organizers for putting such an unusual topic on and for inviting me to participate. My goal this morning is really to set the stage for this great group of panelists to be able to give you some of their insights into what it's been like working as a woman in the world of sports. And I think to do this, what I really want to do is kind of take that 10,000 foot bird's eye view for a minute. It's hard to understand where we are if you don't know a little bit about where we've been. Medical school is very different now. It's very different from when the ladies on this panel and I went to school. Ruth Jackson, I'm sure you've all heard of. Ruth Jackson was the first boarded female orthopedic surgeon. She graduated from Baylor in 1928. When I went to medical school, about 15% of my class was female. And now as of 2019, actually about half of medical school is female. So lots of changes we're going to see coming down the line with that many more women entering our world. That was about 100 years ago, Ruth Jackson. 50 years ago we had Title IX and I think everybody's familiar with the changes that came after Title IX. So not only is medical school looking different now, the athletes are looking different now. So what does that mean for our world as women working with elite athletes? Well if you look at the most recent publications about this specific topic, women now are accounting for between 10 and 15% of all team physicians. More on the college level than on the professional level. More primary care people like me than orthopedic surgeons like Robin. But still not representing, you know, the full demographic. This was an article that was very interesting that was in OJSM and it looked at head team physicians in the NFL, MLB, and the NBA. And I think this was a really interesting article because they didn't just look at gender, they looked at who the team physicians actually were. 94% of them were men and only 6% of them were women. The mean age of the physicians was 55.4 and the mean time from fellowship training to completing their first year in their current role was almost 10 years. The mean time spent in the current role was about 14 years. So what this tells us is that the women who are coming along now are not going to show up right away, but they're going to show up down the line because they're about half of our medical school graduates currently. I think what this also says is there's a wonderful opportunity for all of us who are in these roles to mentor the young people who are coming behind us. This was a study that looked at gender in team physicians in just the NBA and the WNBA. And I'm one of those three. In the first list, there are 122 out of the 125 are male and three were female. In the WNBA, women have had a greater opportunity and that's something I want us to get out a little bit because there's a little bit of a tendency sometimes to think that maybe women are here to take care of women. And as the co-founder of the first women's sports medicine center in the country, I get asked about that a lot. And so I think that's a really important conversation for us to have. So we aren't there yet, but I'm going to digress just a little bit from sports medicine for a minute and just say that the road ahead is not unique to those of us in sports medicine. I don't know how many of you saw this article in JAMA surgery, but it was just a couple of years ago. And what we saw was that men, male surgeons tend to refer to male surgeons. Male physicians tend to refer to male physicians. Women actually don't necessarily have that same gender pattern. And what that means is that you can have the best trained female surgeon and the most talented female surgeon, but if she doesn't get referred patients, she doesn't have the opportunity to develop academically, it's part of the difference in gender pay, and so it's something people should be aware of because it's something that we're going to need to see change. This is also true just for patients. Women get treated differently than men. I don't think anybody does this intentionally, but if you look at some of the studies on gender disparity in healthcare, it's a real issue. This first study, women went to an emergency room with abdominal pain, and what the study found was that women were actually less likely to be given analgesics, including opiates, for abdominal pain, even if their pain scores were the same as a male patient. So the conclusion was that people working in an emergency room didn't take a woman's abdominal pain as seriously as they might a man's. Bring it back to orthopedics, this is an issue also with arthroplasty. Studies showed us that if a man and a woman both had arthritis of a joint, men were more likely to get referred for arthroplasty surgery. And I don't know why that is, but I think it's something that we all need to be aware has been a tendency in our current medical system. So I'm going to bring it back to sports. This is not a pleasant topic, but it's something that, you know, I think everybody is very aware of. This hasn't just happened to female athletes. There have been abuse of male athletes as well as female athletes, but it's been a recurrent issue with women in sports. And so this is one of the reasons people have said to me over the years, like, well, okay, if this stuff happens, should women be taking care of female athletes? Well, that's like saying that men should only be the ones taking care of men athletes, right? I mean, it kind of doesn't make any sense. The best doctors should be taking care of everyone, and men and women both deserve equal care, and our young athletes both deserve equal care. Joe Hannafin and I founded the first Women's Sports Medicine Center at HSS about 25 years ago. And the reason we did came out of our own experiences and the experiences of our patients. It wasn't because the guys couldn't take good care of women. It was that, frankly, a lot of our colleagues weren't that interested in some of the women's problems. Like, a lot of the wonderful surgeons that I know don't want to take care of patellofemoral pain. I thought it was interesting that Robin was the one doing the talk on patellofemoral surgery. Joe and I both had experiences as athletes ourselves where nobody had an answer if you wanted to know, like, why does your period change when you're training hard? And nobody knew the answer to that. We're still not entirely sure, but we know a lot more about it now than we did 25, 30 years ago. If we went from, it was just me and Joe in the beginning, and we had an interested physical therapist and an interested nutritionist. And now we've grown to this amazing group of women who enjoy tackling problems that are either common in women or unique to women or that have been difficult to address in women. So we have Beth Schubenstein, who's very interested in the patellofemoral joint. We have Marcy Goolsby, who's very interested in stress fractures and the female athlete triad. But what's interesting about it is not just that we've evolved this group to take care of female patients, it's that we have evolved this group of women who have really mentored other women. And so it's really fun to work with people who either have had similar challenges or are very interested in the same types of problems. But we take care of a lot of men, too. It's sort of funny that I've ended up, I started my career really in women's sports, and then I really transitioned to working a lot with men. And I think it's actually been a really nice combination. And I'm really of the mind that your gender is not nearly as important as your skill set and your interest in your patient's problems. We're also so lucky these days to have so many people excelling in different fields that you don't have to be everything to everyone, but it's really important to have an interest in your patient's issues if you're going to be a good doctor for them. So I told you a little about where we've been, kind of my thoughts on where we are. What's going to happen next? Well, some of those young women in medical school are going to follow in our footsteps. We're going to have more and more women entering the sports medicine world in medicine. We're seeing that in athletic training and physical therapy and all of our different sports-related fields. There's a new journal, the first article here, the Female Representation in Orthopedic Surgery and Primary Care in Sports Medicine. That's actually a new journal that's just been published for the last couple of years that spun out of the Journal of Women's Health. It's the Journal of Women in Sports Medicine. It published one journal, one annual a year for the first couple of years, and I think they published two. But there's a very interesting review article. If anybody is interested more in this topic, there's a very interesting review article that's much more eloquent than me on where we have been and where we are going. There was an interesting article in Nature, just published in December of 22, about how we really aren't doing any research on women in sports. And so a lot of the things we know, we know from looking at men, but as we all know, women are not small men. And so there are a lot of things that are very different. The way women react to medications, the way women report their injuries, the way women converse about their injuries. So there's a lot to be learned, and this field is wide open, and I expect we're going to see a lot of growth in the next couple of decades in this area specifically. So I'd like to close by just taking a little bit of a moment to say these are some of the things that I'm hoping the panelists will talk about, because some of you probably have young female colleagues. Some of you may have daughters who are coming along and are interested in doing what we're doing. Some of you are women yourselves. And these are some of the things that I think are always questions, are how do you get started as a woman in this world? My feeling is you just say yes. You say yes when opportunities present themselves, but you should never say yes if you're a man or a woman. You should never say yes if you're not going to give it your best effort. I will say as a woman in this world, you really have to give it your best effort plus another like 5% beyond your best effort, because there's a woman standing behind you over there who's watching you, and if you succeed, she's going to have a better opportunity to follow in your footsteps. Being open and willing to learn. It's very unlikely that your teachers and mentors are going to continue to look like you. I look around this room, and there's a lot of diversity in this room. This is very different than 25 years ago when I probably went to my first AOSSM meeting, or even 20-some years ago when Ronnie Barnes gave me my first opportunity with the NFL Giants. There's a lot of different diversity now, and we should be able to take advantage and maximize that, but I will tell you some of my most important mentors have been men, and I wouldn't be where I was today without them. And then the last thing I just want to say, and I think this is something that's very interesting for some of these women at this table, they're all incredibly accomplished, they've done really interesting things, but none of them, none of these women has a big ego. They're all very confident, they're all very competent, but they don't have a big ego. So they're never going to tell you it's about them, even when it is about them, they're not going to tell you that. And I think the key for me is communication. Communication among ourselves, communication among our colleagues, and communication with our athletes. So I'll try to just fly through that quickly to set a little bit of a stage so that Robin can turn it over to the panel. Thank you.

women in sports medicine

gender representation

medical schools

team physicians

gender disparities