Orthopaedic surgery residency program ranking and the current state of leadership: what are the characteristics of the leaders in the "Top-tier" programs?

Background: Orthopaedic surgery residency program ranking and leadership can influence applicant and program decision-making. The study objective was to evaluate the relationship between program rankings and characteristics of their leadership. Methods: The Accreditation Council for Graduate Medical Education, Doximity, and program-specific websites were queried, identifying 193 programs and 426 leaders for analysis. Leadership positions evaluated included: Chairs, Vice Chairs, Program Directors, and Assistant Program Directors. Residency programs were categorized into tiers based on 2022-2023 Doximity reputation ranking. Program ranking was stratified as follows: Tier 1 (rank 1-50, highest-ranking programs), Tier 2 (rank 51-100), Tier 3 (rank 101-150), and Tier 4 (rank 151-201, lowest-ranking programs). Leaders were described according to demographics, training, research productivity, and experience. Results: A total of 426 leaders at 193 programs were included. The average number of leadership positions per program was 2.2 +/- 1.0. Higher-tier programs had more leadership positions and were more likely to have chairpeople (P<0.001). They also had a larger proportion of women leaders (P=0.023), although only 11.2% of leaders overall were women. Residency training outside the US did not vary across tiers (P=0.881). Higher-tier leaders were more likely to complete fellowship (P<0.001) and specialize in pediatrics, oncology, and spine (P<0.032), although trauma was the most common specialty among leaders regardless of ranking. Program rank correlated strongly with program size (number of residents) (r(2)=-0.69) and weakly with leadership h-index (r(2)=-0.33) and research documents (r(2)=-0.40). Rank did not correlate with years in practice (r(2)=0.06), years until attaining a leadership position (r(2)=0.06), or years in present leadership position (r(2)=0.07). Conclusions: Program ranking correlated with the number of leaders and residents, as well as research productivity, but not with years of experience or training within the US. Top-tier programs have a higher proportion of women leaders, although the overall number is still low.