Latinxs in Orthopaedics: Perspective of Two Latinx Med Students Pursuing the Least Diverse Specialty

Cristian Escalera BS, Patricia Rodarte BS

Among the 62 million Latinx individuals living in the United States (U.S.), 40% report having a musculoskeletal condition.1,2 According to the United States Bone and Joint Initiative, the rate of chronic musculoskeletal conditions outruns the prevalence of reported chronic heart and lung conditions. More specifically, chronic low back pain, joint pain and disability from arthritis are three of the top five most common medical conditions reported by patients in the United States, many of which we know are Latinx patients.2

Orthopaedics is one of the least diverse fields in medicine when taking both race and gender into account. As the U.S. Latino population steadily increases, the number of Latinx orthopaedic surgeons lags behind. The American Academy of Orthopaedic Surgeons reports 3.5% of their members identify as Hispanic/Latinx.3 Similarly, while the representation of Hispanic/Latinx trainees has increased in the past years, they still only account for 250 (6.7%) of the total 3,724 U.S. orthopaedic residents.4,5

It is essential to increase the number of Latinx surgeons in orthopaedics to address the musculoskeletal health disparities prevalent in the Latinx population. Latinx orthopaedic surgeons may possess greater cultural competence than those of non-minority identities when working with Latinx patients.6 Likewise, patients seen by race-concordant physicians report more participation in decision-making, a benefit that could ultimately improve overall patient outcomes and satisfaction.7 More Latinx orthopaedic surgeons can address the lack of equal access to orthopaedic care, as physicians from minority identities care for a disproportionately high fraction of patients with similar identities, including patients covered by Medicaid or whom do not have health insurance.8

There are limited studies explaining why orthopaedic surgery struggles to improve the diversity of the workforce. Possible barriers for medical students pursuing orthopaedic surgery include a lack of available mentors, increased research requirements, and limited exposure in the field. Fortunately, many organizations and institutions have made large efforts to diversify the field of orthopaedics in the past several years.9 Programs such as Nth Dimensions have continuously supported Latinx students in both their Summer Internship Program and their Medical Student Symposium. For women pursuing orthopaedics, the Ruth Jackson Orthopaedic Society and the Perry Initiatives host outreach workshops and sessions to increase the support of women in the field, including interested medical students. Similarly, the American Association of Latino Orthopaedics Surgeons (AALOS) has hosted luncheons and discussion sessions to inspire Latinx medical students at orthopaedic conferences. However, we hope that such organizations continue to increase their impact on the future generation of Latinx surgeons through larger-scale mentorship and earlier programming in order to create stronger interest. These organizations can also aim to provide orthopaedics-focused resources (such as research and clinical opportunities) for Latinx medical students. Similarly, given that only 6% of all orthopaedic surgeons are women, and only, 3.5% of all orthopaedic surgeons are Latinx, we imagine the number of Latina orthopaedic surgeons is minimal. Organizations such as the Ruth Jackson Orthopaedic Society and Perry Initiative can create programming focused on the intersectionality of gender and race to attract Latina medical students into a field where their composite is unknown.

At the national level, the American Academy of Orthopaedic Surgeons (AAOS) has recently announced the AAOS IDEA Grant Program, a multi-year initiative to inspire diversity, equity, and access within the field of orthopaedics. With the intention of awarding a minimum of $1 million over the next five years, this program will fund educational, community, or outreach projects or programs that focus on eliminating bias/discrimination or promoting diversity, equity, and/or inclusion (DEI) within orthopaedics. Non-profit organizations and educational institutions are eligible to apply.10 With this source of funding that AAOS has allocated to improving diversity in the field, it is an opportune time for Latinx-serving organizations such as the Latinx Medical School Association (LMSA) to think about the roles they can play in decreasing the disparities in the orthopaedic surgery workforce.

Latinx communities within the United States are in need of surgeons whom they can relate to, especially in specialty fields that have remained homogeneous in their physician workforce, such as orthopaedics. In order to better address the increasing burden of musculoskeletal disease among a growing Latinx population, we must aim to attract, train, and ultimately help yield a greater number of practicing Latinx orthopaedic surgeons in the near future to create a healthier Latinx population in the long term.

Personal Reflections

Cristian Escalera

My interest in orthopedics sparked when witnessing the mounting obstacles that Latinos face when receiving orthopedic care. I have heard the stories of family members and Latino patients painfully working with arthritic joints. They had no options as orthopedic care was limited, expensive, and difficult to access. Countless patients deserve

surgeons that look like them and speak in their native language. Closing this disparity is one of the reasons why I want to pursue orthopedic surgery.

While pursuing this path, I have faced many obstacles, including doubt from peers, limited mentorship, and personal fears of not matching in residency. However, my desire to restore mobility, coupled with my commitment to Latino health, drives my interest in orthopedics. My advice to future applicants would be to not be afraid to reach out to others in the field and ask for mentorship. On the same note, always believe in yourself and know that you belong.

Patricia Rodarte

In my gap year before medical school, I met Dr. Luis Urrea, my first Latino orthopedic surgeon mentor, who offered me a scribe position at his practice. While scribing with him in my hometown-- El Paso, Texas--, I noticed he was one of the only Spanish-speaking surgeons in practice despite the fact that we were in the largest orthopedic practice in the city that served a 90% Hispanic population. Since then, I’ve wanted to help fill that gap by becoming an orthopaedic surgeon who can communicate and culturally relate to my patients.

Over the years, I’ve been honored to have mentors who push and inspire me to pursue orthopedics, especially those in the 2021 Nth Dimensions Summer Internship. While my Latinx and female identity may make me an “odd” applicant in the eyes of the pattern-perspective, I see how Latinx communities in the U.S. need surgeons like me. Despite the fact that it is increasingly difficult to match into orthopaedic surgery, I hope to not only match, but match into a program that is inclusive and supportive to the atypical orthopaedic trainee. I am aware that even though Black and Latinx physicians represent a low proportion of orthopaedic trainees, they are disproportionately over-represented in those that leave orthopaedic residency. As such, a goal of mine is to not only start an orthopedic residency but finish. After completing residency, I aspire to complete a fellowship in either Sports, Trauma, or Hip/Knee arthroplasty… but I am really excited about all of the fields within orthopaedics!

About the Author:

Cristian Escalera is a medical student at Albert Einstein College of Medicine. He is the 2022-2023 Golden Research Fellow at the Hand and Upper Extremity Division at the Hospital for Special Surgery in New York City. He has interests in Latinx health and orthopedic health disparities.

Patricia Rodarte is a medical student at the Warren Alpert Medical School of Brown University. She is currently a research fellow at the Institute for Global Orthopaedics and Traumatology (IGOT) at the University of California San Francisco and completed a 2021 Nth Dimensions Internship (NDSI). Patricia is a Zimmer Biomet/NMF Orthopaedic Scholar, and is passionate about advocacy for women in orthopaedics and disparities in Latinx orthopaedics domestically and abroad.

About the Work:

This article highlights the status of musculoskeletal health in the U.S. Latino population and the dire need for Latinx orthopaedic surgeons. It mentions programs doing work to address that need, and proposes a few options for improvement. Ultimately, it is an informational and perspective piece on the lack of Latinx representation within orthopedics and two medical student personal reasons for pursuing this field.

1. Bureau UC. 2020 Census Illuminates Racial and Ethnic Composition of the Country. Census.gov. Accessed October 19, 2022.

https://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-rev eal-united-states-population-much-more-multiracial.html

2. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States BMUS. Third Edition.; 2014. Accessed October 19, 2022. https://www.boneandjointburden.org/

3. Jiménez-Almonte JH, Jensen AR, Ghodasra JH, Chan WW. Minority Representation Among Orthopaedic Surgery Residents. American Academy of Orthopaedic Surgeons. Published July 1, 2017. Accessed October 19, 2022.

https://www.aaos.org/aaosnow/2017/jul/clinical/clinical06/

4. Poon S, Kiridly D, Mutawakkil M, et al. Current Trends in Sex, Race, and Ethnic Diversity in Orthopaedic Surgery Residency. J Am Acad Orthop Surg. 2019;27(16):e725-e733. doi:10.5435/JAAOS-D-18-00131

5. Table B5. Number of Active MD Residents, by Race/Ethnicity (Alone or In Combination) and GME Specialty. AAMC. Accessed October 19, 2022. https://www.aamc.org/data-reports/students-residents/interactive-data/report-resident s/2021/table-b5-md-residents-race-ethnicity-and-specialty

6. Ramirez RN, Franklin CC. Racial Diversity in Orthopedic Surgery. Orthopedic Clinics of North America. 2019;50(3):337-344. doi:10.1016/j.ocl.2019.03.010 7. Saha S, Arbelaez JJ, Cooper LA. Patient–Physician Relationships and Racial Disparities in the Quality of Health Care. American Journal of Public Health. 2003;93(10):1713. doi:10.2105/ajph.93.10.1713

8. Komaromy M, Grumbach K, Drake M, et al. The Role of Black and Hispanic Physicians in Providing Health Care for Underserved Populations. New England Journal of Medicine. 1996;334(20):1305-1310. doi:10.1056/NEJM199605163342006

9. Day MA, Owens JM, Caldwell LS. Breaking Barriers: A Brief Overview of Diversity in Orthopedic Surgery. The Iowa Orthopaedic Journal. 2019;39(1):1.

10. AAOS IDEA Grant ProgramTM- Diversity and Inclusion | American Academy of Orthopaedic Surgeons. Accessed November 1, 2022.

https://www.aaos.org/about/diversity-in-orthopaedics/idea-grant-program/