Allison Lewis, a rising second-year student at the Medical College of Georgia in Augusta, has noticed something since she’s been shadowing Dr. Larry Martin, an orthopedic surgeon with Novant Health Orthopedics & Sports Medicine in Mint Hill, North Carolina.
“When Dr. Martin consults with a patient before surgery, he talks about whether it's going to be done with a camera – arthroscopically – or as open surgery,” she said. “But he doesn't necessarily go into great detail about the tools he’ll use.”
“I can understand why,” she continued. “It can be jarring for a patient if you mention a drill or saw or something that reminds you of Home Depot. That would make me uncomfortable, too. So, he talks about the angle of the surgery and the access points, how the incision will be made and the expected outcome.”
An orthopedic surgeon’s tools – drill, saw, mallet, hammer – are eerily similar to those of a carpenter.
In fact, Patricia Rodarte, a rising second-year medical student at Brown University and an intern paired with Dr. Paulvalery Roulette, an orthopedic surgeon at Novant Health Orthopedics & Sports Medicine – Matthews, said the tools aren’t foreign to her.
“I’m a first-generation college student, the first in my family to go to medical school, and God willing, I'll be the first physician and orthopedic surgeon in my family,” she said. “Coming from a working-class family, I’m used to hammers and drills and saws. I’ve always been surrounded by them. When I’m in the OR, there’s a weird sense of familiarity. It’s like a construction zone.”
Diversifying the field
There are few women orthopedic surgeons. In America, women make up just 6.5% of all orthopedic surgeons. And there are even fewer Black women in the field – just 3%.
Novant Health wants to help change that. The Novant Health Orthopedics and Sports Medicine Institute and Novant Health Diversity & Inclusion are partnering with Nth Dimensions to host two medical students – Lewis and Rodarte – for an eight-week clinical and research summer internship in Charlotte.
Nth Dimensions is a nationally recognized student pipeline for orthopedic surgery. It was founded by a Black female orthopedic surgeon (Dr. Bonnie S. Mason) and is led by another Black female orthopedic surgeon (Dr. Letitia Bradford). Nth Dimensions interns get to follow a surgeon/mentor during clinic and in the OR. They’re also required to complete a research project which may be shared at the National Medical Association’s annual meeting.
Zack Landry, vice president at Novant Health’s Orthopedics & Sports Medicine Institute, hopes the partnership will continue.
“Ultimately, we want to recruit a physician workforce that reflects the communities we serve,” he said. “The challenge is that in orthopedic surgery, there is a relatively small percentage of minority and female candidates available to recruit. Recruiting diverse candidates will always be an important strategy, but the internship allows us to dig a little deeper.”
It takes a certain someone
Orthopedic surgery is not for the squeamish. But Lewis is hooked. She already knows this is the area of medicine she wants to pursue – even though there aren’t a lot of people who look like her in the field. “As a woman of color, you don't see a lot of representation,” she said.
Given the lack of diversity, Rodarte wondered if the specialty was right for her until she worked for a Latino orthopedic surgeon in her hometown of El Paso, Texas, during a gap year after college. “I’m Latina, too,” she said. “I saw how a lot of his patients depended on orthopedic interventions to not only live a good quality of life but to make a living. It really impacted me.”
And this summer has confirmed she’s on the right path: “I've been exposed to so much that I’m no longer thinking about barriers in the way. Orthopedic surgery is what I’m excited and passionate about. I'm no longer questioning.”
Roulette understands. In medical school, he said, “I did not have access to many Black orthopedic surgeon mentors, though there was at least one Black male orthopedist that I reached out to.”
“For Black women in orthopedics, it’s even harder,” he continued. “Women colleagues have told me that people asked them in med school, ‘Are you sure you want to go into orthopedic surgery? What about when you have kids?’ No one would ask me that.”
“Women make up more than 50 percent of people who hurt their bones,” he added. “It doesn't make sense that you have less than a 10 percent chance of having a woman talk to you about bone health surgical needs.”
‘The hidden curriculum’
You have to excel academically to get to medical school and then to get a residency. But you also need letters of reference. That’s why Sonya Seymour, Nth Dimensions’ director of partnerships and programs, said “the hidden curriculum” is so important. It’s part of what the program teaches.
Some Nth Dimensions interns – like Rodarte – are part of the first generation in their families to go to college. They don’t have built-in connections. Nth Dimensions creates those connections. “We help them understand what residency programs are looking for,” Seymour said. “What makes someone successful? What does it take when you're going into a residency and you’re the only minority in your program?”
Roulette put it this way: “You’ve got to find allies willing to take a chance on you.”
It’s especially true in orthopedics, one of the most competitive fields in medicine. “A residency program, on average, can have 900 applicants for between six and 20 spots,” Seymour said.
Physician mentors ensure the interns they supervise get hands-on experience. “I treat Patricia as if she's a senior medical student,” Roulette said. “In my clinic, she's evaluating patients on her own and devising treatment plans.” She’s also observing in the OR.
Matchmaking, med school style
Nth Dimensions believes in starting early.
“We specifically look for students in their first year of medical school,” Seymour said. “That year is important because it provides early exposure and a foundation. If we give that student a foundation, she has a competitive edge.”
The program works. Since its founding in 2004, Nth Dimensions has helped produce over 350 orthopedic surgeons. “We are one of the most successful pipeline programs for students of color, women and underrepresented minorities interested in medicine,” Seymour said. The numbers back that up.
Match Day, held every March, is when graduating medical students are paired with a residency program. It’s like a real-life dating app for new doctors. Nth Dimensions’ average match rate over the past five years is 92 percent. In other words, 92 percent of the people who complete the program are matched with a residency program. That’s well above the national match rate, which Seymour said is 70 to 78 percent.
‘A long-term commitment’
Allison Lewis said, “This summer has been amazing. I cannot wait to go back to school and show off what I've learned.”
Rodarte has lost count of how many surgeries she’s gotten to observe this summer. “It might be 25 or 30,” she said. “And I've had the opportunity to see a lot of different fields in orthopedic surgery – joint, trauma, sports medicine. It has been such a blessing.”
“Before this summer, I’ve had to go out of my way to find people to mentor me,” she continued. “Whereas, in this program, everyone is excited for me to learn – whether it be the nurse who's teaching me how injections work or the PA who explains each part of the physical exam or the staff in the OR making sure I have the correct glove size and showing me how to drape a patient correctly. Everyone has taken me under their wing.”
Landry, the orthopedics leader, views this summer’s partnership with Nth Dimensions as just the beginning. “We see this as a long-term commitment,” he said. “It would be a great benefit for us and for the community if the students have a phenomenal experience, become advocates for Novant Health Orthopedics & Sports Medicine and want to come back as caregivers in our organization down the road.”
That’s Seymour’s goal, too.
“We hope, of course, that Patricia and Allison choose orthopedics and orthopedics chooses them,” she said. “Maybe they will come back and work with Dr. Roulette and Dr. Martin. We do have success stories like that. A lot of interns tell us this was their life-changing summer.”