Gender Issues in Academic Hospital Medicine: a National Survey of Hospitalist Leaders

Gender disparity between first and senior authors on liver cancer research in the top journals of Gastroenterology and Hepatology

BACKGROUND

Gender disparity is pervasive in academic medicine. This study aimed to assess the disparity between men and women with regard to first and senior author positions in primary studies on liver cancer over the last two decades.

METHODS

We conducted a review of articles published in high-impact factor journals of the field of Gastroenterology and Hepatology in 2005, 2010, 2015 and 2020. First and senior authors of all ages were considered as the study population. The authors' genders were determined using the online artificial intelligence tool genderize.io (https://genderize.io/). The disparity between men and women authors was assessed using the linear-by-linear association test.

RESULTS

665 original articles from 10 journals were reviewed. The point prevalence of first women authors was 25.0% compared with 75.0% for men. The point prevalence of senior women authors was 16.3% compared with 83.7% for men. From 2000 to 2020, the proportion of first women authors increased 14.4% to 26.8% compared with 85.6%-73.2% for men (P = 0.009), and the proportion of senior women authors increased from 7.4% to 19.5%, compared with 92.6%-80.5% for men (P = 0.035). The factor independently associated with a reduced representation of women among first authors was the region of author. The factor independently associated with a reduced representation of women among senior authors was the impact factor of journals.

CONCLUSION

The findings indicated a remarkable increase in the proportion of women, both first and senior authors, over the past two decades in the field of liver cancers. However, the representation of women authors in this area is far less than that of men.

Why Are There So Few Women Medical School Deans? Debunking the Myth That Shorter Tenures Drive Disparities

PURPOSE

Gender disparities among the senior echelons of academic medicine are striking and persistent. The role of medical school dean has been particularly immune to gender diversity, and limited prior research identified women's shorter decanal tenures as a potential driver. The authors assessed gender differences in tenure length of deanships in the current era to elucidate this finding.

METHOD

From October 2020 to June 2021, the authors collected information about medical school deanships that were held from January 1, 2006, to June 30, 2020. All schools were members of the Association of American Medical Colleges (AAMC). The authors collected data from online public records and augmented their findings via direct outreach to medical schools. They used time-to-event analyses before and after adjustment for interim vs permanent status of the initial appointment, school ownership (public/private), and school size to assess for gender differences in length of deanship tenure during the study period. The unit of analysis was deanships, and the primary outcome was length of deanships measured in years.

RESULTS

Authors included data on 528 deanships. Women held 91 (17%) of these terms. Men held the majority of permanent deanships (n = 352 [85%]). A greater percentage of the deanships held by women were interim only (n = 27 [30%]) compared with men (n = 85 [20%]). In unadjusted and adjusted analyses, there were no significant gender differences in length of deanship tenures.

CONCLUSIONS

Analysis of appointments of AAMC-member medical school deans from 2006 to 2020 revealed that women have remained in their deanships as long as their male counterparts. The myth about women deans' shorter longevity should no longer be promulgated. Academic medicine should consider novel solutions to addressing women's persistent underrepresentation in the dean role, including employing the gender proportionality principle used in the business and legal communities.

Perceptions of Gender Stereotypes among Women Residents in Surgical and Nonsurgical Specialties

OBJECTIVE

The objective of this study was to determine whether and to what degree residents experience stereotype perception by gender and specialty type (surgical vs nonsurgical).

METHODS

A cross-sectional survey was sent to resident physicians across all specialties at a single academic institution in February 2021. The survey items asked whether participants believe residents, faculty, and the public expect men or women to be better physicians on a numerical scale from 1 to 7. A χ² test compared the calculated mean and standard error for each survey item. This study took place at Washington University School of Medicine in St. Louis, Missouri, a large academic tertiary care center.

RESULTS

A total of 411 (46% of total) residents participated; 13 were excluded because of nonbinary gender or missing demographic information, for a final sample of 398. Participants perceived all three groups to expect men to be better physicians than women. Regression analysis showed a significant effect of gender on stereotype perception, with women reporting stronger stereotype perceptions than men. There were no significant differences in stereotype perceptions by specialty type.

CONCLUSIONS

Women resident physicians in both surgical and nonsurgical fields reported higher levels of gender stereotype perception compared with men, making it imperative that graduate medical education leadership support changes to the current learning environment.

The Gender Landscape of Academic Pediatric Emergency Medicine: An Observational Study of Leadership Positions as Described by Fellowship Programs' Online Presence

OBJECTIVES

Although many areas of medicine are male dominated, pediatric emergency medicine (PEM) is a female-dominated subspecialty. Despite this, executive leadership within PEM remains male dominated. The aim of this study was to describe the gender landscape of the key positions within academic PEM fellowship programs within the United States, as described by PEM fellowships' online presence.

METHODS

Using the 2021-2022 Electronic Residency Application Service American Association of Medical Colleges Pediatric Fellowships ( services.aamc.org/eras/erasstats/par/ ) application service, we were able to identify published information from 84 academic PEM fellowship programs in the United States. Each program's Web site was evaluated to determine which individuals held the position of chief or chair, medical director, and fellowship director. These individuals' genders were then cross-referenced with the National Provider Inventory database.

RESULTS

There were 154 executive leadership roles (division chief or medical director) in total. The executive leadership role was significantly different by gender ( z score: 2.54, P < 0.01), with greater male representation (n = 61; 62.9%) among identified executive leadership roles (n = 97). There were significantly more men for the medical director role ( z score: 2.06, P < 0.05). Female representation was greater than male in the fellowship program director role (n = 53; 67.9%) among listed roles ( z score: -3.17, P < 0.001). This gender landscape among key leadership positions was not influenced by the geographic location of the PEM fellowship program.

CONCLUSIONS

Although PEM is a female-dominated specialty, executive leadership positions continue to be male dominated. To promote improved gender representation within leadership positions in PEM, PEM fellowship programs must provide consistent and easily accessible executive leadership descriptions within their online storefront.

Relationship Between Gender and Academic and Military Achievement Among USU Medical School Graduates

INTRODUCTION

Despite increases in the number of female matriculants in medical school, civilian data demonstrate that women still struggle to reach parity in attainment of leadership positions. In military medicine, we have seen a major increase in the number of women graduating from the USU. Yet, we still know little about the representation of female military physicians in leadership positions. The aim of this study is to examine the relationship between gender and academic and military achievement among USU School of Medicine graduates.

METHODS

Utilizing the USU alumni survey sent to graduates from the classes of 1980 to 2017, items of interest, such as highest military rank, leadership positions held, academic rank, and time in service, were used to evaluate the relationship between gender and academic and military achievement. Contingency table statistical analysis was conducted to compare the gender distribution on the survey items of interest.

RESULTS

Pairwise comparison demonstrated significant differences between gender in the O-4 (P = .003) and O-6 (P = .0002) groups, with females having a higher-than-expected number of O-4 officers and males having a higher-than-expected number of O-6 officers. These differences persisted in a subsample analysis that excluded those who separated from active duty prior to 20 years of service. There was a significant association between gender and holding the position of commanding officer (χ2(1) = 6.61, P < .05) with fewer females than expected. In addition, there was a significant association between gender and the highest academic rank achieved (χ2(3) = 9.48, P < 0.05) with lower-than-expected number of females reaching the level of full professor, in contrast to males who exceed the expected number.

CONCLUSIONS

This study suggests that female graduates of USU School of Medicine have not achieved promotion to the highest levels of rank, military, or academic leadership at the projected rate. Efforts to explore what barriers may impact military medicine's desire to have more equal representation of women in higher ranks and positions should be undertaken with specific attention to what drives retention versus separation of medical officers and if systematic changes are needed to help promote equity for women in military medicine.

Gender differences in COVID-19-related manuscript authorship by hospitalists during the pandemic: A bibliometric analysis

BACKGROUND

Hospital medicine (HM) has a well-described gender disparity related to academic work and promotion. During the COVID-19 pandemic, female authorship across medicine fell further behind historical averages.

OBJECTIVE

Examine how COVID-19 affected the publication gender gap for hospitalists.

DESIGN, SETTINGS, AND PARTICIPANTS

Bibliometric analysis to determine gender and specialty of US-based physician first and last authors of COVID-19 articles published March 1, 2020 to February 28, 2021 in the four highest impact general medical journals and two highest impact HM-specific journals.

MAIN OUTCOME AND MEASURES

We characterized the percentage of all physician authors that were women, the percentage of physician authors that were hospitalists, and the percentage of HM authors that were women. We compared author gender between general medical and HM-specific journals.

RESULTS

During the study period, 853 manuscripts with US-based first or last authors were published in eligible journals. Included manuscripts contained 1124 US-based physician first or last author credits, of which 34.2% (384) were women and 8.8% (99) were hospitalists. Among hospitalist author credits, 43.4% (n = 43/99) were occupied by women. The relative gender equity for hospitalist authors was driven by the two HM journals where, compared to the four general medical journals, hospitalist authors (54.1% [33/61] vs. 26.3% [10/38] women, respectively, p = .002) and hospitalist last authors (51.9% [14/27] vs. 20% [4/20], p = .03) were more likely to be women.

CONCLUSIONS

Across COVID-19-related manuscripts, disparities by gender were driven by the high-impact general medical journals. HM-specific journals had more equitable inclusion of women authors, demonstrating the potential impact of proactive editorial policies on diversity.

Equal Pay for Equal Work in the Dean Suite: Addressing Occupational Gender Segregation and Compensation Inequities Among Medical School Leadership

In 2022, the Association of American Medical Colleges published data from its annual Dean's Office Staff Compensation and Dean's Compensation Surveys in a new report addressing salary equity among medical school leadership. These data, disaggregated by gender and race/ethnicity, represent earnings of the senior most leaders in the dean suite and have historically been shared only with medical school Deans and principal business officers. The report shows that the highest-ranking decanal positions in U.S. medical schools are filled along the lines of traditional gender stereotypes (with men in clinical affairs and research affairs deanships and women in admissions, diversity affairs, faculty affairs, and student affairs deanships) and that the roles held mostly by men carry grander titles (e.g., senior associate dean vs assistant dean) and significantly higher salaries than those typically held by women. Additionally, within the same decanal positions, women earn lower median compensation than men. In this commentary, the authors describe limited advancement and lower compensation as foregone conclusions for women in medicine and science due to a professional model that places a premium on activities traditionally pursued by men. They define and characterize the impact of this occupational gender segregation in the dean suite and offer a roadmap for an alternative value system that recognizes complementary leadership activities across the mission areas of academic medicine and ensures that the contributions of women in the profession are appropriately recognized, valued, and rewarded.

Gendered Expectations: the Impact of Gender, Evaluation Language, and Clinical Setting on Resident Trainee Assessment of Faculty Performance

BACKGROUND

Gender inequity is pervasive in academic medicine. Factors contributing to these gender disparities must be examined. A significant body of literature indicates men and women are assessed differently in teaching evaluations. However, limited data exist on how faculty gender affects resident evaluation of faculty performance based on the skill being assessed or the clinical practice settings in which the trainee-faculty interaction occurs.

OBJECTIVE

Evaluate for gender-based differences in the assessment of general internal medicine (GIM) faculty physicians by trainees in inpatient and outpatient settings.

DESIGN

Retrospective cohort study SUBJECTS: Inpatient and outpatient GIM faculty physicians in an Internal Medicine residency training program from July 1, 2015, to December 31, 2018.

MAIN MEASURES

Faculty scores on trainee teaching evaluations including overall teaching ability and Accreditation Council for Graduate Medical Education (ACGME) competencies (medical knowledge [MK], patient care [PC], professionalism [PROF], interpersonal and communication skills [ICS], practice-based learning and improvement [PBLI], and systems-based practice [SBP]) based on the institutional faculty assessment form.

KEY RESULTS

In total, 3581 evaluations by 445 trainees (55.1% men, 44.9% women) assessing 161 GIM faculty physicians (50.3% men, 49.7% women) were included. Male faculty were rated higher in overall teaching ability (male=4.69 vs. female=4.63, p=0.003) and in four of the six ACGME competencies (MK, PROF, PBLI, and SBP) based on our institutional evaluation form. In the inpatient setting, male faculty were rated more favorably for overall teaching (male = 4.70, female = 4.53, p=<0.001) and across all ACGME competencies. The only observed gender difference in the outpatient setting favored female faculty in PC (male = 4.65, female = 4.71, p=0.01).

CONCLUSIONS

Male and female GIM faculty performance was assessed differently by trainees. Gender-based differences were impacted by the setting of evaluation, with the greatest difference by gender noted in the inpatient setting.

Gender Distribution of Scholarship and Measures of National Recognition in Hospital Medicine

OBJECTIVE

Our specific aim was to assess the gender distribution of aspects of scholarly productivity and professional standing for pediatric hospital medicine over a 5-year period. We also evaluated for correlation between the makeup of editorial boards, conference planning committees, and chosen content.

METHODS

We reviewed scholarly publications, presentations, editorial boards, planning committees, awardees, and society leadership in pediatric hospital medicine from 2015 to 2019 and determined gender using published methods to assess for differences between observed proportions of women authors and presenters and the proportion of women in the field.

RESULTS

The field of pediatric hospital medicine at large is 69% women (95% confidence internal [CI] 68%-71%), and an estimated 57% of senior members are women (95% CI 54%-60%). We evaluated 570 original science manuscripts and found 67% (95% CI 63%-71%) women first authors and 49% (95% CI 44%-53%) women senior authors. We evaluated 1093 presentations at national conferences and found 69% (95% CI 65%-72%) women presenters of submitted content and 44% (95% CI 37%-51%) women presenters of invited content. Senior authorship and invited speaking engagements demonstrated disproportionately low representation of women when compared with senior members of the field (senior authorship, P = .002; invited presenters, P < .001). Strong positive correlation between gender composition of conference planning committees and selected content was also noted (r = 0.94).

CONCLUSION

Our study demonstrated representative gender distribution for some aspects of scholarly productivity in pediatric hospital medicine; however, a lack of gender parity exists in senior roles.

Gender Gap in the Leadership of Health Institutions: The Influence of Hospital-Level Factors

Objective: To analyze whether the increased representation of women in the health field is accompanied by a greater presence in leadership positions in the public health system and whether there are differences according to the hospital level.

Methods: A descriptive study of the distribution of leadership positions by sex and type of hospital within the health centers of a regional public health system.

Results: In total, 74.01% of the professionals were women. The representation of women in management positions was 33.1%, and among service chiefs, it was 24.01%. In the service headings, we observed that surgical specialties had a lower representation of women (30.9% in medical specialties vs. 18.1% in surgical specialties, p<0.0001). By type of hospital, no differences were found in the management positions, but there were differences in the medical chiefs, with less female representation in the regional hospitals (28.6% vs. 39.7%, p=0.003).

Conclusion: Women represent the majority in the public health system. Nonetheless, their representation in positions of greater responsibility and decision-making is very limited, being particularly low in county hospitals. Increasing female representation in these positions is a current challenge for society, and equality policies need to be developed and applied to minimize this gender gap.

Perception of barriers to research among internal medicine physician hospitalists by career stage

BACKGROUND

Physician hospitalists may participate in research and generate knowledge for evidence-based hospital practice. Despite this, physician hospitalists are primarily involved in patient care, and there is sparse information on barriers for their participation in research and if these barriers differ by career stage.

METHODS

We conducted a survey of physician hospitalists at Mayo Clinic sites based in four states (Arizona, Florida, Minnesota, and Wisconsin). We surveyed physician hospitalists on demographics, academic rank, current research skills, barriers for participation in research, and research skills they aspire to acquire. Responses were summarized using descriptive statistics and categorized by early-career (<10 years), mid-career (10-20 years), and later-career (≥20 years) stages at Mayo Clinic. The survey was conducted from March to April 2019.

RESULTS

Of 188 physician hospitalists, there was a 52% response rate with 71% in early career, 21% mid-career, and 7% late career, with 39% female. Physician hospitalists at early-career (90%), mid-career (76%), and later-career (71%) stages were interested in participating in research. Among physician hospitalists with ≤3 peer-reviewed publications, barriers for participation in research included lack of mentorship, time, research skills, and funding. Among physician hospitalists with ≥4 peer-reviewed publications, factors for research success included mentorship (89% early-career, 38% mid-career, 75% later-career; p = 0.002) and membership in a research team. Compared to mid- and later-career physician hospitalists, a higher proportion of early-career hospitalists was interested in acquiring skills to both critically review the literature (70% early-career, 43% mid-career, 0% later-career; p = 0.006) and write manuscripts (86% early-career, 57% mid-career, 50% later-career; p = 0.02); there was generally similar interest across career stages to acquire skills to conduct literature searches and write grants.

CONCLUSION

The generally similar responses from physician hospitalists across career stages highlight system-level opportunities to increase research mentorship, promote the acquisition of research skills, and reduce barriers for participation in research.