Gender Differences in Publication Productivity Among Academic Urologists in the United States

Sticky Floor, Broken Ladder, and Glass Ceiling in Internal Medicine Academic Ranking, Leadership, and Research Productivity

BACKGROUND

Despite more women entering medicine, substantial gender disparities remain in various medical disciplines. This study explores the extent of these disparities in Canadian academic internal medicine, particularly in academic ranks, leadership positions, and research productivity.

DESIGN

Cross-sectional.

SUBJECTS

Faculty physicians within internal medicine and subspecialties.

MAIN MEASURES

Data on faculty physicians with Medical Doctorate (MD), Doctor of Osteopathic Medicine (DO), or Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees were compiled from 17 internal medicine programs listed in the Canadian Resident Matching Service (CaRMS). Research metrics were obtained using Elsevier's Scopus, and analyses were performed with Stata v14.2.

KEY RESULTS

Among 5099 physician faculty members in internal medicine, 34% were women, and 66% were men. Among the faculty members holding leadership positions, 68% were men, and 32% were women. There was a significant difference in h-index between men and women physician faculty members (p ≤ 0.001), with men having a higher research output. Across all academic ranks, men faculty had higher median h-index values: Assistant Professor (12 vs. 9), Associate Professor (20 vs. 16), and Professor (40 vs. 30). Women were underrepresented in the procedural specialties, while only a few internal medicine subspecialties, such as palliative medicine and geriatrics, had a women predominance.

CONCLUSIONS

Our study underscores existing gender disparity within academic internal medicine in Canada, aligning with global trends. Women remain disproportionately underrepresented in academic ranks, leadership positions, and research productivity. Addressing these disparities necessitates a systemic and multifaceted approach, encompassing policy reforms, mentorship, and fostering an inclusive work environment.

Gender gap in cardiothoracic surgery randomized controlled trial and post-hoc analysis of randomized controlled trial authorship from 2014 to 2020

OBJECTIVES

To estimate gender disparities among first and last authorships in cardiothoracic randomized controlled trials (RCTs) and association of gender with publications in high-impact journals.

METHODS

PubMed/MEDLINE database was searched from 1 January 2014 to 31 December 2020 using R statistical software via the 'easyPubMed' package to retrieve pertinent data. The 'gender' package was utilized to determine gender using the United States Social Security Administration Baby Name Data. The percentage of female first and last authors were computed along with determining the uniqueness of the names. The association of gender and publication in high-impact peer-reviewed journals was delineated. Jonckheere's trend was computed.

RESULTS

The database search retrieved a total of 4820 RCTs, of which gender was encoded for the first author in 3247 (67%) RCTs, among which 911 (28%) studies had women as first authors, with a similar trend across 7 years (P = 0.23). Gender was encoded for the last author of 3204 (66%) RCTs, of which 622 (19%) studies had women as last authors, with a similar trend across 7 years (P = 0.45). A total of 627 studies were published in high-impact-factor journals, among which 79 (16%) studies had female first authors and 67 (13%) studies had female last authors.

CONCLUSIONS

There is an obvious gender disparity of first and last authors in cardiothoracic surgery-related RCTs, with a similar trend across 7 years. However, the post-hoc analysis did demonstrate a positive trend with an increase in the number of female first authors, demonstrating progress.

Characterizing Gender and Leadership Trends Among Mohs Micrographic Surgery Fellowship Directors

BACKGROUND

Fellowship directors (FDs) play a key role in shaping Mohs micrographic surgery (MMS). Studies characterizing director trends are lacking and may provide a framework for improving gender diversity.

OBJECTIVE

To explore characteristics of FDs and trends in gender of both fellows and FDs over time.

MATERIALS AND METHODS

The authors compiled a comprehensive list of FDs and fellows for all Accreditation Council for Graduate Medical Education-accredited Micrographic Surgery & Dermatologic Oncology programs from 1996 to 2023. Publicly available data from various internet sources from February 1, 2023 to May 30, 2023 were used to assess characteristics of MMS FDs.

RESULTS

The percentage of female FDs increased from 6% to 25% from 1996 to 2023. Female directors were more likely to select female fellows than male directors ( p = .0002) and had fewer years between fellowship completion and FD appointment (9.1 ± 4.7 years) compared with male directors (13.6 ± 8.8 years; p = .036). H-index, program type, and academic rank were similar between male and female directors.

CONCLUSION

Although gender parity among MMS trainees has been achieved, discrepancies remain in the gender composition of FDs. Further studies are required to determine why women are underrepresented as FDs.

Academic productivity and NIH funding for anesthesiology departmental chairs: A 15-year comparison

STUDY OBJECTIVE

This study evaluated whether there were improvements in the number of departmental National Institutes of Health (NIH) training grants and the academic productivity of departmental chairs in terms of NIH research funding and PubMed-cited publications when compared to chairs of the same departments in 2006.

DESIGN

Each chair was identified from the Society of Academic Associations of Academic Anesthesiology & Perioperative Medicine's Association of Academic Anesthesiology Chairs and entered into the NIH Research Portfolio Online Reporting Tools (RePORTER), PubMed, SCOPUS, and the National Provider Identifier Registry.

MEASUREMENTS

The number and funding amounts of training grants awarded to the department in 2010, 2015, and 2020 were obtained as well as the department's national ranking and total dollar amount for NIH funding in 2020. For the current chair cohort, total publications and m-quotient (h-index corrected for active research years) were recorded along with each chair's history of NIH grant funding. These data were compared to a previous study of anesthesiology chairs that reviewed funding and publications through 2006.

MAIN RESULTS

We analyzed data from 100 academic departments of anesthesiology and compared their scholarly activity relative to data gathered in 2006. In 2020, 52 of 100 departments of anesthesiology had evidence of NIH funding. There were not statistically significant (P > 0.05) differences in grants funding obtained by chairs between 2006 and 2020 with the exception that more chairs in 2006 had program or center grants. Median publications for chairs significantly increased from 35 in 2006 to 55 in 2021 (IRR = 1.5, 95% CI = 1.2-2.0, P = 0.003). Nineteen percent of chairs were female, which did not significantly differ from the proportion of women in the 2006 paper (15%, χ2 = 0.57, df = 1, P = 0.452). Of the male chairs, 90% were professors whereas 63% of female chairs were professors (χ2 = 8.8, df = 1, P = 0.003). Female chairs had fewer publications than male chairs (IRR = 1.8, 95% CI = 1.2-1.8, P = 0.002); however, m-quotients were not significantly different between men and women (P = 0.602).

CONCLUSIONS

When compared to 2006, department of anesthesiology chairs had more publications in 2021; however, NIH funding rates remained unchanged. The specialty had 19% female chairs, and those chairs had fewer publications than their male counterparts, though sex differences were attenuated using metrics that account for disparities in career length.

Progress in transforming a health sciences postgraduate cohort in a south african research-intensive institution, 2008-2017

BACKGROUND

Equity redress in the higher education and health sectors is a global discourse that seeks to address the inequalities caused by past discrimination practices. The apartheid regime in South Africa fragmented both the higher education and the health sectors, creating White and male dominated systems. Consequently, Black Africans and females were under-represented in these sectors. Furthermore, the provision of higher education including medical training was unequal between the different populations. As democracy was established in South Africa in 1994, it is necessary to assess whether transformation in population affinity and sex of postgraduate students in the higher education and health sector has occurred, as these individuals are crucial for providing the future academic workforce and also healthcare to the public.

METHODS

The demographic profile of postgraduate students graduating in a health sciences facility in South Africa over the period 2008-2017 was retrospectively assessed. Survival analysis models were used to investigate the time taken to graduate. Log-rank tests were used to compare the completion rates.

RESULTS

More females (53.3%) than males (41.9%) completed their postgraduate degree over the period 2008-2017 (p˂0.0001). In relation to population affinity, more White students (56.4%) than Black African students (40.8%) completed their degrees overall (p˂0.0001).

CONCLUSION

While transformation occurred in the sex of graduating students over the ten year period, the same change has not occurred with regards to population affinity. The under-representation of Black African graduates is a major setback for efforts to diversify the South African higher education and health sectors. Transformation of the demographic profile of postgraduate students at South African institutions is vital for developing individuals who will contribute to equitable redress of academic staff in the higher education sector and also of the healthcare workforce. Diversified health personnel including highly skilled clinician scientists will aid in improving the provision of health care to communities particularly the underpriviledged rural areas, and also assist in training the next generation of healthcare staff. The challenges identified in this study may assist other countries where adequate transformation of the education and health sectors has not occurred.

Gender disparity trends in genitourinary oncology academic publishing over the past 3 decades: A bibliometric analysis

OBJECTIVES

To examine gender disparities in genitourinary (GU) oncology academic publishing over the past three decades.

MATERIALS AND METHODS

We performed a bibliometric analysis of eight academic journals featuring GU oncology research articles: Journal of Clinical Oncology, Cancer, European Journal of Cancer, European Urology, Journal of Urology, BJU International, Prostate Cancer and Prostatic Diseases, and Urologic Oncology: Seminars and Original Investigations. After selecting four time points (1990, 2000, 2010, 2020), we recorded the gender of the first and senior authors and investigated their association with independent variables including publication year, research field, and geographic continent. Results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 14,786 articles were included in our analyses. Females comprised 25.7% of first and 18.1% of senior authors. Compared to 1990, there was a trend of progressively higher female first author (OR 1.47 [95% CI 1.27-1.69] in 2000; 2.28 [95% CI 2.00-2.59] in 2010; 3.10 [95% CI 2.71-3.55] in 2020) and senior author positions (OR 1.23 [95% CI 1.05-1.45] in 2000; 1.67 [95% CI 1.45-1.93] in 2010; 2.55 [95% CI 2.20-2.96] in 2020). Compared to GU oncology, non-GU oncology articles were more likely to have female first (OR 2.61, 95% CI 2.38-2.86) or senior authors (OR 2.61, 95% CI 2.35-2.91). Articles from Asia (OR 0.45, 95% CI 0.38-0.51), Africa (OR 0.45, 95% CI 0.22-0.91), and international collaborations (OR 0.62, 95% CI 0.50-0.76) had a lower proportion of female first authors compared to North America. First authors were significantly more likely to be female when senior authors were also female (OR 2.45, 95% CI 2.23-2.69).

CONCLUSIONS

Despite the bridging trend demonstrated, GU oncology remains a male-predominant discipline. Female leadership and mentorship are pivotal in achieving gender parity in the academic medicine community.

Academic Productivity Among Underrepresented Minority and Women Urologists at Academic Institutions

OBJECTIVE

To characterize academic productivity for underrepresented minorities (URMs) vs non-URMs and by gender in Urology.

METHODS

A database was created from 145 Urology residency programs. URM status was determined by origin of name, photo, biography, Twitter, LinkedIn, and Doximity. A PubMed query was performed for publication output. URM status, gender, post-graduate year/years of practice, and Doximity residency rank were factors in multivariable analysis.

RESULTS

For residents, the median total publications was 2 [1,5] for URMs and 2 [1,5] for non-URMs (P=.54). The median first/last author publications was 1 [0,2] for URMs and 1 [0,2] for non-URMs (P=.79). The median total publications was 2 [0,4] for women and 2 [1,6] for men (P=.003). The median first/last author publications was 1 [0,2] for women and 1 [0,2] for men (P=.14). For faculty, the median total publications was 12 [3,32] for URMs and 19 [6,45] for non-URMs (P=.0002). The median first/last author publications was 4.5 [1,12] for URMs and 7 [2,20] for non-URM faculty (P=.0002). The median total publications was 11 [5,25] for women and 20 [6,49] for men (P<.0001). The median first/last author publications was 4 [1,11] for women and 8 [2,22] for men (P<.0001). On multivariable analysis, there was no difference in total publications and first/last author publications for URMs vs non-URMs. There remained a difference between genders for residents and faculty with total publications but not first/last author publications (P=.002/P=.10 residents, P=.004/P=.07 faculty).

CONCLUSION

Academic productivity was not different in URMs and non-URMs for both residents and faculty. Men residents and faculty had more total publications compared to women.

Women as Urologists in Saudi Arabia: Career Choice and Practice Challenges: A Comparative Cross-Sectional Study

Background

There is limited research on whether women choose urology as a future career. Therefore, we aimed in this study to assess the influencing and challenging factors among female physicians in Saudi Arabia.

Methods

We approached 552 female physicians, including 29 (5.2%) urologists and 523 (94.7%) non-urologists. A cross-sectional survey was carried out, which included five sections and 46 items to assess and compare the perspectives of (urologists and non-urologists regarding influencing factors to choose urology, challenges toward applying to urology, and challenges during and after urology residency. Statistical analysis was conducted using SPSS software. Responses were presented as frequencies and percentages, while associations were studied using the Chi-squared test/Fisher's exact test. A p-value of ≤ 0.05 was considered significant.

Results

Out of 552 female physicians, 466 completed the survey. The survey items compared urologists and non-urologists among female physicians. Among both cohorts, the most influencing factors in choosing urology were the diversity of practice and urological procedures (p =0.002, p<0.001). There were no social barriers or challenges when applying for urology residency (p<0.001). Overall, the majority of female urologists reported a high level of agreement that they have more time to work at the clinic (55.2%), they are satisfied as they are currently being urologists (75.8%), satisfied with their current lifestyle (72.6%). They would choose urology again as a future career (58.6%). Non-urologist female physicians 326 (74.6%) think they are more likely to have experienced gender discrimination than urologists 15 (51.7%) (p<0.001). Female urologists were less likely to face social barriers when applying for urology residency than non-urologists (p<0.001).

Conclusion

As urologists, we must understand women's struggles, such as gender discrimination, a lack of academic advancement, and a lack of mentorship. To foster women's careers in urology, we must understand their unique needs, provide adequate mentorship, exterminate gender discrimination bias, and improve mentorship.

Gender Equity in Academic Female Pelvic Medicine and Reconstructive Surgery Departments: A Cross-Sectional Observational Study

IMPORTANCE

Gender equity in obstetrics and gynecology remains a barrier to career mobility and workplace satisfaction.

OBJECTIVE

This study aimed to evaluate gender equity for academic positions in female pelvic medicine and reconstructive surgery (FPMRS) divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship in the United States.

STUDY DESIGN

This was a cross-sectional observational study of all FPMRS divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship program in the United States in July 2020 using publicly available demographic and academic data collected from online search engines. Gender equity in academic FPMRS was assessed by gender representation, academic appointment, and research productivity of each attending physician within the division. Research productivity was assessed using both the H-index with career length controlled for with the M-quotient.

RESULTS

There were 348 attending physicians from 72 FPMRS divisions (198 female [56.9%], 150 male [43.1%]). A large percentage of female attending physicians were at the assistant professor level (75.8% [94 of 124]) when compared with their male counterparts (24.4% [30 of 124]; P < 0.001). Conversely, there were a larger percentage of male attending physicians (62.2% [56 of 90]) at the professor level when compared with their female counterparts (37.8% [34 of 90]; P < 0.001). There was no difference in research productivity between male and female attending physicians after controlling for career length with the M-quotient (P = 0.65). Only age (odds ratio, 1.14; 95% confidence interval, 1.05-1.24) and the M-quotient (odds ratio, 36.17, 95% confidence interval, 8.57-152.73) were significantly associated with professorship.

CONCLUSIONS

Our study found that there are more female attending physicians in FPMRS and that most are assistant professors. Male and female FPMRS attending physicians had similar research productivity with respect to their career lengths. Gender was not a determinant for achieving a "professor" appointment.

Gender representation at scientific congresses: focus on functional and female urology-a study from the EAU Young Academic Urologist Functional Urology Group

PURPOSE

Female representation at scientific conferences is crucial for encouraging women pursuing an academic career. Nevertheless, gender inequity at urological conferences is common place and women are often stereotyped choosing functional urology. However, there is no evidence whether female representation is higher in functional urology. This investigations aims to analyze gender representation at functional urology sessions.

METHODS

National and international urological congresses between 2019 and 2021 with a focus on functional urology and female urology sessions were evaluated. Congresses were categorized as national or international. Session type, topic, gender of chairs and speakers of the identified sessions were recorded. In addition, affiliation and medical specialty were collected for chairs.

RESULTS

A total of 29 congresses were evaluated. Out of a total of 2893 chairs and speakers, 1034 (35.7%) were women and 1839 (63.6%) were men. This represents an overall gender gap of 27.9% for functional urology sessions. No significant differences in gender representation between national and international congresses could be identified (p = 0.076). When considering gender distribution of chairs, the gap was more pronounced by 35.5%. Furthermore, men were more likely to be invited to be a speaker in plenary and podiums sessions.

CONCLUSIONS

Gender inequality is present in functional urology sessions. There is a need for greater efforts to achieve gender equality. An important step to remedy the situation is the inclusion of women in scientific program committees. Furthermore, support by the leadership of urological societies and academic departments is essential to herald a lasting change in gender inequality.

A Glass Ceiling in Orthopedic Surgery: Publication Trends by Gender

Women are underrepresented across the field of orthopedic surgery and may face barriers to academic advancement. Research presentation at national meetings and publication record are important drivers of advancement in academic orthopedic surgery. However, little is known regarding potential gender differences in publication after orthopedic conference research presentation. This investigation analyzed research presentations at the Annual Meeting of the American Academy of Orthopaedic Surgeons in 2016 and 2017. Author gender was determined through a search of institutional and professional networking websites for gender-specific pronouns. Resulting publications were identified using a systematic search of PubMed and Google Scholar databases. A total of 1696 of 1803 (94.1%) abstracts from 2016 to 2017 had identifiable gender for both the first and last authors, with 1213 (71.5%) abstracts ultimately being published. There were no differences in average sample size or level of evidence between genders. Abstracts authored by women were significantly less likely to lead to publication compared with those by men (67.1% vs 72.1%, P=.023), with articles authored by women having a longer median time to publication (median, 20 months [interquartile range, 19] vs 17 months [interquartile range, 15]; P=.003). This discrepancy was most apparent in adult reconstruction, with women having a 15.5% lower rate of publication (55.1% [27/49] vs 70.6% [307/435]; P=.026) and lower publication journal impact factor (2.7±1.4 vs 3.4±3.4, P=.040) than men. Potential reasons for these discrepancies, including disproportionate domestic obligations, inadequate mentorship, and bias against female researchers, should be addressed. [Orthopedics. 2023;46(2):e118-e124.].

Highlighting Gender Differences in RLS: Analysis of Gender in Robotic and Laparoscopic Surgical Volume in Urology Vs Other Subspecialties

OBJECTIVE

To evaluate the involvement of women surgeons in RLS over time and across fields. While women are an increasing proportion of the urological workforce, the overall percentage of women urologists remains low. As robotic/laparoscopic surgery (RLS) has become first-line for many surgical problems, we hypothesized that women in urology may have lower participation than other specialties.

MATERIALS AND METHODS

We obtained country-wide data by surgeon from the Data.CMS.gov database for 2014-2019 for major RLS procedures in colorectal surgery, gynecology, thoracic surgery, and urology. Data were sorted by gender and CPT code. Temporal trends were assessed, and estimation was performed by exponential regression comparing means and rates of change between departments and surgeon genders.

RESULTS

Surgeons across disciplines and genders showed increases in RLS volume over time (P <.05). There were significant differences between men and women surgeons between specialties in average number of surgeons (P <.0001) and rate of change over time (P = .0035). The difference of the rate of increase in the number of surgeons performing RLS between genders was significant for all disciplines, suggesting women were entering RLS surgery faster than men across specialties (P <.05).

CONCLUSION

There is a disparity in RLS procedure performance in men vs women across surgical disciplines. The greatest discrepancy in participation between genders existed in Urology, despite the field having a higher percentage of women physicians than other some subspecialties. Targeted action to address barriers to women surgeons' participation in RLS will increase diversity of thought and improve clinical care.

Perceptions of Gender Equity by Urologic Subspecialty

OBJECTIVES

To evaluate how urologists in various subspecialties view the climate for female urologists, comparing perceptions of gender inequity based on characteristics including gender, subspecialty training, faculty status, parental status, and years in practice. Despite growth in female representation in urology, gender inequalities in career opportunities and compensation continue to exist.

METHODS

An IRB approved survey was sent out to the following list-serves: Society of Urological Oncology (SUO), Society of Endourology (ENDO), Genitourinary Reconstructive Surgeons (GURS), Society of Pediatric Urology (SPU), Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), and American Urogynecologic Society (AUGS). A validated study, the Culture Conducive to Women's Academic Success (CCWAS) was used, and scores analyzed using Wilcoxon Rank-Sum and Kruskal-Wallace tests.

RESULTS

There were 430 survey responses (35.3% female, 64.7% male). There was a statistically significant difference in CCWAS score for gender, parental status, and society. On multiple regression analysis controlling for gender, parental status and society were not statistically significant. Years in practice and practice type were not significant. Male urologists perceived practice culture toward women as more equitable than their female colleagues, (median [interquartile range] CCWAS score, 203.5 [184.25, 225.0] vs 162.5 [130.75, 188.0]; P < .0001). This discrepancy in perception between genders was consistent across all subcategories; equal access, work-life balance, freedom of gender bias, and leadership support.

CONCLUSIONS

This study suggests that there are gender-based differences in how gender inequities are perceived and experienced in urology. Acknowledgment of these differences is the first step in identifying opportunities for improvement.

Publication rate and impact stratified by gender among pharmacists designated Fellow in the American College of Critical Care Medicine

BACKGROUND

There are approximately 352,000 pharmacists practicing in the United States, with most (59%) being female. Editorial board membership and publications with a female as the first author in selected pharmacy journals has increased in the past 2 decades. This study determined whether these positive trends are also occurring in critical care pharmacy.

OBJECTIVE

To report publication rate and publication impact stratified by male and female gender among pharmacists designated Fellow of Critical Care Medicine (FCCM).

METHODS

Pharmacists designated FCCM from inception through the 2020 convocation year were identified in January 2021 using a list provided by the Society of Critical Care Medicine. Pharmacists were excluded if they were designated Master of Critical Care Medicine, did not have an active pharmacist license, or did not have data in the Scopus database. Data were collected in February 2021 including year of first publication, total number of publications, citations, and Hirsch index (h-index).

RESULTS

A total of 134 pharmacists were evaluable, including 76 males (57%) and 58 females (43%). Males had an earlier first publication year than females (2005 vs. 2010; P < 0.001). Males have produced a higher number of publications per individual pharmacist (29 vs. 13; P = 0.002) and a similar number of publications per year (2 vs. 1; P = 0.05). When comparing publication impact, males generated more citations (384 vs. 139; P = 0.001) and had a higher h-index (10 vs. 6, P < 0.001). These trends persisted when data from only the past 5 years were used.

CONCLUSION

There is statistically significant gender disparity in publication rate and impact. However, this disparity seems to be decreasing with time as the rate of females designated FCCM is increasing. This is consistent with an overall increase in the proportion of pharmacists who are female and deserves further exploration.

Perceptions and Experiences of Gender Equity Among Endourologists

Introduction: Only 9.9% of practicing urologists in the United States are women. This percentage is even smaller in leadership positions and high-ranking appointments. Endourology is one of the least reported fellowships completed by women urologists. We sought to evaluate how endourologists perceived the climate for women physicians and compare perceptions and experiences of gender equity. Materials and Methods: An IRB approved and validated survey, Culture Conducive to Women's Academic Success (CCWAS) questionnaire was sent out to the Endourological Society listserve. Subcategories of equal access, work-life balance, freedom of gender bias, and leadership support were analyzed. An open comment section was provided for respondents to include their own experiences. Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare CCWAS scores between groups. Results: A total of 104 completed surveys were received. Response rate was 7% (104/1492), 26.9% of which were female. There was a statistically significant difference between male and female respondent CCWAS scores; p < 0.05. The male CCWAS score median was 196.0 (interquartile range [IQR] 176.75-214.0) vs female CCWAS score median of 166.5 (IQR 127.5-210.0). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic vs private practice. Discussion: In this study, male endourologists' perceptions of gender equity were incongruent with the reported experiences of their female colleagues. This indicates that male respondents perceive the culture in their department toward women more positively than their female colleagues. This is suggestive that there are gender-based differences in how gender inequities are perceived and potentially experienced.

Redefining the Gender Gap in Urology Authorship: An 18-Year Publication Analysis

BACKGROUND

Academic authorship is a critical productivity metric used for academic promotion.

OBJECTIVE

To characterize temporal changes in female representation in academic authorship in ten primary urology journals as the complement of female urologists is increasing.

DESIGN, SETTING, AND PARTICIPANTS

Publication records were retrieved from 2002 to 2020 for the ten urology journals with the highest impact factor. The names of all authors were gathered and gender was inferred using first names.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Trends in first and last/senior authorship by gender were evaluated overall, within journals, and by geographic region.

RESULTS

A total of 59,375 articles were analyzed, of which 94.1% had gender information for the first author and 94.2% had gender information for the last author. The percentage of overall female authors increased positively from 17.2% (95% highest density interval [HDI] 12.9-21.4%) in 2002 to 27.2% (HDI 21.7-33.6%; p < 0.01) in 2020. Overall female first authorship increased from 15.2% (95% HDI 11.0-19.5%) to 28.5% (95% HDI 21.8-35.6%; p < 0.01). There was also significant growth for female senior authors from 10.4% (95% HDI 7.6-13.5%) to 18.6% (95% HDI 13.6-23.8%; p < 0.01). Assessment of journal-specific changes revealed that Neurourology and Urodynamics (12.6%, 95% HDI 9.9-15.1%) and The Journal of Sexual Medicine (16.2%, 95% HDI 13.6-19.0%) had significantly higher growth in female authorship when compared to Journal of Endourology (7.2%, 95% HDI 5.5-8.7%) and Urologic Oncology (4.5%, 95% HDI 2.0-6.8%; p < 0.05).

CONCLUSIONS

Although overall female authorship increased between 2002 and 2020, women remain underrepresented in urology authorship. The percentage of females in senior (last) author positions is less than the percentage of females in first author positions. Journal-specific differences can probably be attributed to gender-based differences in subspecialized fields.

PATIENT SUMMARY

In this study, we characterized the underrepresentation of women as authors in urology journals and analyzed the change in female authorship for ten academic urology journals over the course of 18 years. Although the proportion of female authors has increased over that time, the percentage of females in senior authorship roles is less than the percentage of females in first author positions.

Academic Radiology in the United States: Defining Gender Disparities in Faculty Leadership and Academic Rank

RATIONALE AND OBJECTIVES

Female physicians in academic medicine have faced barriers that potentially affect representation in different fields and delay promotion. Little is known about gender representation differences in United States academic radiology departments, particularly within the most pursued subspecialties.

PURPOSE

To determine whether gender differences exist in United States academic radiology departments across seven subspecialties with respect to academic ranks, departmental leadership positions, experience, and scholarly metrics.

MATERIALS AND METHODS

In this cross-sectional study from November 2018 to June 2020, a database of United States academic radiologists at 129 academic departments in seven subspecialties was created. Each radiologist's academic rank, departmental leadership position (executive-level - Chair, Director, Chief, and Department or Division Head vs vice-level - vice, assistant, or associate positions of executive level), self-identified gender, years in practice, and measures of scholarly productivity (number of publications, citations, and h-index) were compiled from institutional websites, Doximity, LinkedIn, Scopus, and official NPI profiles. The primary outcome, gender composition differences in these cohorts, was analyzed using Chi² while continuous data were analyzed using Kruskal-Wallis rank sum test. The adjusted gender difference for all factors was determined using a multivariate logistic regression model.

RESULTS

Overall, 5086 academic radiologists (34.7% women) with a median 14 years of practice (YOP) were identified and indexed. There were 919 full professors (26.1% women, p < 0.01) and 1055 executive-level leadership faculty (30.6% women, p < 0.01). Within all subspecialties except breast imaging, women were in the minority (35.4% abdominal, 79.1% breast, 12.1% interventional, 27.5% musculoskeletal, 22.8% neuroradiology, 45.1% pediatric, and 19.5% nuclear; p < 0.01). Relative to subspecialty gender composition, women full professors were underrepresented in abdominal, pediatric, and nuclear radiology (p < 0.05) and women in any executive-level leadership were underrepresented in abdominal and nuclear radiology (p < 0.05). However, after adjusting for h-index and YOP, gender did not influence rates of professorship or executive leadership. The strongest single predictors for professorship or executive leadership were h-index and YOP.

CONCLUSION

Women academic radiologists in the United States are underrepresented among senior faculty members despite having similar levels of experience as men. Gender disparities regarding the expected number of women senior faculty members relative to individual subspecialty gender composition were more pronounced in abdominal and nuclear radiology, and less pronounced in breast and neuroradiology. Overall, h-index and YOP were the strongest predictors for full-professorship and executive leadership among faculty.

KEY RESULTS

● Though women comprise 34.7% of all academic radiologists, women are underrepresented among senior faculty members (26.1% of full professors and 30.6% of executive leadership) ● Women in junior faculty positions had higher median years of practice than their male counterparts (10 vs 8 for assistant professors, 21 vs 13 for vice leadership) ● Years of practice and h-index were the strongest predictors for full professorship and executive leadership.

Using the H-index as a factor in the promotion of surgical faculty

Introduction

Academic productivity is an important determinant for promotion. However, the measurement of academic productivity is ill-defined. The aim of this study is to demonstrate the academic productivity at the time of promotions at our institution.

Methods

We reviewed the data of 33 faculty from Department of Surgery at our institution who were promoted from 2006 to 2021. Gender, academic productivity at hiring, and each promotion were obtained. Academic productivity was assessed by bibliometric indices including total number of publications and citations, and H-index, which were obtained from Web of Science. T-test, Mann-Whitney U test, Fisher’s exact test and linear regression analysis were used to assess the association of H-index with length of promotion and gender. P < 0.050 were considered statistically significant.

Results

The medians (interquartile ranges) of indexes at hiring, at promotions from assistant professors to associate professors, and from associate professors to full professors were 6.0 (1.5–9.5), 11.0 (9.0–18.0) and 17.0 (9.0–23.0) respectively. A simple linear regression showed significant correlation between the length of promotion to associate professors and their H-indexes at hiring. (F (1, 27) = 10.55, p = 0.003, R² of 0.281.) There was no statistical significance in the difference of H-indexes at promotions between male and female faculty.

Conclusion

At our institution, the median H-indexes at the time of promotions from assistant professor to associate professor and from associate professor to full professor are 11.0 and 17.0. Using the H-index as an objective measure can be a useful tool to junior surgical faculty as reference for applying promotion.

Impact of Mentoring on Academic Career Success for Women in Medicine: A Systematic Review

PURPOSE

Research has shown that barriers to career success in academic medicine disproportionately affect women. These barriers include inadequate mentoring, which may perpetuate the underrepresentation of women in senior leadership positions. The purpose of this review was to summarize the qualitative and quantitative evidence of the impact of mentoring on women's career outcomes and to inform future interventions to support the promotion and retention of women in academic medicine.

METHOD

The authors conducted a systematic review of original research published in English-language, peer-reviewed journals through March 20, 2020. Search terms related to mentorship, women, and academic medicine. The authors searched MEDLINE, Embase, Scopus, Current Contents Connect via Web of Science, Cochrane Library, and PsycINFO. They excluded studies not specifically addressing women and those without gender-stratified outcomes. They extracted and analyzed the following data: study design, population, sample size, response rate, participant age, percentage of women, mentoring prevalence, and outcomes.

RESULTS

Of 2,439 citations identified, 91 studies met the inclusion criteria, including 65 quantitative and 26 qualitative studies. Mentoring was associated with objective and subjective measures of career success. Women perceived mentorship to be more valuable to their career development yet were more likely to report having no mentor. Additionally, women were more likely to report lower levels of research productivity, less career satisfaction, and greater barriers to promotion. Qualitative results indicated that women had less access to informal mentoring and family responsibilities had a greater effect on their career outcomes. Professional networking, female mentors, and relational aspects of mentoring were common themes.

CONCLUSIONS

This review examined gender disparities in mentoring and the impact on research productivity, promotion success, and career satisfaction for women in academic medicine. Institution-supported mentoring programs are needed to facilitate identification of appropriate mentors and promotion of a more equitable academic career environment for women.

The Hirsch Index and Self-Citation in Academic Physiatry Among Graduate Medical Education Program Directors

ABSTRACT

The Hirsch Index is a measure of academic productivity which captures both the quantity and quality of an author's output. A well-accepted bibliometric, the Hirsch Index still may be influenced by self-citation, which has been assessed in other medical and surgical specialties. This study aims to evaluate research output and self-citation in physiatry, establishing a benchmark for the field, in addition to identifying differences between physical medicine and rehabilitation subspecialties. This study identified physical medicine and rehabilitation residency and fellowship program directors and analyzed the number of publications, citations, self-citations, and h-indices. A total of 169 program directors were identified, and the mean number ± SD of publications, citations, and Hirsch Index for the cohort were 16.7 ± 29.5, 348 ± 753, and 5.7 ± 6.7, respectively. When self-citation was excluded, less than 2% of program directors (3 of 169) had changes in Hirsch Index greater than one integer, and none greater than two integers. The Hirsch Index remained unchanged for 90% (152 of 169). Spinal cord injury fellowship directors had significantly higher mean number of publications (28, P = 0.04), mean number of citations (672, P = 0.03), and Hirsch Index (9.2, P < 0.01; 95% confidence interval). Overall, self-citation is infrequent in physical medicine and rehabilitation, and spinal cord injury directors had more robust academic profiles.

Authorship Gender Composition in Urology Literature From 2015 Through 2020

OBJECTIVE

To describe the current landscape of first and last female authorship in urology journals relative to the journals' impact factor. We hypothesized that women would have a smaller proportion of publications in journals with higher impact factors.

METHODS

Eighteen urology journals were divided into groups based on impact factor accordingly: from 33.2 to 6.2 were classified as high (European Urology, Nature Reviews Urology, The Journal of Urology, BJU International, Prostate Cancer and Prostatic Diseases, and The Journal of Sexual Medicine), from 5.8 to 5.0 as medium (Asian Journal of Andrology, European Urology Focus, Sexual Medicine Reviews, Bladder Cancer, Prostate and World Journal of Urology), and from 4.8 to 2.2 as low (Urologic Oncology, Journal of Endourology, Neurourology and Urodynamics, Urology, Journal of Pediatric Urology and Female Pelvic Medicine & Reconstructive Surgery). A computer script was designed using Python to search PubMed and record first and last author of publications between 2015 and 2020. Gender was determined by Gender-Api (https://gender-api.com). Names with an accuracy of <90% were excluded. Type of peer-review and scope of each journal were also analyzed. Statistical analysis was performed using Matlab.

RESULTS

A total of 37,413 first and 28,414 last authors were identified during the study period. Overall, women represented 21% (8,029/37,413) of first and 15% (4,232/28,414) of last authors. Women were significantly less published in high impact journals compared to both medium and low impact journals (P <.001 in all). Among all journals, articles with female first authors were more likely to have a female last author (OR: 2.72, CI: 2.5-2.9, P <.001). Subspecialty journals had more female last authors than general journals (P <.05), and female representation increased if reviews were double-blinded (P <.001). Over the last 6 years, there has been a significant increase in female senior authorship among all journals (P = .045).

CONCLUSION

The proportion of female authorship was significantly lower in higher impact urology journals. While the underlying cause is likely multifactorial, this finding highlights a gender discrepancy that may impact women's ability to achieve career goals in academic medicine when compared to their male counterparts.

Career barriers for women in surgery

BACKGROUND

Despite the increasing numbers of female medical students, surgery remains male-dominated.

PURPOSE

To highlight the principal career obstacles experienced by aspiring female surgeons.

METHODS

A narrative review of literature on the position and career barriers of female surgeons has been conducted, using the MEDLINE and EMBASE databases.

MAIN FINDINGS

Implicit and even explicit biases against female surgeons remain prevalent, negatively impacting their training performance and overall professional trajectory. Female surgeons are globally underrepresented in leadership positions and senior academic rankings, especially that of a full professor. They feel hampered by lack of effective mentorship, whose value for a successful career has been acknowledged by all medical students, surgeons and surgical leaders. Their work-life imbalance is sometimes expressed as lower likelihood than their male contemporaries of getting married or having children and may be attributed to their conventional association with the role of caretaker, their personal desire to accommodate occupational and family duties and the inadequate implementation of parental leave and childcare policies. Female surgeons' "infertility" may be further explained by direct and indirect pregnancy-related difficulties. Female surgeons are also financially undercompensated compared to their male contemporaries. Finally, specialty-specific challenges should not be overlooked.

CONCLUSIONS

While encouraging steps have been made, women in surgery feel still hindered by various obstacles. The qualitative, interview-based nature of current literature requires more meticulous studies on these barriers with a more quantitative and objective approach. Attenuation of gender imbalance in surgical specialties requires further changes in mentality and more targeted modifications in relevant policies.

Challenges and gender-based differences for women in the Indian urological workforce: Results of a survey

Introduction

Entry of women into urology has not kept pace with that in other surgical branches with only 1% of Urological Society of India (USI) members being female. The objective of this study was to explore the personal and professional challenges, practice barriers, and level of satisfaction among female urologists/urology trainees in India.

Methods

A strictly confidential and anonymous 26-item questionnaire with respect to professional and personal challenges, workplace discrimination, and family satisfaction was circulated as a Google form through email and WhatsApp to all the female members of the USI (full and associate) and trainees (n = 48) based on identification from the USI directory.

Results

Thirty-three out of 48 female urologists responded (68%). Among the respondents (n = 33), majority had <5 years of experience (60.6%), of which 30.3% were residents, which reflected a recent surge in women joining urology. Majority (57.7%) chose to subspecialize, commonly in "female urology". Many (72.7%) were encouraged to take this subspecialty. Gender discrimination at workplace was reported by 54.5%, commonly by patients and consultants. 68% of respondents had conceived either before or during residency, leading to additional domestic responsibilities. 9.1% suffered a pregnancy-related complication, which they believed was a direct consequence of their work environment. These obstacles led to 30.3% of women reporting that their personal life had compromised their careers. Professional dissatisfaction was reported by 60.1% of women, with common causes being less operative time than male counterparts and lack of mentorship. Despite these challenges given a chance, 78.7% would choose urology again, and 66.7% would encourage their daughter to pursue a career in urology.

Conclusion

Professional and personal challenges as perceived by women responding to our survey include gender discrimination in training and work, lack of mentorship, pregnancy-related compilations, and compromised career due to family responsibilities. Despite these, most would choose this specialty again.

Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis

OBJECTIVE

Many studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020.

STUDY SELECTION

All original studies reporting faculty rank stratified by gender worldwide were included.

DATA EXTRACTION AND SYNTHESIS

Study screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models.

RESULTS

Our search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010-2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12).

CONCLUSIONS

Gender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists.

PROSPERO REGISTRATION NUMBER

CRD42020197414.

Benchmarking Scholarly Activity by Pharmacists Who Are Fellows Within the American College of Critical Care Medicine

Quantify scholarly activity by pharmacists who are Fellows within the American College of Critical Care Medicine and to develop a potential publication benchmark for fellowship application.

Gender disparity in dermatologic society leadership: A global perspective

BACKGROUND

In the last half-century, there has been increased representation of women in medicine. Despite this increase, there continues to be underrepresentation of women in medical leadership positions. The objective of this study was to investigate the phenomenon of gender disparity in the leadership of professional societies of dermatology worldwide.

METHODS

Online databases were used to extract the names of global dermatologic societies. Individual society websites were accessed to obtain information on executive members. Data not available on society websites were obtained through internet searches. Scopus was used to obtain H-indexes and other bibliometric outcomes.

RESULTS

Our data collection spanned 92 countries, with 1733 society leaders identified and information available for 1710. In North America, Europe, Asia, Australia, and the Middle East, women were in a minority in dermatology professional society leadership. In South America, Central America, and Africa, women were in a slight majority. Across all professional societies, the role of president was more frequently held by men (n = 95) as opposed to women (n = 75). Female leaders were less likely to hold concurrent academic positions as deans/chairpersons/directors (83.33%) than their male counterparts (92.06%). The median H-index of female leaders (9) was lower than that of men (14).

CONCLUSION

Gender disparity exists in leadership positions in professional dermatology societies. Cultural/continental specific factors should be explored further. Enhancement of institutional support, mentorship, and sponsorship for female dermatologists should be encouraged.

Gender imbalance amongst promotion and leadership in academic surgical programs in Canada: A cross-sectional Investigation

BACKGROUND

Women are underrepresented at higher levels of promotion or leadership despite the increasing number of women physicians. In surgery, this has been compounded by historical underrepresentation. With a nation-wide focus on the importance of diversity, our aim was to provide a current snapshot of gender representation in Canadian universities.

METHODS

This cross-sectional online website review assessed the current faculty listings for 17 university-affiliated academic surgical training departments across Canada in the 2019/2020 academic year. Gender diversity of academic surgical faculty was assessed across surgical disciplines. Additionally, gender diversity in career advancement, as described by published leadership roles, promotion and faculty appointment, was analyzed.

RESULTS

Women surgeons are underrepresented across Canadian surgical specialties (totals: 2,689 men versus 531 women). There are significant differences in the gender representation of surgeons between specialties and between universities, regardless of specialty. Women surgeons had a much lower likelihood of being at the highest levels of promotion (OR: 0.269, 95% CI: 0.179-0.405). Men surgeons were statistically more likely to hold academic leadership positions than women (p = 0.0002). Women surgeons had a much lower likelihood of being at the highest levels of leadership (OR: 0.372, 95% CI: 0.216-0.641).

DISCUSSION

This study demonstrates that women surgeons are significantly underrepresented at the highest levels of academic promotion and leadership in Canada. Our findings allow for a direct comparison between Canadian surgical subspecialties and universities. Individual institutions can use these data to critically appraise diversity policies already in place, assess their workforce and apply a metric from which change can be measured.

Gender inequalities on editorial boards of indexed pediatrics journals

BACKGROUND

The presence of women in decision-making positions, such as on editorial committees of biomedical journals, is not the same as that of men. This paper analyzes the gender composition of editorial committees (EBMs) and editors-in-chief (ECs) positions of pediatric journals.

METHODS

The gender of EBMs and ECs of 125 journals classified in the pediatrics area of the Journal Citation Report (JCR) was analyzed. The following indicators were calculated: gender distribution of ECs and EBMs by journal, publisher, subject speciality, country, quartile of the journal in JCR and country of affiliation of the members.

RESULTS

The total number of EBMs was 4242. The distribution by sex of the ECs was 19.44% women and 80.56% men, while that of the EBMs were 33.05% women and 66.95% men. Twenty journals exhibited a greater representation of women than of men, and in four there was parity. Journals with greater participation of women specialized in nursing and physical therapy and were related to nutrition (lactation and breastfeeding).

CONCLUSIONS

Only one-fifth of ECs and one-third of EBMs are females. Women's participation is higher in journals related to nursing, physical and occupational therapy, and nutrition. The United States has the highest number of EBMs, followed by the European Union.

IMPACT

Only one-fifth of Editors-in-chief in pediatrics journals are female. Only one-third of Editorial Board Members in pediatrics journals are female. Women's participation is higher in editorials committees in pediatrics journals related to nursing, physical and occupational therapy, and nutrition. Medical and pediatric associations and societies must work together to eliminate the disparities that exist between women and men. Achieving gender equity and empowering all women is one of the World Health Organization's Sustainable Development Goals.

Women doctors in female urology: current status and implications for future workforce

OBJECTIVE

To objectively determine the percentage of female trainees and consultants who are interested in their career being focussed on female urology (FU) in order to facilitate the improved planning for the future of this sub-specialty.

SUBJECTS AND METHODS

This was an international cross-sectional study spanning 1 year, from December 2018 to December 2019. An anonymous, voluntary survey was generated using the online survey generator Survey monkey^® . The survey was sent to urology consultants and trainees who were female from Australia, New Zealand, and Canada.

RESULTS

The total response rate to the survey was 61%. Up to 50% of female consultants and trainees selected a career in FU due to their gender, but up to 75% of respondents were also interested in FU of their own accord. Common concerns held by a majority of respondents included both the medical community's and the public's lack of awareness of FU as a component of urological expertise. Despite these concerns, most of the trainees were not concerned regarding their future work opportunities in FU, and many had intentions to pursue a fellowship in FU.

CONCLUSION

Female urology is an increasingly popular sub-specialisation of urology, given the steady increase in the intake of female trainees. Similar trends were identified internationally. Urology training in this area will need to continue to increase the community's and the primary health care referrer's awareness in order to ensure the continued success and growth of the sub-specialty.

Comparison of women and men in biomedical informatics scientific dissemination: retrospective observational case study of the AMIA Annual Symposium: 2017-2020

OBJECTIVE

Although the representation of women in science has improved, women remain underrepresented in scientific publications. This study compares women and men in scholarly dissemination through the AMIA Annual Symposium.

MATERIALS AND METHODS

Through a retrospective observational study, we analyzed 2017-2020 AMIA submissions for differences in panels, papers, podium abstracts, posters, workshops, and awards for men compared with women. We assigned a label of woman or man to authors and reviewers using Genderize.io, and then compared submission and acceptance rates, performed regression analyses to evaluate the impact of the assumed gender, and performed sentiment analysis of reviewer comments.

RESULTS

Of the 4687 submissions for which Genderize.io could predict man or woman based on first name, 40% were led by women and 60% were led by men. The acceptance rate was smilar. Although submission and acceptance rates for women increased over the 4 years, women-led podium abstracts, panels, and workshops were underrepresented. Men reviewers increased the odds of rejection. Men provided longer reviews and lower reviewer scores, but women provided reviews that had more positive words.

DISCUSSION

Overall, our findings reflect significant gains for women in the 4 years of conference data analyzed. However, there remain opportunities to improve representation of women in workshop submissions, panel and podium abstract speakers, and balanced peer reviews. Future analyses could be strengthened by collecting gender directly from authors, including diverse genders such as non-binary.

CONCLUSION

We found little evidence of major bias against women in submission, acceptance, and awards associated with the AMIA Annual Symposium from 2017 to 2020. Our study is unique because of the analysis of both authors and reviewers. The encouraging findings raise awareness of progress and remaining opportunities in biomedical informatics scientific dissemination.

Women are underrepresented in prestigious recognition awards in the American Urological Association

OBJECTIVES

To determine the proportion of women who received awards from the American Urological Association (AUA) and evaluate whether this has changed over time as the proportion of practicing female urologists has increased.

METHODS

A retrospective review of award recipients from the AUA website was performed. Gender of award recipient, type of award and year received were collected and the trend over time was compared with the AUA census.

RESULTS

Of the 622 award recipients, 43 (6.9%) were women. There was a larger proportion of women who received early career awards (15/65; 23.1%) compared to women who received more prestigious mid (1/44; 2.3%) or senior (27/513; 5.3%) career awards. Additionally, 17/43 (39.5%) of female award recipients were not clinical urologists, compared to only 33/579 (5.7%) of male award recipients.

CONCLUSIONS

Despite increased representation by women in the field of urology, women remain underrepresented in awards given by the AUA. Although the proportion of women receiving awards over time has increased, it remains less than expected given the increased proportion of practicing female urologists. Strategic initiatives should be employed to help advance women in academic urology.

Does Gender Matter in Academic Surgery? Author and Mentor Gender Impact Publication Citations in Surgical Research

OBJECTIVE

To examine female author representation within publications in the field of urology from the United States from 2000-2019.

METHODS

All 25,787 articles with a U.S. correspondence address published in the two largest U.S. headquartered general urology journals, Urology and Journal of Urology, were analyzed from 2000-2019. Gender was assigned to each first and last author based on the author's first name. First names were matched to a database of U.S. Social Security Administration data to determine gender.

RESULTS

Overall female authorship, female senior authorship, and female first authorship exhibited a significant upward trend from 2000 to 2019 (P <0.001, P <0.001, P = 0.002). As the number of female last authors increased, female last authors were significantly more likely to publish with female first authors, and significantly less likely publish with male first authors (P <0.001, P <0.001). Furthermore, we found a significant difference for female authors being less likely to get cited than male authors (p = 0.02), despite the greater proportion of females that authored research articles with higher citation counts compared to males (P <0.05).

CONCLUSION

Despite the significant progress in female representation within urological publications, female-authored publications continue to constitute a smaller proportion of the urological literature and are less likely to be cited. Our study provides the first evidence on the current status of female underrepresentation within academic urology and literature productivity at this watershed moment. As the number of female urologists evolves, these findings will be of significant impact in the advancement of female investigators in urology.

Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis

IMPORTANCE

Despite equal numbers of men and women entering medical school, women are underrepresented in the upper echelons of academic medicine and receive less compensation and research funding. Citation-related publication productivity metrics, such as the h-index, are increasingly used for hiring, salary, grants, retention, promotion, and tenure decisions. Exploring sex differences in these metrics across academic medicine provides deeper insight into why differences are observed in career outcomes.

OBJECTIVE

To systematically examine the available literature on sex differences in h-index of academic faculty physicians across all medical specialties and all levels of academic rank.

DATA SOURCES

Medical literature with the term h-index found in PubMed and published between January 1, 2009, and December 31, 2018, was used.

STUDY SELECTION

A PICOS (Population, Intervention, Comparison, and Outcomes), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and MOOSE (Meta-analysis of Observational Studies in Epidemiology) selection protocol was used to find observational studies that published h-indexes for faculty physicians that were stratified by sex. Studies were excluded if they were review articles, retracted, or unavailable online. Ultimately, 14 of 786 studies (1.78%) met the inclusion criteria.

DATA EXTRACTION AND SYNTHESIS

Data from 9 studies across 16 specialties were examined using weighted random-effects meta-analyses. Five studies were excluded because of overlapping specialties with another study or because they were missing appropriate statistics for the meta-analysis. Four of these studies were included in qualitative synthesis to bring the total to 13 studies.

MAIN OUTCOMES AND MEASURES

The primary study outcome was the h-index.

RESULTS

The meta-analysis included 10 665 North American unique academic physicians across 9 different studies from the years 2009 to 2018. Of the 10 665 physicians, 2655 (24.89%) were women. Summary effect sizes for mean h-indexes of men and women and mean h-index difference between men and women were determined for all faculty physicians and at each academic rank. Overall, female faculty had lower h-indexes than male faculty (mean difference, -4.09; 95% CI, -5.44 to -2.73; P < .001). When adjusting for academic rank, female faculty still had lower h-indexes than male faculty at the ranks of assistant professor (mean difference, -1.3; 95% CI, -1.90 to -0.72; P < .001), associate professor (mean difference, -2.09; 95% CI, -3.40 to -0.78; P = .002), and professor (mean difference, -3.41; 95% CI, -6.24 to -0.58; P = .02).

CONCLUSIONS AND RELEVANCE

In this systematic review and meta-analysis, women had lower h-indexes than men across most specialties and at all academic ranks, but it is unclear why these differences exist. These findings suggest that future investigation should be conducted regarding the causes of lower h-indexes in women and that interventions should be developed to provide a more equitable environment for all physicians regardless of sex.

Perceptions of gender equity in pediatric urology

INTRODUCTION/OBJECTIVE

Women constitute more than 50% of medical students in the United States. However, only 9.9% of practicing urologists are women, with much fewer numbers in high ranking appointments and positions of leadership. With a growing number of women in pediatric urology, we sought to evaluate how pediatric urologists perceive the climate for women physicians and compare perceptions and experiences of gender equity based on characteristics including gender, practice type, parental status, and years in practice.

STUDY DESIGN

An IRB approved survey was sent out to the Society of Pediatric Urology (SPU) listserve of active members. We utilized a validated study, the Culture Conducive to Women's Academic Success questionnaire (CCWAS, higher scores indicating better perceived culture toward women). Subcategories (equal access, work-life balance, freedom of gender bias, and leadership support) were also analyzed. A comment section was provided for respondents to include their own experiences. Descriptive statistics were used for demographics and clinical characteristics. Wilcoxon Rank-Sum and Kruskal-Wallace tests were used to compare CCWAS scores between groups.

RESULTS

A total of 116 practicing physicians returned completed surveys for analysis (response rate, 116/355 (33%) [ n = 41,35.3%] female [n = 75,64.7%] male). There was a statistically significant difference in total CCWAS score between male and female genders, indicating male physicians perceived the culture of their department toward women more positively than their female counterparts (median [ interquartile range] CCWAS score, 208.0 [189.0-228.0] vs 164.0 [136.0-190.3]; P < 0.0001). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic versus private practice.

DISCUSSION

Limitations of our survey include both participation and non-response bias. Those with strong opinions may have been more likely to respond to the survey. Male respondents comprised 64.7% (n = 75) of overall respondents, representing 25% active male SPU members. Whereas the response rate of active female members of the SPU was 70%. The survey was designed to assess gender equity in academia, and may not be as generalizable to the private practice community. Yet, the differences in perceptions and experiences of gender equity of this study have been noted by studies in other specialties, as well as the 2018 AUA Census report, and may provide insight into the presence and perpetuation of unconscious or systemic biases within medicine.

CONCLUSION

In this study, male physician perceptions of gender equity were different from those reported by female physicians, suggesting there are gender-based differences in how gender inequities are perceived and experienced.

Trends in Female Authorship: A Bibliometric Analysis of The Annals of Thoracic Surgery

BACKGROUND

Women continue to comprise a small minority of cardiothoracic surgeons. Representation of women in areas of academic achievement has not been well characterized. This study aims to evaluate female representation among authorship positions in high-impact articles published in The Annals of Thoracic Surgery.

METHODS

Altmetric scores were used to identify the top 50 articles published in 2013, 2015, and 2017 in The Annals of Thoracic Surgery. Article characteristics as well as author demographics were collected. Bibliometric analysis was performed to identify longitudinal changes with regard to female representation as first and last authors.

RESULTS

Female authors remain underrepresented in authorship, despite a temporal trend toward improvement in female representation over the years for first author position (16% in 2013, 22% in 2015, 20% in 2017) and last author position (8% in 2013, 16% in 2015, 20% in 2017). Articles authored by women were equally likely to achieve high impact as compared with men, as evaluated by Altmetric score (women 30.1 ± 38.6 vs men 39.1 ± 73.5, P = .53), citations (women 14.3 ± 19.1 vs men 17.6 ± 20.8, P = .45), and to be mentioned by news outlets, blogs, patents, Facebook, Wikipedia, Mendeley, Google, LinkedIn, and Reddit. Female first and last authors achieved comparable numbers of publications and H-index scores compared with male authors.

CONCLUSIONS

Significant sex-based differences in authorship representation persist, but with favorable improvement in female representation over time. Importantly, citations and high-impact status were independent of author sex. Characterization of the representation of women in academic achievement helps us strive for gender equity in our specialty.

Gender Representation in American Urological Association Guidelines

OBJECTIVE

To study patterns and factors associated with female representation in the American Urological Association (AUA) guidelines.

METHODS

We gathered publicly available information about the panelists, including the AUA section, practice setting, academic rank, fellowship training, years in practice, and H-index. The factors associated with the proportion of female panelists and trends were investigated. We also examined the proportion of female panelists in the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) urology guidelines.

RESULTS

There were 483 non-unique panelists in AUA guidelines, and 17% are female. Non-urologist female panelists in AUA guidelines represented a higher proportion than female urologists (30% vs 13%, P<0.0001). Compared with male panelists, females had lower H-indices (median 23 vs 35, P<0.001), and fewer were fellowship-trained (77.2% vs 86.8%; P=0.042). On multivariate analysis, non-urologists and panelists with lower H-indices were more likely to be female but there was no association between guideline specialties, academic ranking, geographic section, years in practice, and fellowship training with increased female authorship. Overtime, the proportion of female participation in guidelines remained stable. In the EAU and NCCN guideline panels, 12.2% and 10.7% were female, respectively.

CONCLUSION

Female representation among major urologic guidelines members is low and unchanged overtime. Female urologist participation was proportional to their representation in the urology workforce. Being a non-urologist and lower H-indices were associated with female membership in guideline panels.

Organizational behavior among academic medical school faculty

The study of organizational behavior in an academic medical school setting has many variables for consideration, including fragmentation, responsibilities, professionalism, burnout, and gender. In this Commentary, the author highlights some major factors affecting osteopathic physicians who practice in an academic setting, to bring to the attention of the medical community some of the inherent problems with modern academic medical education structure.

Sex-Based Language Differences in Female Pelvic Medicine and Reconstructive Surgery Fellowship Recommendation Letters

INTRODUCTION

Letters of recommendation (LORs) are a significant component of residency and fellowship applications. Applicant sex may play a role in the language used in letters, which could hinder progress in academic fields, particularly for women. Although differences in language based on applicant sex have been identified in other fields, no prior studies have evaluated LORs for female pelvic medicine and reconstructive surgery (FPMRS) fellowships.

METHODS

Letters of recommendations for applicants to an urban, tertiary care academic medical FPMRS fellowship from 2017 to 2019 were collected. Using the Linguistic Inquiry and Word Count program, a licensed text analysis software for academic purposes, we analyzed LORs based on 16 categories. The Wilcoxon rank sum test, Fisher exact test, and a generalized linear mixed model were used for statistical analyses.

RESULTS

A total of 97 fellowship applications were analyzed, yielding 354 LORs; 32 applicants were male, whereas 65 were female. Letters written for male applicants contained significantly more power words (P = 0.022) and significantly less affiliation words (P = 0.025) compared with female counterparts. Differences were maintained after adjusting for age, race/ethnicity, step 1 to step 3 scores, Phi Beta Kappa status, Alpha Omega Alpha status, and writer's sex.

CONCLUSIONS

Significant linguistic differences based on applicant sex exist in FPMRS fellowship LORs. Differences are consistent with previous analyses within science and medical fields. These findings did not show a significant association with an applicant's ability to match; however, we did not analyze whether the matched institution was the preferred choice for each applicant.

Sex Disparity Among Faculty of Physiology in North American Academia: Differences in Scholarly Productivity and Academic Rank

Medical academic research done in various specialties shows sex disparity in terms of academic and leadership rank. Research shows that in many medical academic research fields, there are a greater number of men with higher academic and leadership ranks, as well as higher research productivity. This begs the question: What is the case for medical academic research specifically in physiology departments throughout North America? Upon review of the literature, we found that a knowledge gap still exists in North America regarding sex differences among the faculty of physiology. Our rationale for this study is that if a sex disparity among the faculty of physiology in North American academia is found, steps can be taken to lower this disparity. The very first step is identifying that a problem exists. Scopus was used to obtain the h-index, years of active research, and the number of publications and citations of each faculty member. The h-index was used as a metric of academic output and scholarly productivity. Univariate regression was run with the h-index as the outcome of interest and multiple linear regression analysis was used to determine factors associated with a higher h-index. The analysis showed that while the overall number of females holding academic positions in physiology departments throughout North America has increased over the years, a large sex disparity still exists between males and females in the field. This disparity exists not only in academic and leadership rank but also in research productivity, a key predictor of success in the field. This finding warrants that further work be done to find what is causing this disparity and how it can be addressed.

Gender gap in mental health research productivity: Results from Qatar

OBJECTIVES

Qatar's contribution to biomedical research has increased significantly in the past couple of decades, but the exact participation of women researchers remains obscure. This study aims to explore the gender gap in research production of Qatar in the field of mental health.

METHODS

The authors searched five databases for published articles from Qatar in the field of mental health from 2015 to 2019. The authors examined the retrieved articles for the gender gap in 1) the number of researchers. 2) the numbers of articles produced by men-only research teams vs. the research teams included women. 3) h-index. 4) foreign collaboration. 5) research design and themes.

RESULTS

The authors identified 152 published articles in the field of mental health. Men researchers outnumbered women researchers (124 vs. 81). Men had statistically significant higher h-index compared to women (14.6 ± 1.4 vs 4.6 ± 0.9; p < 0.001). Research teams that included women had produced fewer articles compared to men-only groups (41.4 %), they also had less foreign collaborators (68 % vs. 91 %, p = 0.001). They were less involved in experimental research and more involved in observational research compared to male-only research groups (15.90 % vs. 38.6 % and 47.6 % vs. 25 % respectively; p = 0.034). In articles with women authors, women were the first authors in 50.8 % of the articles, and men were the senior authors in 79.4 % of them.

CONCLUSION

The study identifies gender gaps in some aspects of research productivity in Qatar. This data will provide a benchmark for future research in the field.

Equity, Diversity, and Inclusion in Academic American Surgery Faculty: An Elusive Dream

BACKGROUND

In the context of shifting population demographics in the United States, a diverse workforce in health care can lead to improved patient outcomes and enhance access to culturally competent care for minorities. The objective of this study was to analyze and quantify the relationship of gender, race, and academic rank, tenure status, and degree in American academic surgical faculty.

MATERIALS AND METHODS

A 12-y retrospective cross-sectional analysis of the data from the Association of American Medical Colleges was performed. The distribution of race and gender across academic ranks, tenure, and degree types were recorded from 2007-2018. Simple descriptive statistics and chi-square analysis was used to analyze the time trends and association between gender and race across academic rank, tenure status, and degree types.

RESULTS

When averaged over the 12 y of this study, there were significantly more whites (69.8%) and males (74.5%) among the academic surgery faculty compared with other races and females, respectively (P value <0.05). Asians and females experienced the greatest increase in proportional representation across all academic ranks with an absolute increase of 7% and 5% in full professor, 5% and 6% in associate professor, and 7% and 3% in chairperson (P value <0.05), respectively. No significant association was observed between gender and race with tenure status or degree type.

CONCLUSIONS

Female and Asians are increasing in proportional representation; however, racial and gender disparities remain prevalent at higher academic ranks and positions of leadership, especially among black and Hispanic academic surgeons.

Academic achievement and gender among adult critical care program directors

PURPOSE

Accreditation Council for Graduate Medical Education (ACGME) program director (PD) qualifications includes scholarly activity with demonstrated academic productivity and dissemination. Our hypothesis: academic productivity among adult critical care medicine (CCM) fellowship PDs is affected by gender with women having lower productivity.

MATERIALS AND METHODS

PDs in 39 institutions with CCM fellowships in anesthesiology, surgery, and pulmonary medicine were analyzed using data from ACGME website, PubMed, and NIH Research Portfolio Online Reporting Tools. Primary outcomes were total publications and h-index. Secondary outcomes included NIH funding and past five year publications. Independent variables and covariates included gender, academic rank, year appointed as program director, years certified in CCM, and specialty.

RESULTS

PDs who were women had fewer total publications (median: 13 vs: 20, p = 0.030), past 5 years publications (median: 6 vs median: 9; p = 0.025), and less NIH funding (12% vs 32%; p = 0.046) compared to men. In exploratory analyses stratified by rank, assistant professor ranked women had fewer total (p = 0.027) and recent publications (p = 0.031) compared to men.

CONCLUSIONS

Women who were PDs had fewer publications and less NIH funding compared to men with differences in publications more prominent in early career faculty.

Women in Leadership in Urology: The Case for Increasing Diversity and Equity

There is a persistent male gender predominance in urology, especially with respect to female representation in leadership. We review the current status of women in urology leadership, discuss challenges women face in leadership positions, present the case for adopting inclusive practices that increase diversity and gender equity in urology leadership, and review the potential benefits of such an expansion. We discuss practical strategies to grow the role of women in urologic leadership, including increasing mentorship, modifying academic promotion criteria, and addressing implicit bias, while presenting a roadmap toward achieving equity and diversity at the highest ranks of urologic leadership.

Trends in Female Authorship Within Urologic Literature: A Comparison of 2012 and 2017

OBJECTIVE

To evaluate trends in female authorship in the recent urologic literature.

METHODS

We examined articles published in 2012 and 2017 from 5 urologic journals: Journal of Urology, Journal of Endourology, Neurourology and Urodynamics, Urologic Oncology, and Urology. Gender was recorded for first, supplemental, and last authors. Articles were further categorized by subspecialty focus of the published article. Chi-square tests and multiple logistic regression modeling were used to assess for differences in female authorship by year, journal, and article subspecialty.

RESULTS

One thousand four hundred and thirty-three and 1374 articles were published in 2012 and 2017, respectively. There was a significant increase in all female authorship categories between years: first (19%-25%), last (12-16%), and any (67%-74%) (P<.01, all). By journal, the highest proportion of articles with any female authors for both years was in Neurourology and Urodynamics (80%, 2012; 85%, 2017) while lowest was in Journal of Endourology (49%, 2012; 54%, 2017). Likewise, female authorship was generally higher in female/voiding dysfunction /incontinence and lower in endourology subspecialty articles. Controlling for journal and subspecialty, multiple logistic regression analysis showed no change in last authorship between years.

CONCLUSION

Overall female authorship in the urologic literature has increased in recent years. However, after controlling for journal and subspecialty we found no increase in female last authorship between years, suggesting that disparities in senior authorships exist based on journal and subspecialty topic. Our findings further suggest an authorship plateau, highlighting the importance of efforts to optimize advancement and promotion of women in academic urology.

Assessing Contemporary Trends in Female Speakership within Urologic Oncology

OBJECTIVE

To evaluate multidisciplinary female representation at urologic oncology conferences, we reviewed speakership trends at contemporary Society of Urologic Oncology (SUO) and American Society of Clinical Oncology Genitourinary Symposium (GU-ASCO) annual meetings.

METHODS

Meeting programs from SUO and GU-ASCO from 2015 to 2019 were analyzed. Biographical information was determined by querying institutional websites and social/professional media platforms. Statistical analyses were performed to assess for differences and relationships between male and female authorship based on gender, specialty, professional, and educational factors.

RESULTS

We identified 1102 speakers at genitourinary oncology conferences. Overall, 222 (20%) were female. There was no significant difference between female speakership rates at SUO and GU-ASCO. The overall proportion of female speakers increased over time, but not when analyzing each individual subspecialty conference separately. Several professional and educational differences were noted between genders. Female speakers were more likely to be medical oncologists (P <.001), have more recent years of graduation (2001 vs 1996, P <.001), hold an additional advanced degree (OR 2.09, P = .005), and speak in sessions where other women served as chair (OR 1.42, P = .044). Conversely, female speakers had lower odds of delivering a plenary or keynote address (OR 0.28, P = .015).

CONCLUSION

We identified a significantly positive trend towards increased female representation within contemporary genitourinary conferences over time; these trends did not remain significant when analyzing each meeting separately. Several important disparities between men and women speakers were identified. Our data suggests that inclusion of women in planning committees may help reduce gender bias and promote diversity within urologic oncology.

Gender Bias in Medicine: Does It Exist at AUA Plenary Sessions?

OBJECTIVE

To determine if gender bias exists at the plenary sessions of the American Urological Association (AUA) annual conference by evaluating variations in the use of a professional title (PT) during speaker introductions at these sessions.

METHODS

We retrospectively reviewed video archives of all plenary sessions from the AUA annual conferences from 2017 to 2019. Videos that included both plenary introducer and speaker were included for analysis. The following data were collected: conference year, gender, and academic rank of "introducer" and of "speaker," and use of PT (ie, doctor) during speaker introduction. Variations in use of PT for introductions of speakers based on gender of introducer and of speaker were analyzed by chi-square tests.

RESULTS

Four hundred and fourteen videos were reviewed; 195 (47%) with a composite 622 introducer/speaker pairs were reviewed and analyzed. Only 8.7% of introducers and 14.6% of speakers were female (Table 1). Overall, there was no difference in the use of PT for introductions of female vs male speakers (61.5% vs 60.8%, P = 0.90). However, male speakers were more likely to be introduced as doctor when introduced by a female vs a male (75.60% vs 59.60%, P = 0.04). Female speakers were equally likely to be introduced as doctor regardless of introducer gender.

CONCLUSION

Men represented the majority of presenters and speakers in the plenary session at AUA meetings. However, there is not a significant difference in the use of PT for AUA plenary speaker introductions based on gender.