Longitudinal Trends in Female Representation Among Orthopaedic Residency Programs Most Visible to Potential Applicants, 2005 to 2025

Background: Despite comprising 50.5% of medical students, women remain underrepresented in orthopaedic surgery. As of 2024, orthopaedics had the lowest rate of female residents among surgical specialties at 23.7%. While early exposure programs and signaling have helped promote access, some residencies still match classes without a female resident. Tracking long-term trends in female match rates may highlight opportunities to improve representation. The purpose of this study was to provide longitudinal context for the gender composition of orthopaedic residency programs most visible to applicants by tracking changes in female representation from 2005 to 2025. Methods: We used Doximity’s Residency Navigator to sort programs by perceived reputation, and the programs in the top third results were included in our analysis as these programs are most visible to residency applicants and are presumed to shape applicant perceptions and behavior. Gender composition of interns was collected from program websites and social media for each available year. Weighted linear regression assessed temporal trends; two-proportion Z-tests evaluated regional and urbanicity differences. Results: Among 69 programs, women comprised 23.2% of interns overall. Representation rarely exceeded 20% before 2017, reaching a low of 11.5% in 2006, but surpassed 30% annually since 2022. Female representation increased by 1.2% per year (p < 0.001, R 2 = 0.77). Regional variation persisted, but growth was consistent across geography and program size. Significant increases occurred in metropolitan programs (+18.9%, p < 0.0001) from 2015 to 2025. Conclusion: Female representation at orthopaedic programs most visible on Doximity has risen steadily, with a marked inflection after 2017 and exceeding 30% since 2022. These gains likely reflect combined effects of diversity initiatives, preference signaling, and broader cultural movements advocating gender equity. Future research should examine the impact of signaling on gender diversity and evaluate gender diversity in all orthopaedic residency programs.