Subspecialty Selection Impacts Research Productivity and Faculty Rank of Academic Orthopaedic Surgeons

Background: Faculty promotion and research productivity are important for the overall career trajectory of academic orthopaedic surgeons. The purpose of this study was to investigate the role that subspecialty and demographic factors play in research productivity and academic advancement among orthopaedic surgeons. Methods: We conducted a retrospective cross-sectional analysis of academic rank among orthopaedic surgeons in 2018. We identified academic orthopaedic programs in the United States from the Fellowship and Residency Electronic Interactive Database (FREIDA) and collected publicly available data for surgeons, including fellowship training, gender, faculty rank, geographic region, and years since residency, from institutional websites. Research productivity was defined with the Hirsch index (h-index) from Scopus, and the m-index was calculated from the surgeon's h-index and the date of the first publication. Multivariate regression analyses were performed to determine the variables that are associated with associate professorship, full professorship, and the h-index. Results: In this study, we identified and included 2,879 academic orthopaedic surgeons. Completion of a fellowship in foot and ankle (odds ratio [95% confidence interval]: 2.45 [1.17 to 5.15]), sports medicine (2.15 [1.12 to 4.15]), trauma (2.83 [1.42 to 5.66]), hand and upper extremity (2.20 [1.13 to 4.28]), musculoskeletal oncology (3.28 [1.49 to 7.21]), or upper-extremity reconstruction (3.20 [1.31 to 7.81]) was associated with associate professorship. Completion of a trauma fellowship was associated with full professorship (2.93 [1.27 to 6.77]). Completion of a fellowship in adult reconstruction (difference in least-squares means [95% confidence interval]: 5.01 [1.22 to 8.81]), sports medicine (4.52 [1.00 to 8.04]), spine (5.40 [1.63 to 9.18]), or upper-extremity reconstruction (10.64 [6.15 to 15.12]) or the completion of multiple fellowships (5.12 [1.27 to 8.94]) were independently associated with a higher h-index. Women had significantly lower h-indices than men at the assistant (median [interquartile range]: 3 [1 to 6] versus 4 [2 to 8]) and full professor (17 [12 to 26] versus 22 [13 to 34]) levels. There were no differences in the m-index between men and women at any academic rank. Conclusions: Orthopaedic subspecialty selection is independently associated with research productivity and academic rank. The differences in research productivity may be important to consider when evaluating orthopaedic surgeons for promotion. While female surgeons had lower h-indices than their male counterparts, this difference was not seen when using the m-index.