Why orthopaedics and trauma surgery loses part of its future workforce – a cross-sectional study of gender differences in medical students’ specialty choice

BACKGROUND: As patient volumes rise and the workforce ages, medical specialties face mounting pressure to attract and retain new talent. Despite women making up the majority of medical students in Germany, their representation in surgical fields, especially orthopaedics and trauma surgery (O&T), remains comparatively low and has shown little improvement over the past decade. To ensure the future of surgical care, it is essential to understand how medical students - particularly women - perceive O&T and what factors shape their specialty choices. METHODS: In this prospective cross-sectional survey, 676 medical students from 32 medical faculties in Germany and Austria completed a questionnaire to assess specialty preferences, career motivations, educational experiences, and attitudes toward potential reforms in specialty training. Descriptive statistics, group comparisons, and regression analyses were used to examine gender differences and trends across stages of medical education. RESULTS: O&T was selected as a preferred specialty by 11.5% of respondents, with no significant gender difference at baseline (p = 0.213). However, female interest declined significantly throughout medical school, while male interest remained stable (p = 0.028). The most important influencing factors were subject-related interest, work environment, and practical clinical experiences. Female students rated work-life balance, part-time options, and gender representation significantly higher than male peers (all p < 0.01). Only 67.9% of students considered O&T a suitable field for women. More than half reported having been actively discouraged from entering the field-frequently by O&T physicians themselves (accounting for 30% of reported discouragement). CONCLUSION: This study reveals a persistent gap between early interest in O&T and the structural realities that may shape students' long-term career decisions. This disconnect does not appear to stem from a lack of interest or ability but may be linked to perceived barriers such as rigid hierarchies, limited female representation, and exclusionary workplace cultures. Supporting future talent may therefore require attention to sustainable career paths, inclusive leadership, and visible efforts toward structural change.