Why Orthopaedics and Trauma Surgery Loses Part of Its Future Workforce – A Cross-Sectional Study of Gender Differences in Medical Students’ Specialty Choice

Background As patient volumes rise and the workforce ages, medical specialities face mounting pressure to attract and retain new talent. Despite women making up the majority of medical students in Germany, their representation in surgical fields, especially orthopaedics and trauma surgery (O&T), remains disproportionately low and has shown little improvement over the past decade. To ensure the future of surgical care, it is essential to understand how medical students – particularly women – perceive O&T and what factors shape their specialty choices. Methods In this prospective cross-sectional survey, 676 medical students from 32 medical faculties in Germany and Austria completed a questionnaire to assess specialty preferences, career motivations, educational experiences, and attitudes toward potential reforms in specialty training. Descriptive statistics, group comparisons, and regression analyses were used to examine gender differences and trends across stages of medical education. Results O&T was selected as a preferred specialty by 11.5% of respondents, with no significant gender difference at baseline (p=0.213). However, female interest declined significantly throughout medical school, while male interest remained stable (p = 0.028). The most important influencing factors were subject-related interest, work environment, and practical clinical experiences. Female students rated work–life balance, part-time options, and gender representation significantly higher than male peers (all p < 0.01). Only 67.9% of students considered O&T a suitable field for women. More than half reported having been actively discouraged from entering the field—frequently by O&T physicians themselves (accounting for over 30% of reported discouragement sources). Conclusion This study reveals a persistent gap between early interest in O&T and the structural realities that shape students’ long-term career decisions. This disconnect is not due to a lack of interest or ability, but to systemic barriers: rigid hierarchies, limited female representation, and exclusionary workplace cultures. To retain future talent, O&T must adapt to the expectations of a new generation by enabling sustainable career paths, promoting inclusive leadership, and committing visibly to structural reform.