Sex, Racial, and Ethnic Diversity of US Musculoskeletal Oncology Fellows, a 10-year Analysis.

BACKGROUND: Diversity in the orthopaedic surgery workforce is essential for addressing healthcare disparities, enhancing patient-physician trust, and improving outcomes. Despite a growing diverse US population, orthopaedics remains one of the least diverse surgical specialties. However, diversity within musculoskeletal oncology fellowships has not been examined. Identifying disparities in representation is a critical step toward fostering a more inclusive workforce that better reflects the patient population. This study asked (1) is female representation equitable in musculoskeletal oncology fellowships, and (2) are individuals from underrepresented racial and ethnic backgrounds equally represented? METHODS: We analyzed publicly available demographic data for US medical graduates, orthopaedic surgery residents, and musculoskeletal oncology fellows from 2013 to 2022. Sex and race/ethnicity were extracted, and annual percentages for each demographic category were assessed. Participation-to-prevalence ratios (PPRs) were calculated to determine overrepresentation (>1.2), equitable representation (0.8 to 1.2), and underrepresentation (<0.8) relative to US Census data. RESULTS: Female fellows were underrepresented (PPR = 0.73). Hispanic and Black fellows were also underrepresented, with PPRs of 0.21 and 0.29, respectively. Notably, there were no Native Hawaiian/Pacific Islander or Native American/Alaskan Native fellows in this subspecialty. Asian fellows were overrepresented (PPR = 1.47), and White fellows were equitably represented (PPR = 1.08). CONCLUSION: Musculoskeletal oncology fellowships continue to demonstrate sex and racial/ethnic disparities, with notable underrepresentation of female, Hispanic, Black, Native Hawaiian/Pacific Islander, and Native American/Alaskan Native fellows. Despite increasing diversity at earlier stages of medical training, these improvements are not reflected in fellowship representation, highlighting the need for targeted efforts to promote inclusivity.