Recognition as the next frontier in orthopedic innovation

Of everything my residency gave me, the most important was my teacher. He taught me that every presentation deserves meticulous preparation, regardless of the stakes. He believed it was a chance to grow, find one’s voice, and contribute to a scientific forum. So, every slide of mine was scrutinized and every line rehearsed. He taught me to never step onto a podium unprepared. Though he is no longer with us, I still prepare with the same rigor. 

And yet, at the very end of it all, most of my certificates read: “This is awarded for his presentation.” This statement is grammatically correct and syntactically sound. But also, deeply jarring. I am a woman by birth and an orthopedic surgeon by choice, and not one of those certificates was written with me in mind. I am not alone in this. Colleagues elsewhere have encountered the same pattern in their certificates, with the same default pronoun.

It is not just certificates. Even in professional correspondence, forms, or documents, “sir” tends to be the default. I do not believe it is intentional. And it is not unique to any one institution or system. These templates were created when orthopedics was practiced only by men. But the population has since changed, while the template has not.

The weight of microaggressions

In India, the first women in medicine faced a world without precedent and carved a path for those who would follow. Dr Anandibai Joshi traveled to the US to become the first Indian woman to earn a medical degree, while Dr. Muthulakshmi Reddy required a royal decree just to gain entry into medical lecture halls. This was not unique to India. Across the world, women had to forge their way into systems that were not built for them.

A misgendered certificate does not belong in the same sentence as the barriers these women faced. But scale alone is an incomplete measure of importance. In academic literature, what I am describing is recognized as a “microaggression.” It refers to brief, everyday instances of bias that accumulate over time. 

The prevalence of microaggressions in the surgical workplace is well-documented. Research indicates that female surgeons are exposed to gender-based microaggressions at a rate 15.9 times higher than their male counterparts. This pattern is often sustained by protocols or templates that were not designed with women in mind. Studies show that bias is frequently embedded in the formal language used for evaluations, awards, and professional records. When a system produces a misgendered certificate, it becomes a metric of an environment in which the "default" surgeon is still assumed to be male.

A single pronoun is easy to dismiss. But a pronoun repeated across an entire career becomes impossible to overlook. It creates a persistent dilemma: does one speak out and risk being perceived as “difficult,” or remain silent and accept the erasure? More often than not, I choose a third option. I remind myself of the support I have received from my teachers and colleagues and convince myself that this is insignificant by comparison. However, relying on personal goodwill to navigate an outdated system is not a sustainable solution. Kindness is not a substitute for design.

The leaky pipeline

When the design repeatedly fails, many do not stay long enough to find a third option. Globally, the representation of women in orthopedics remains remarkably low, at 1% in India, 7% in the UK, and 7.5% in the US. Orthopedics also records the highest attrition of women among all surgical specialties. Studies across medicine have shown that even seemingly small, repeated forms of gender bias and misrecognition contribute to a workplace culture in which women continue to feel unseen, excluded, or treated as exceptions rather than the norm. A misgendered certificate is not the biggest leak in the pipeline, but it is one with no defensible excuse for remaining unsolved. 

The precision of identity

As orthopedic surgeons, achieving perfection isn’t just an aspiration. It’s a compulsion. There is no higher compliment than a colleague studying our post-operative X-rays and struggling to find the fracture line. There is no greater satisfaction than a patient walking back into their life as if they were never on our table. And it is because we hold ourselves to this standard that we are incredibly hard on ourselves. We may know that a fracture is technically beyond salvage, and yet, we pour countless hours into it to chase the best possible outcome. “Acceptable” is not our ceiling. It's barely where we begin.  

As someone who was shaped by this uncompromising culture, how can I be expected to make peace with an “acceptable reduction” of my identity? If precision is non-negotiable in the operating room, why must I accept anything less on paper?

The next frontier

“Female orthopedic surgeon" is how we are introduced, referenced, and remembered. This is not a grievance, but a mere observation. If our gender is significant enough to be a mandatory prefix in conversation, it must be significant enough to be recorded correctly on a document. Perhaps the next frontier in orthopedics is not an innovation at all, but something far simpler and far more overdue.

A pronoun can be corrected in seconds. A template can be updated in minutes. None of this requires a committee, a budget, or a conference. It requires only the same attention to detail we bring into the operating room every day. Irrespective of gender, no surgeon should have to fight for their identity on a document they earned, or even in routine correspondence.

Every time we sign a certificate, draft a letter, or introduce a colleague, we have an opportunity to get it right. The next time you have that power, will you?