On July 26, 2024, the JRGOS Board of Directors sent a letter to the American Academy of Orthopaedic Surgeons (AAOS), Accreditation Council for Graduate Medical Education (ACGME), and American Board of Orthopaedic Surgeons (ABOS), in response to the disproportionate rate of remediation and attrition of Black Orthopaedic Surgery Residents. The lack of accountability to our governing bodies, the ABOS, AAOS, and ACGME, and the lack of transparent and uniform standard and process for Orthopaedic Residencies that terminate residents affects all Residents regardless of race and gender. This significant problem jeopardizes the entire Orthopaedic Surgery Community.

Dear Leadership of American Academy of Orthopaedic Surgeons, Accreditation Council for Graduate Medical Education, and AmericanBoard of Orthopaedic Surgery:

The J. Robert Gladden Orthopaedic Society (JRGOS) is profoundly concerned about the escalating rate of remediation and attrition among Black Orthopaedic Surgery Residents. This pressing issue demands the immediate attention of, and concerted action from, the American Academy of Orthopaedic Surgeons (AAOS), Accreditation Council for Graduate Medical Education (ACGME), and American Board of Orthopaedic Surgery (ABOS).

Extensive research has documented the pervasive discrimination and bias faced by Black Orthopaedic Surgery Residents, which significantly contributes to their high attrition rates and the exceedingly low representation within our field. Presently, Black Orthopaedic Surgeons make up less than 1.8% of all practicing Orthopaedic Surgeons, a distressing statistic that underscores the gravity of the situation

The disproportionately high number of Black Orthopaedic Surgery Residents identified for remediation and subsequently dismissed from their programs is deeply troubling. From 2001 to 2020, Black males constituted only 3.7% of Orthopaedic Surgery Residents but then accounted for 15% of all unintended attrition. Similarly, Black female residents represented only 0.76% of the resident population, yet experienced an unintended attrition rate of 6.9%.

Scientific studies have demonstrated that Black Orthopaedic Surgery Residents endure a significant number of microaggressions from their attendings, fostering an environment prone to abuse and the unjust targeting of Black residents for undue criticism, discipline, and remediation. This hostile atmosphere not only affects current residents but also deters competitive Black Medical Students from entering Orthopaedic Residency Programs, thereby exacerbating the already critical shortage of Black Orthopaedic Surgeons. Research has further shown that race, rather than gender, significantly influences admission into orthopedic residency programs.

Black residents are often subjected to non-standardized, opaque processes for remediation and dismissal, which lack uniform guidelines and oversight. This creates a perilous environment for Black Orthopaedic Residents, influencing their career paths and discouraging prospective BlackMedical Students from pursuing Orthopaedics.

JRGOS implores the AAOS, ACGME, and ABOS to urgently harness their substantial resources and influence to establish and enforce transparency, standardization, reporting, oversight, and accountability across all Orthopaedic Surgery Residency Programs. These measures are essential to rectify the current disparities in the resident remediation and termination processes. Without critical oversight and standardized procedures at every teaching institution, the existing inequities will persist, further diminishing the number of Black Residents graduating from Orthopaedic Surgery Residencies and perpetuating the insufficient representation of Black Orthopaedic Surgeons in our nation.

Sincerely,

The J. Robert Gladden Orthopaedic Society Board of Directors