Perceived fit and identity alignment as drivers of orthopedic attrition: a cross-sectional survey of medical trainees

Background Orthopedic surgery remains one of the least diverse medical specialties despite efforts to improve recruitment and representation. While exposure and mentorship influence specialty choice, the contributions of perceived competitiveness, diversity, and personal fit remain incompletely understood.Methods We conducted a cross-sectional survey of resident and fellow physicians across multiple institutions in Texas assessing demographics, orthopedic exposure, mentorship access, perceived competitiveness, and factors influencing specialty choice.Results Fifty participants completed the survey, 54% female and 46% male. Half reported prior interest in orthopedic surgery, whereas 18% were currently in orthopedic surgery. Although 84% reported access to orthopedic subspecialty rotations and 78% to orthopedic faculty or mentorship, only 48% completed an orthopedic subspecialty rotation and 54% reported difficulty establishing connections within the field. Only 34% considered orthopedic surgery a diverse field. In gender-stratified analyses, female respondents reported lower perceived gender fit than male respondents (33.3% vs 82.6%, P < 0.001, q = 0.018), the only association that remained significant after correction for multiple comparisons. Perceived personality fit and prior orthopedic interest also differed by gender before adjustment.Conclusion These exploratory findings suggest that perceptions of identity alignment and accessibility may influence pursuit of orthopedic surgery despite available exposure and mentorship. Larger studies are needed to validate these findings and better characterize barriers to recruitment and inclusion.