Navigating the Intersection of Identity and Mental Health: A Literature Review of Non-White Women in Orthopedic Surgery

Anjali Malhotra MPH¹, Laura Palma MS^1, , Janae Rasmussen DO², Elena Myalo BS³, Vivian Liang BS⁴, Melody Wang MS⁵, Thelma Jimenez Mosquea MD⁶ and Julia Hanna MMS⁷

¹State University of New York Upstate Medical University, Syracuse, NY, USA

²Valley Consortium for Medical Education, Modesto, CA, USA

³Lake Erie College of Osteopathic Medicine, Elmira, NY, USA

⁴A.T Still University School of Osteopathic Medicine, Mesa, AZ, USA

⁵Touro University California, Vallejo, CA, USA

⁶NYU Langone Health, New York, NY, USA

⁷Lake Erie College of Osteopathic Medicine, Erie, PA, USA

Cite this paper:
Anjali Malhotra MPH, Laura Palma MS, Janae Rasmussen DO, Elena Myalo BS, Vivian Liang BS, Melody Wang MS, Thelma Jimenez Mosquea MD and Julia Hanna MMS. Navigating the Intersection of Identity and Mental Health: A Literature Review of Non-White Women in Orthopedic Surgery. American Journal of Medical Sciences and Medicine. 2025; 13(2):15-22. doi: 10.12691/ajmsm-13-2-1

Abstract

Non-white women in orthopedic surgery face various challenges at the intersection of identity and mental health. Underrepresentation and systemic barriers can lead to increased rates of stress, lower sense of belonging, and lower confidence in an individual’s perception of success in orthopedics. This literature review explores the impact of these factors on mental health, professional advancement, and patient care. Our analysis of the current literature identifies unique challenges that non-white women orthopedic surgeons face and highlights the further need for systematic changes. Addressing issues that negatively impact diversity, equity, and inclusion within orthopedics, particularly for non-white women, is critical for addressing interventions and policy reform measures, to ultimately improve the well-being of both orthopedic surgeons and their patients.

Keywords:
women orthopedic surgery underrepresented minority diversity mental health

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Flanagin, A., Frey, T., Christiansen, S. L., & AMA Manual of Style Committee (2021). Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA, 326(7), 621–627.
[2]	Day, M. A., Owens, J. M., & Caldwell, L. S. (2019). Breaking Barriers: A Brief Overview of Diversity in Orthopedic Surgery. The Iowa Orthopaedic journal, 39(1), 1–5.
[3]	Owuor, H. K., Strauss, E. J., McLaurin, T., Zuckerman, J. D., & Egol, K. A. (2024). Increasing Diversity in Orthopaedic Surgery Residency: A Case Report of One Program's Experience Using Pipeline Programs. JB & JS open access, 9(4), e24.00077.
[4]	Liew, S. K., Lee, J. A., Tamam, F., Ismail, I. I., Mohamed-Saaid, F., & Chye, P. C. (2023). Women in Orthopaedics: A Perspective from Malaysian Female Orthopaedic Surgeons. Malaysian Orthopaedic journal, 17(1), 70–78.
[5]	Sedani, A. B., Yakkanti, R. R., Syros, A., Swonger, R. M., LaPorte, D. M., Aiyer, A. A., D'Apuzzo, M. R., & Hernandez, V. H. (2023). An overview of occupational injuries among female orthopaedic surgeons. Journal of orthopaedics, 47, 94–99.
[6]	Chou, L. , Kha, S. & Shapiro, L. (2024). Health Considerations for Female Orthopaedic Surgeons. Journal of the American Academy of Orthopaedic Surgeons, 32 (3), e125-e133.
[7]	Balch Samora, J., Van Heest, A., Weber, K., Ross, W., Huff, T., & Carter, C. (2020). Harassment, Discrimination, and Bullying in Orthopaedics: A Work Environment and Culture Survey. The Journal of the American Academy of Orthopaedic Surgeons, 28(24), e1097–e1104.
[8]	Ode, G. E., Brooks, J. T., Middleton, K. K., Carson, E. W., & Porter, S. E. (2022). Perception of Racial and Intersectional Discrimination in the Workplace Is High Among Black Orthopaedic Surgeons: Results of a Survey of 274 Black Orthopaedic Surgeons in Practice. The Journal of the American Academy of Orthopaedic Surgeons, 30(1), 7–18.
[9]	Gerull, K. M., Klein, S. E., Miller, A. N., & Cipriano, C. A. (2024). Do Women and Minority Orthopaedic Residents Report Experiencing Worse Well-being and More Mistreatment Than Their Peers?. Clinical orthopaedics and related research, 482(8), 1325–1337.
[10]	Okike, K., Chang, R. N., Royse, K. E., Paxton, E. W., Navarro, R. A., & Hinman, A. D. (2022). Association Between Race/Ethnicity and Total Joint Arthroplasty Utilization in a Universally Insured Population. The Journal of the American Academy of Orthopaedic Surgeons, 30(20), e1348–e1357.
[11]	Liew, S. K., Lee, J. A., Tamam, F., Ismail, I. I., Mohamed-Saaid, F., & Chye, P. C. (2023). Women in Orthopaedics: A Perspective from Malaysian Female Orthopaedic Surgeons. Malaysian orthopaedic journal, 17(1), 70–78.
[12]	Paul, D., Ghoshdastidar, S., Halder, S., & Sarkar, D. K. (2023). Are Women Finally Joining Orthopedics in India? A Study of the Causes Limiting the Number of Women in Orthopedics in India with Steps for Furthering Progress. Indian journal of orthopaedics, 57(4), 586–595.
[13]	Flint, J. H., Jahangir, A. A., Browner, B. D., & Mehta, S. (2009). The value of mentorship in orthopaedic surgery resident education: the residents' perspective. The Journal of bone and joint surgery. American volume, 91(4), 1017–1022.
[14]	Gulati, K., Davies, J., Gonzalez de la Fuente, A., & Singh, A. R. (2024). Striving for equity: exploring gender-inclusive medical leadership in India. BMJ leader, 8(4), 318–323.
[15]	Zhou, L., Liu, B., Fu, W. et al. Surgical career choices of medical students in China: does gender bias play a role?. BMC Med Educ 22, 378 (2022).
[16]	Alansari, A. N., Alhussaini, N. W., Elshaikh, U., & Al-Zoubi, R. M. (2024). The journey of female surgeons in the Arab region: A scoping review. The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 22(5), 307–318.
[17]	Valji, R. H., Valji, Y., & Turner, S. R. (2023). Sex and Racial Diversity in Canadian Academic Surgery. Canadian Journal of Surgery. Journal Canadien de Chirurgie, 66(4), E411–E414.
[18]	Osseo-Asare, A., Balasuriya, L., Huot, S. J., Keene, D., Berg, D., Nunez-Smith, M., Genao, I., Latimore, D., & Boatright, D. (2018). Minority Resident Physicians' Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace. JAMA network open, 1(5), e182723.
[19]	Amini, M. J., Shafiee, A., Mirhoseini, M. S., Mohammaditabar, M., Salehi, S. A., Abdarian, G., Sadeghi, D., Tajvidi, M., Bakhtiyari, M., & Bahadorimonfared, A. (2024). Prevalence of depression and anxiety in orthopedic residents: a systematic review and meta-analysis. BMC medical education, 24(1), 1261.
[20]	Ross, P. P., Okafor, L. C., Rumps, M. V., & Mulcahey, M. K. (2025). Promoting Wellness among Orthopaedic Surgeons. JB & JS open access, 10(1), e24.00090.
[21]	Travers V. (2020). Burnout in orthopedic surgeons. Orthopaedics & traumatology, surgery & research: OTSR, 106(1S), S7–S12.
[22]	Fu, W. W., Gauger, P. G., & Newman, E. A. (2021). Mental Illness and Stigma in Surgical Residencies-An Unspoken Truth. JAMA surgery, 156(2), 117–118.
[23]	Ranson, R., Webber, K., Saker, C., Cashin, I., Bunstine, J. L., Patel, A. P., Kirkland, J., Gianakos, A. L., Rumps, M. V., & Mulcahey, M. K. (2025). Representation Matters: A Higher Percentage of Women Orthopaedic Surgery Faculty Is Associated With an Increased Number of Women Residents. The Journal of the American Academy of Orthopaedic Surgeons, 33(5), 253–260.
[24]	American Academy of Orthopaedic Surgeons (AAOS). (2025). Diversity & AAOS. Retrieved from [https:// www.aaos.org/ about/diversity-in-orthopaedics/].
[25]	Silvestre, J., Ahn, J., & Levin, L. S. (2017). National Institutes of Health Funding to Departments of Orthopaedic Surgery at U.S. Medical Schools. The Journal of bone and joint surgery. American volume, 99(2), e5.
[26]	Imam, N., Sudah, S. Y., Shaikh, S. Z., Nicholson, A. D., Namdari, S., & Menendez, M. E. (2023). National Institutes of Health Funding to Departments of Orthopaedic Surgery at U.S. Medical Schools from 2015 to 2021. The Journal of bone and joint surgery. American volume, 105(15), 1205–1213.
[27]	FY 2024 Budget-Congressional Justification. National Institute of Mental Health. National Institutes of health. Available at: https:// www.nimh.nih.gov/about/budget/fy-2024-budget-congressional - justification#: ~: text=Note%20that% 20there% 20may% 20be,the%20FY%202023%20Enacted%20level. Accessed March 28, 2025.
[28]	Hewitt, D. B., Ellis, R. J., Chung, J. W., Cheung, E. O., Moskowitz, J. T., Huang, R., Merkow, R. P., Yang, A. D., Hu, Y. Y., Cohen, M. E., Ko, C. Y., Hoyt, D. B., & Bilimoria, K. Y. (2021). Association of Surgical Resident Wellness with Medical Errors and Patient Outcomes. Annals of surgery, 274(2), 396–402.
[29]	Shanafelt, T. D., Balch, C. M., Bechamps, G., Russell, T., Dyrbye, L., Satele, D., Collicott, P., Novotny, P. J., Sloan, J., & Freischlag, J. (2010). Burnout and medical errors among American surgeons. Annals of surgery, 251(6), 995–1000.
[30]	Shin, P., Desai, V., Conte, A. H., & Qiu, C. (2023). Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine. The Permanente journal, 27(2), 160–168.
[31]	Lajam, C. M., & O'Connor, M. I. (2023). Equity360: Gender, Race, and Ethnicity-All Orthopaedic Surgeon Burnout Is Not Created Equal. Clinical orthopaedics and related research, 481(3), 451–454.
[32]	Gottlieb, A. S., & Jagsi, R. (2025). Removing diversity, equity, and inclusion infrastructure in medicine, public health, and science: the cost of overcorrection. BMJ, 388.
[33]	Dyer, O. (2025). What is happening to the US Natioanl Institutes of Health? BMJ, 388.
[34]	US Department of Health. List of NIH-funded studies terminated for DEI or gender reasons. 11 April 2025. https:// taggs.hhs.gov/ Content/Data/HHS_Grants_Terminated.pdf.
[35]	Ruth Jackson Orthopaedic Society. (2025).
[36]	Czerwonka, N., Russo, C. M., & Cannada, L. K. (2023). Publication and Career Trends of Ruth Jackson Orthopaedic Society Grant Winners Over the Past Decade. The Iowa orthopaedic journal, 43(1), 7–13.
[37]	Brooks, J. T., Taylor, E., Peterson, D., & Carson, E. (2022). The J. Robert Gladden Orthopaedic Society: Past, Present, and Future. The Journal of the American Academy of Orthopaedic Surgeons, 30(8), 344–349.
[38]	Whiteleather, J. C., Rosario-Rivera, B., Haruna, A., Munoz-Valencia, A., Ondecko-Ligda, K., Vogt, K. M., & Ibarra, A. J. (2024). Diversity engagement is associated with lower burnout among anesthesia providers. El Servier, 1(3-4).
[39]	Gomez, L. E., & Bernet, P. (2019). Diversity improves performance and outcomes. Journal of the National Medical Association, 111(4), 383–392.
[40]	Chou, L. B., Chandran, S., Harris, A. H., Tung, J., & Butler, L. M. (2012). Increased breast cancer prevalence among female orthopedic surgeons. Journal of women's health (2002), 21(6), 683–689.
[41]	Lopez Vera, A., Thomas, K., Trinh, C., & Nausheen, F. (2023). A Case Study of the Impact of Language Concordance on Patient Care, Satisfaction, and Comfort with Sharing Sensitive Information During Medical Care. Journal of immigrant and minority health, 25(6), 1261–1269.
[42]	Snow, M., McDaniel, C., Bronheim, R. S., & LaPorte, D. (2022). Representation of women and underrepresented minorities among grand rounds speakers in orthopaedic surgery. Surgery in practice and science, 11, 100148.
[43]	Winfrey, S. R., Parameswaran, P., Gerull, K. M., LaPorte, D., & Cipriano, C. A. (2022). Effective Mentorship of Women and Underrepresented Minorities in Orthopaedic Surgery: A Mixed-Methods Investigation. JB & JS open access, 7(4), e22.00053.
[44]	Adeleye, O., Brinkman, J., Yu, S., Chhabra, A. and Misra, L. (2024) A Cross-Sectional Study of Factors Influencing Orthopedic Surgery Application, Diversity, and Trainee Experiences. Open Journal of Anesthesiology, 14, 197-208.
[45]	Aronson, J., Fried, C. B., & Good, C. (2002). Reducing the effects of stereotype threat on African American college students by shaping theories of intelligence. Journal of Experimental Social Psychology, 38(2), 113-125.
[46]	Brooks, J. T., Porter, S. E., Middleton, K. K., Carson, E. W., & Ode, G. E. (2023). The Majority of Black Orthopaedic Surgeons Report Experiencing Racial Microaggressions During Their Residency Training. Clinical orthopaedics and related research, 481(4), 675–686.
[47]	Ortega, G., Benson, E., Pierrie, S. N., McLaurin, T. M., & Tejwani, N. C. (2021). Diversity in orthopaedic trauma: where we are and where we need to be. OTA international: the open access journal of orthopaedic trauma, 4(2), e102.
[48]	Reid, R. T., Odum, S. M., Rosopa, P. J., Brooks, J. T., Scannell, B. P., Poon, S., Williams, T., Patt, J. C., & Ode, G. E. (2025). Perception of Residency Program Diversity Is Associated With Vulnerability to Race and Gender Stereotype Threat Among Minority and Female Orthopaedic Trainees. JB & JS open access, 10(1), e24.00084.
[49]	Wang, J. C., Chang, S. W., Nwachuku, I., Hill, W. J., Munger, A. M., Suleiman, L. I., & Heckmann, N. D. (2023). Trends in Race and Sex Representation among Entering Orthopaedic Surgery Residents: A Continued Call for Active Diversification Efforts. The Journal of the American Academy of Orthopaedic Surgeons, 31(12), e530–e539.