions from 8% to 23% in the years studied.

      Discussion

      The percentage of women Active Members in the ASSH has shown a steady increase during the study period, from 11% of its members in 2014 to 13% in 2018. Although females still represent the minority of members, the results from this study indicate that women are applying to and participating in early society advancement pathways such as committees and the Young Leaders Program at a higher percentage, compared with overall female membership, and earlier in their careers than their male counterparts. Committee chair positions similarly demonstrated increased representation of females over the study period. Although there are not enough data for statistical analysis, women appeared to ascend through early career advancement activities at a pace similar to or faster than that of men, which may indicate that future women leaders are not only appropriately supported but actively encouraged in the ASSH.
      Later societal advancement, in the form of Council positions and election to the presidential line, would be difficult to assess given the short time frame of the study and because many of these highly selective positions are multiyear commitments and they are open only to the most senior society members. However, the small number of women at the highest levels of the society does not appear to correlate with a lack of participation among female members in early career activities.
      There were several limitations to this study. Most important, only 5 years of data were available from ASSH. The short study period may not accurately represent participation trends because the number of available positions was variable and participation rates could be attributed to natural variation. In addition, the study was limited to hand surgeons in the ASSH and may not be generalizable to other subspecialty organizations. Notably, the specialty of hand surgery is composed of orthopedic, plastic, and general surgeons, and further analysis is warranted to determine differences in participation and advancement trends among the various pre-fellowship training pathways.
      Previous efforts to promote gender diversity can help formulate new strategies to increase women representation within hand surgery. Evidence from orthopedic residencies suggests that making diversity an institutional goal through professional platforms correlates with increased minority representation.
      • Bae G.H.
      • Lee A.W.
      • Park D.J.
      • et al.
      Ethnic and gender diversity in hand surgery trainees.
      ,
      • Mankin H.J.
      Diversity in orthopaedics.
      Such efforts have been similarly championed by the ASSH through the Diversity Committee, and early analysis shows an increase in both gender and ethnic representation across the society in both membership and society activities.
      • Earp B.E.
      • Mora A.N.
      • Rozental T.D.
      Extending a hand: increasing diversity at the American Society for Surgery of the Hand.
      The current study’s analysis further supports the notion that such initiatives have been successful in recruiting more women to the specialty of hand surgery, and that in their early career stages, women are highly active and appropriately supported. It has been hypothesized in other surgical subspecialties that a lack of women representation at higher levels of leadership might be due to the time it takes for a member to advance through the hierarchy of a society,
      • Poon S.
      • Abzug J.
      • Caird M.
      • et al.
      A five-year review of the designated leadership positions of Pediatric Orthopaedic Society of North America: where do women stand?.
      a trend that may be true in ASSH as well. Additional research and time are necessary to see whether women will be able to reach equal representation at the highest levels of the organization. Continued efforts within the society are important to advance women through their professional development and on to leadership positions.

      Acknowledgments

      The authors would like to thank Pamela Schroeder, CAE, Haley M. Licata, CAE, Mary McCarthy, and the ASSH for their assistance in conducting this study.

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