Orthopedic surgery has been identified as the least diverse medical specialty, according to at least one report published in 2025 by The Journal of Bone and Joint Surgery.
More than 80% of orthopedic surgeons are male and more than 74% identify as white, according to the report. Brian Nwannunu, MD, an orthopedic surgeon at the Texas Joint Institute in McKinney, has spent his career defying this demographic status.
His journey began as an undergraduate at Morehouse College in Atlanta, a historically Black university. Dr. Nwannunu, a first-generation Nigerian-American, had always sought out a career in healthcare and a mentor introduced him to orthopedics.
“My introduction into orthopedics wasn’t that it was this predominantly white, male-dominated field,” he said. “It was this person that I look up to as an orthopedic surgeon. So once I started my track and my path through medical school and residency, I started to see that [orthopedics] is a little different. It’s not as diverse as internal medicine or pediatrics.”
Despite this realization, Dr. Nwannunu was locked in and determined to build a career in the specialty. During his residency program, Dr. Nwannunu was one of just two residents of color in the program, and just one of three who had ever gone through the program since its inception in 1968.
While this in and of itself was a “shock,” he said, most of the discrimination he encountered did not come from other physicians.
“They had their differences and opinions, but they respected you, because we all did the same training. We all went through the same rigor,” he said. “What was a shock was the entire community, the staff, the nurses and the patients.”
Dr. Nwannunu said that patients or other staff were often surprised or confused to see him in the operating room, not expecting their surgeon to be Black.
“They were like, ‘Who are you? You can’t be the surgeon, because I’ve never seen a surgeon like you,'” he said. “There was so much fighting to prove yourself to people that you’re just here to help, which was pretty tough.”
While this dynamic proved to be challenging for Dr. Nwannunu, it was also rewarding.
“What it taught me was that for every few people who discriminated against you or didn’t want to talk to you, or just didn’t believe you as a doctor, there were 1,000 others that were so excited to see you and so inspired by you,” he said. People would often gravitate to him and ask him questions about his path and his journey, sometimes over his more experienced peers.
“I had more of a presence, which I appreciated,” he added. “But I also had more of a spotlight, more of a microscope. Any small thing that happened, somebody would blow it out of proportion. It was [about] learning how to navigate both aspects of it.”
This feeds into why the representation of different races, ethnicities and other minority groups is important in medical fields. Dr. Nwannunu said that after his residency and fellowship, he sought out a job specifically because another person of color worked at that employer, and he knew he would be able to talk to them about things his other colleagues may never experience. And now, in his current role, his senior partner is also a person of color.
“Think about that — from somebody who is fully trained, finished medical school, done the rigors of residency and did an extra year [fellowship] in adult reconstruction, and I still seek that person that represents me,” he said. “Let alone the representation I give to other students, kids, college students, medical students. … It’s powerful. I think people have to see and to visualize to then go and execute.”
Alongside having a more diverse range of identities and experiences in medicine, Dr. Nwannunu emphasized the importance of talking about these issues and communicating between colleagues and community members.
“The discrimination or even racism that occurs, I do want people to know, is rare,” he said. “However, I don’t want people to ignore it. I want people to embrace it and use those opportunities to have conversations. Because when you’re scared to talk about racism, the discrimination, it gets kind of swept under the rug.”
He has found that in many of these instances, people were more receptive when communication was more open and he could acknowledge and explain that while his presence may be unique in orthopedics, he and other surgeons of color are just as well trained as others.
“In some instances, we’re more relatable because we come from upbringings that are humble,” Dr. Nwannunu added. “We didn’t have a dad who was an orthopedic surgeon, that left his practice to me and his dad left to him. We can relate to somebody who’s underinsured or uninsured. We can talk to you about other things, and you’ll realize that Black, white, Hispanic, other … they will prefer you.”
This open communication has proved helpful not only in his relationships with patients but with other staff.
“Just have that conversation with people. What is your resignation? What do you fear? Do you think I’m not qualified? Do you want to talk to me about it?” he said. “You’ll realize you have way more in common. Embrace those differences, and you’ll learn a lot more.”
