Sex differences in academic advancement. Results of a national study of pediatricians

Lack of women physician representation in the Japanese Society of Hospital General Medicine

Background

The increasing number of women physicians is in contrast to their underrepresentation in academic positions and professional associations. This study aimed to evaluate the status of women physicians in the Japanese Society of Hospital General Medicine (JHGM) based on society membership, board membership, and annual meeting authorship.

Methods

A cross-sectional analysis was conducted. Information on women physicians, society and board membership, and annual meeting authorship was collected. Data from the Japanese Primary Care Association (JPCA) served as the control. The gender of authors with accepted abstracts in the JHGM and JPCA annual meetings was determined by name or Internet search.

Results

In the JHGM, 14.2% of members were women physicians, compared to 19.1% in the JPCA (p < 0.001). None of the 21 JHGM board members were women, compared to 20.5% in the JPCA (p < 0.001). The average number of years of experience was significantly higher for the JHGM board members than for the JPCA board members (37.0 vs. 28.1 years, p < 0.001). Women first authors in the 2022-2023 JHGM meeting comprised 17.9%, significantly lower than the 28.4% in the 2023 JPCA meeting (p = 0.002). Similar patterns were seen for women last authors (6.0% in the JHGM vs. 18.8% in the JPCA, p < 0.001) and women chairpersons (17.9% in the JHGM vs. 40.3% in the JPCA, p = 0.036).

Conclusions

The JHGM has low women representation in society and board membership, and annual meeting authorship. Strategies are needed to enhance diversity and inclusion by increasing women's participation and leadership in the JHGM.

End of Affirmative Action-Who Is Impacted Most? Analysis of Race and Sex Among US Internal Medicine Faculty

BACKGROUND

For over 50 years, the United States (US) used affirmative action as one strategy to increase diversity in higher education including medical programs, citing benefits including training future public and private sector leaders. However, the recent US Supreme Court ending affirmative action in college admissions threatens advancements in the diversity of medical college faculty.

OBJECTIVE

Our study evaluated the demographic trends in Internal Medicine (IM) faculty in the US by assessing sex and race/ethnicity diversity to investigate who is likely to be impacted most with the end of affirmative action.

DESIGN

Longitudinal retrospective analysis SUBJECTS: IM faculty from the Association of American Medical Colleges faculty roster from 1966 to 2021 who self-reported sex and ethnicity MAIN OUTCOMES: The primary study measurement was the annual proportion of women and racial/ethnic groups among IM faculty based on academic rank and department chairs.

RESULTS

Although racial/ethnic diversity increased throughout the era of affirmative action, African American, Hispanic, and American Indian populations remain underrepresented. White physicians occupied > 50% of faculty positions across academic ranks and department chairs. Among the non-White professors, Asian faculty had the most significant increase in proportion from 1966 to 2021 (0.6 to 16.6%). The percentage of women increased in the ranks of professor, associate professor, assistant professor, and instructor by 19.5%, 27.8%, 25.6%, and 26.9%, respectively. However, the proportion of women and racial/ethnic minority faculty decreased as academic rank increased.

CONCLUSION

Despite an increase in the representation of women and racial/ethnic minority IM faculty, there continues to be a predominance of White and men physicians in higher academic ranks. With the end of affirmative action, this trend has the danger of being perpetuated, resulting in decreasing diversity among IM faculty, potentially impacting patient access and health outcomes.

The physician gender pay gap in Maryland: current state and future directions

BACKGROUND

Over the last few decades, more attention has been paid to the physician gender pay gap and more interventions have been attempted. This paper discusses the physician gender pay gap between 2017 and 2021 in Maryland.

METHODS

An online cross-sectional survey was distributed to over 10,000 physicians in the Maryland Medical Society, featuring questions regarding employment characteristics, compensation, impact of the COVID-19 pandemic, and educational debt. Using descriptive and regression analyses, we explored cross-sectional associations between gender and employment characteristics.

RESULTS

Male physicians reported a significantly higher average 2020 pre-tax income ($333,732 per year) than female physicians ($225,473 per year, p < 0.001), amounting to a nearly 50% difference in raw income, consistent with a previously reported pay gap in 2016. Women physicians earned 31.5% less than their male colleagues in 2020 and were projected to earn 28.7% less in 2021. Female physicians were also more likely to have educational debt (33.6% vs.12.9%, p < 0.001) and also more likely to have a high burden of debt, with 36% owing over $200,000 in education loans, compared to 14.7% of men (p < 0.01).

CONCLUSION

The physician gender pay gap in Maryland has remained relatively stable over four years, including the period of the COVID-19 pandemic.

Predictors of self-reported research productivity amongst medical students in the United Kingdom: a national cross-sectional survey

BACKGROUND

The number of academic clinicians in the UK is declining and there are demographic inequalities in the clinical-academic workforce. Increased research productivity by medical students is believed to reduce future attrition in the clinical-academic workforce. Thus, this study investigated the association between student demographics and research productivity amongst UK medical students.

METHODS

This is a national multicentre cross-sectional study of UK medical students in the 2020/21 academic year. We appointed one student representative per medical school, and they disseminated a 42-item online questionnaire over nine weeks, through departmental emails and social media advertisements. The outcome measures were: (i) publications (yes/no) (ii) number of publications (iii) number of first-authored publications (iv) abstract presentation (yes/no). We utilised multiple logistic and zero-inflated Poisson regression analyses to test for associations between the outcome measures and predictor variables at a 5% significance level.

RESULTS

There are 41 medical schools in the UK. We received 1573 responses from 36 UK medical schools. We failed to recruit student representatives from three newly formed medical schools, whilst two medical schools prohibited us from sending the survey to their students. Women had lower odds of having a publication (OR: 0.53, 95% CI: 0.33-0.85) and on average had fewer first-author publications than men (IRR: 0.57, 95% CI: 0.37-0.89). Compared to white students, mixed-ethnicity students had greater odds of having a publication (OR: 3.06, 95% CI: 1.67-5.59), an abstract presentation (OR: 2.12, 95% CI: 1.37-3.26), and on average had a greater number of publications (IRR: 1.87, 95% CI: 1.02-3.43). On average, students who attended independent UK secondary schools had a higher rate of first-author publications compared to those that attended state secondary schools (IRR: 1.97, 95% CI: 1.23-3.15).

CONCLUSION

Our data suggest that there are gender, ethnic and socioeconomic inequalities in research productivity among UK medical students. To tackle this, and potentially improve diversity in clinical academia, we recommend that medical schools should facilitate targeted high quality research mentorship, funding and training, especially for under-represented-in-medicine students.

Gender Equity in Medicine and Dermatology in the United States: The Long Road Traveled and the Journey ahead

Over the past 50 years there has been an increase in the representation of women in medicine with similar rates of men and women graduating from medical training today. Nevertheless, gender gaps in leadership, research publications, and compensation persist. Herein, we review trends in gender differences among leadership positions in academic medicine with a particular focus on dermatology, evaluate the roles of mentorship, motherhood, and gender bias on gender equity, and discuss constructive solutions for addressing gender inequities that persist in academic medicine today.

Gender distribution and women leadership in German Otolaryngology, Head and Neck Surgery

Objective

To determine the distribution of female physicians throughout the rank from resident to leadership positions in German Otolaryngology-Head and Neck Surgery (OHNS) departments.

Methods

This cross-sectional study collected data about the physician workforce in the German OHNS.The primary outcome was the proportion of female physicians. Data were collected from 165 departments from January 2022 to February 2022. The physician workforce was stratified based on gender and leadership.

Results

We included 2089 physicians from 165 departments of OHNS in German hospitals. Female residents and specialists outnumbered male peers (484/872 [55.5%] vs. 388/872 [44.5%] and 224/363 [61.71%] vs. 139/363 [38.29%], respectively). However, the women proportion decreased gradually with elevated hierarchical rank starting at the attending physician level to reaching its lowest extreme (14/165 [7.23%]) at the head of the department level. Holding a leadership position was associated with being male (n = 282 [85.2%] vs. n = 49 [14.8%], p < .0001). This persisted even after controlling the academic rank in a multivariable regression model (OR: 5.027, 95% CI: 3.536-7.146). The gap between the two genders in favor of men regarding leadership persisted in all kinds of hospitals. However, this disparity was lowest in university hospitals, (male: n = 83 [78.3%] vs. female: n = 23, [21.7%], p < .0001).

Conclusions

Even though women outnumbered men in resident and specialist positions, they are still underrepresented in leadership positions in OHNS. Continuous surveillance is needed to watch the dynamic changes in the gap between the two genders and address it with more sex equality-supporting policies.

Level of Evidence

IV.

Gender Discrepancies in Middle Author Publications in US Academic General Surgery

INTRODUCTION

To explore gender discrepancies in publications at general surgery departments, we performed a cross-sectional comparing the number of women and men at each academic rank and their number of first author (FA), middle author (MA), last author (LA), and total publications.

METHODS

Thirty academic general surgery departments were randomly selected. For each faculty, we tabulated: first, middle, last names, gender, academic rank, educational leadership, year of medical school graduation, and additional graduate degrees. Bibliography, H-index, and citations were downloaded from the Scopus database.

RESULTS

One thousand three hundred twenty-six faculty sampled, 881 (66.4%) men and 445 (33.5%) women. Men outnumbered women at all ranks, with increasing disparity at higher ranks. Men outnumbered women in all subspecialties-largest difference in transplant surgery (84.4% versus 15.6%, P < 0.001). Men at all ranks had more MA publications: assistant professor (rate ratio 1.20; 95% confidence interval, 1.01-1.43, P = 0.024), associate professor (1.65; 1.31-2.06, P < 0.001), and professor (1.50; 1.20-1.91, P = 0.008). Men associate professors had more LA publications (1.74; 1.34-2.37, P < 0.001). No differences found in FA publications at any rank, nor LA publications at assistant professor and professor ranks. At subspecialty level, men in surgical oncology (1.95; 1.55-2.45, P < 0.001) and transplant surgery (1.70; 1.09-2.66, P = 0.02) had more MA publications.

CONCLUSIONS

While FA and LA publications did not differ significantly across genders, the largest difference lies in MA publications, beginning at junior ranks and persisting with seniority. Discrepancies in MA publications may reflect gender discrepancies in collaborative opportunities, hence total publications should be used cautiously when determining academic productivity.

Analysis of gender representation, authorship inflation, and institutional affiliation in abstract acceptance: a 5-year study

Purpose

Our goals were to characterize associations of author number, author gender, and institutional affiliation on ratings and acceptances of abstracts submitted to one surgical education conference over 5 years.

Methods

We retrospectively reviewed all abstracts submitted between 2017 and 2021 to the annual meeting of the Association for Surgical Education (ASE). Abstract data included average rater scores, acceptance status, author lists, and institutional affiliations. We cross-referenced last author affiliation with top-40 National Institutes of Health (NIH)-funded institutions and used a gender determination software to code first and last author genders.

Results

We analyzed 1,162 abstracts. Higher reviewer scores demonstrated positive, weak associations with more authors [r(1160) = 0.191, p < 0.001] and institutions [r(1160) = 0.182, p < 0.001]. Significantly higher scores were noted for abstracts with last authors affiliated with top-40 NIH-funded institutions [4.18 (SD 0.96) vs. 3.72 (SD 1.12), p < 0.001]. Women were first authors (51.8%) (n = 602) and last authors (35.4%) (n = 411) of the time. Abstracts were rated significantly higher with women rather than men as first authors [3.98 (SD 0.99) vs. 3.82 (SD 1.12), p = 0.011] or last [4.01 (SD 1.04) vs. 3.82 (SD 1.10), p = 0.005]. Across all years, abstracts were accepted more often as podium or plenary presentations when submitted by women first [n = 279, 59.7% (p = 0.002)] or last [n = 183, 38.4% (p = 0.095)] authors.

Conclusion

Abstracts whose last authors were affiliated with top-40 NIH-funded institutions received significantly higher scores, possibly indicating increased tangible or intangible resources contributing to research efforts. Abstracts with women first and last authors scored higher and were more frequently invited for plenary and podium presentations.

Predictors of academic career progression among early career physician-scientists via an intensive research training program abroad: a case study

BACKGROUND

Despite extensive efforts to revitalize the physician-scientist pipeline, attrition has been observed along the physician-scientist developmental pathway. Research exposure during clinical training is considered an important factor favoring the decision to pursue an academic career pathway.

METHODS

The authors sought to identify factors associated with academic career progression among junior physician-scientists following the completion of an intensive research training program, using the framework of the Social Cognitive Career Theory (SCCT), to benefit the design of efforts to revitalize the physician-scientist career pipeline. We conducted a retrospective study of 108 physicians who completed a long-term research training program abroad during residency, or within a few years post-residency completion, between 2010 and 2017. With potential predictors of academic career progression prioritized by SCCT, multivariable logistic regression was used to identify predictors of sustained research involvement, high productivity and high research competency after training, respectively. The SCCT was used to illuminate our findings.

RESULTS

Co-publications with training supervisors abroad and medical oncology/pediatric oncology as a clinical specialty were positively associated with sustained research involvement and high productivity. Joining the training program after the age of 36 was negatively associated with high research competency. All of the predictors shared a common feature of high correlation with both self-efficacy and environmental elements, the reciprocal interactions of which may affect the career progression of physician-scientists.

CONCLUSIONS

Insights gained through this analysis provide policy recommendations for the designing of efforts to revitalize the physician-scientist career pipeline. Priorities should be given to institutional oversight to ensure strengthened self-efficacy at the beginning of one's academic career, by providing long-term research training opportunities to young residents and promoting co-publications with their training supervisors during the training. In order to avoid the negative impact to self-efficacy caused by patient-related burnout or academic isolation, academic medical centers should take measures to guarantee protected research time, and to develop a positive culture encouraging mentoring relationships between junior and experienced physician-scientists in medical departments.

Perceived barriers towards the importance and application of medical research: a source of gender disparity among medical undergraduates

BACKGROUND

Little is known about gender disparity among medical undergraduates in the developing world. Therefore, this study aims to explore the attitudes and perceived barriers among Jordanian medical students, particularly women.

METHODS

An online, self-administered questionnaire, developed after an extensive literature review, was disseminated across all six Jordanian medical schools targeting more than 5000 medical students. Student t-test and ANOVA were used to document mean differences among different groups. Linear and logistic regression models were used to find predictors of publication and number of publications.

RESULTS

A total of 636 students participated in the survey with a women to men ratio of 1.1. Women medical students report significantly higher knowledge (t(634) = 2.47, p = 0.013), personal (t(634) = 3.31, p = 0.001), and total barriers scores than men (t(634) = 3.02, p = 0.003). Moreover, compared to men, women were less likely to find same-sex mentorship (t(634) = 3.18, p = 0.001) or receive credited authorship (t(634) = 2.12, p = 0.011). Overall, women medical students were more likely to perceive that their gender (t(634) = 3.58, p < 0.001) and people's perception of their gender (t(634) = 4.25, p < 0.001) are barriers to their career advancement. Binary logistic regression demonstrated that gender is a significant predictor of being able to publish (OR: 1.645; 95%CI: 1.002-2.731), while linear regression demonstrated that gender is a predictor of number of publications (ß: 0.113; 95%CI: 0.063-0.288).

CONCLUSION

A significant gender disparity exists in terms of both attitudes and overall barriers among Jordanian medical undergraduates which calls for immediate policy changes as to produce successful clinicians and researchers.

Physician Health and Wellness

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.

Family Supportive Supervisor Behaviors Moderate Associations between Work Stress and Exhaustion: Testing the Job Demands-Resources Model in Academic Staff at an Austrian Medical University

The time-intensive work of publishing in scientific journals is an important indicator of job performance that is given much weight during promotion procedures for academic positions. The current study applied the job demands–resources model and analyzed whether family supportive supervisor behaviors (FSSB) moderated associations between work stress and feelings of exhaustion as a job resource and whether feelings of exhaustion ultimately mediated the link between work stress and academic employees’ publication activity. The current online cross-sectional questionnaire study was conducted in 133 academic employees (65.4% women, 34.6% men; M_age = 41.9, SD = 10.1) at an Austrian medical university and assessed employees’ numbers of publications, H-index, work stress, feelings of exhaustion, FSSB, and work–family services used. Manifest path models revealed that FSSB moderated the link between experiencing high levels of work stress and strong feelings of exhaustion, especially in employees who had at least one child below the age of 18. Part-time employment was most strongly linked with lower numbers of publications and lower H-index levels. The finding that FSSB acted as a job resource mostly for employees with at least one child below 18 underlines the fact that FSSB is different from other forms of supervisor support. The current study supports recommendations to increase the amount of work–family services and to change organizational norms to be supportive of the successful management of family and work obligations.

Assessment of Gender Parity: Leadership Representation in Pulmonary and Critical Care Medicine

Background: Academic centers' and professional societies' top leadership representation and professional societies' award recipients remain disparate by gender in many fields. Little is known regarding leadership representation and recognition within pulmonary, critical care, and sleep medicine (PCCM), which has ∼22% women physicians. We sought to understand the landscape of female PCCM leaders. Methods: We abstracted gender of fellowship program directors (PDs), Department of Medicine (DOM) Chairs and Division Chiefs from academic medical centers with PCCM fellowship programs from 2018 and for comparison 2008. We abstracted leadership and recognition award recipients within four PCCM professional societies from 2013 to 2018 (American Thoracic Society [ATS], American Academy of Sleep Medicine [AASM], American College of Chest Physicians [CHEST], and Society of Critical Care Medicine [SCCM]). Results: In 2018, 29% of PCCM PD, 15% of PCCM Division Chiefs, and 15% of DOM Chairs were women. There were significantly more female PDs in 2018 (29%) compared with 2008 (16%, p = 0.04). On average, 25% of society presidents were women, with 28% of PCCM societal awards going to women, with significant difference between societies (p = 0.04). Each society differed in average distribution of female board members over the 6-year period: ATS 38%, AASM 35%, CHEST 18%, and SCCM 44% (p < 0.001). Conclusion: PCCM leadership and societal recognition are disparate by gender with few women holding top leadership roles and receiving societal recognition. Fortunately, the distribution notably is starting to reflect the specialty's demographics. Understanding why these inequalities exist will be essential to achieving gender parity in PCCM.

Gender Disparity in Academic Gastroenterology: Beginning of the End of the Underrepresentation of Women?

BACKGROUND

Though there are an increasing number of female medical graduates, women remain underrepresented in academic medicine. There have been several reasons to explain this gender disparity, including marital status, number of children, number of hours worked, job flexibility, perceptions of women as inferior leaders, gender bias, sexual harassment, and unsupportive academic climates.

AIMS

This study aimed to investigate the relationship between scholarly productivity and the representation of female gastroenterologists in academia. Specifically, scholarly productivity measured by the h-index and academic rank were explored to determine if there were gender disparities in academic productivity and rank in gastroenterology.

METHODS

Gastroenterology departmental listings were obtained from the Fellowship and Residency Interactive Database of the American Medical Association. The Scopus database was used to record each physician's h-index. Statistical analyses were conducted with Wilcoxon rank-sum test, which compared matched samples by academic rank, and ANOVA tests, which compared multiple academic ranks.

RESULTS

Out of 1703 academic gastroenterologists, women account for 25% of academic physicians. Women have statistically lower h-indices at the level of Assistant Professor (p = 0.0012), and at the level of Chair (p = 0.01). There was no difference in h-indices between male and female at the rank of Associate Professor and Professor.

CONCLUSIONS

While these results mirror patterns appreciated in other fields of medicine, the results at the rank of Chair may suggest that despite the lower h-index compared to their male counterparts, females are perceived as having strong inherent leadership skills outside of academic productivity that are also conducive to leading a department and may be contributing to their rise to Chair.

Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists

PURPOSE

To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction.

METHODS

A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area.

RESULTS

Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life.

CONCLUSIONS

The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Impact of Mentorship, by Gender, on Career Trajectory in an Academic Anesthesiology Department: A Survey Study

INTRODUCTION

Mentorship has been identified as a key component of success in business and in academic medicine.

METHODS

After institutional review board approval of the study, an email survey was sent to anesthesiologists in one anesthesiology department to assess mentorship status. A survey link was sent to nonrespondents at 2 weeks and 4 weeks. All participants were deidentified. The identification of a mentor was compared by gender, academic rank, and years of practice.

RESULTS

Among 233 anesthesiologists, 103 (44.2%) responded to the survey. More than 90% of survey respondents agreed or strongly agreed that having a mentor is important to career success. Of the 103 respondents, 31 (30%) indicated they had a mentor. Overall, 84% of the identified mentors were men; however, this percentage differed significantly between men and women respondents (95% versus 60%; P = .03). Characteristics associated with having a mentor included younger age (P = .007), fewer years since finishing training (P = .004), and working full time (P = .02). For respondent age and years since finishing training, there was some evidence that the association was dependent on the gender of the respondent (age-by-gender interaction, P = .08; experience-by-gender interaction, P = .08).

DISCUSSION

Anesthesiologists in this department believed that mentorship led to more academic success. Few women mentors were reported, and women were unlikely to identify a mentor once advanced past an assistant professor rank. Most respondents believed that mentorship was important for overall career success, but only approximately one-third identified a mentor at the time of the survey.

Sex Disparities in Productivity among Oculoplastic Surgeons

Purpose The aim of the study is to investigate sex differences in academic rank, publication productivity, and National Institute of Health (NIH) funding among oculoplastic surgeons and whether there is an association between American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) membership and scholarly output.

Methods Sex, residency graduation year, and academic rank were obtained from institutional websites of 113 U.S. ophthalmology programs. H-indices and m-quotients were obtained from the Scopus database. NIH funding information was obtained from the NIH Research Portfolio Online Reporting Tool.

Results Of the 272 surgeons, 74 (30.2%) were females. When adjusted for career duration, differences in female to male proportions were only significant at the rank of assistant professor (assistant: 74.3 vs. 48.5%, p = 0.047; associate: 18.9 vs. 24.6%, p = 0.243; full professor: 13.0 vs. 37.2%, p = 0.114). Women had a shorter career duration than men [10.0 (interquartile range or IQR 12.0) vs. 21.0 (IQR 20.0) years; p < 0.001] and a lower h-index [4.0 (IQR 5.0) vs. 7.0 (IQR 10.0); p < 0.001], but similar m-quotients [0.4 (IQR 0.4) vs. 0.4 (IQR 0.4); p = 0.9890]. Among ASOPRS members, females had a lower h-index than males [5.0 (IQR 6.0) vs. 9.0 (IQR 10.0); p < 0.001] due to career length differences. No difference in productivity between sexes was found among non-ASOPRS members. ASOPRS members from both sexes had higher scholarly output than their non-ASOPRS counterparts. Just 2.7% (2/74) of females compared with 5.3% (9/171) of males received NIH funding (p = 0.681).

Conclusion Sex differences in academic ranks and h-indices are likely due to the smaller proportion of females with long career durations. ASOPRS membership may confer opportunities for increased scholarly output.

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.

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.

How Does Representation of Women on Editorial Boards Compare Among Orthopaedic, General Surgery, and Internal Medicine Journals?

BACKGROUND

Women have historically been underrepresented as editors of peer-reviewed medical journals. Studies have demonstrated that there are differences in editorial board reviewer behavior based on gender, suggesting that greater representation by women on editorial boards may improve the quality and diversity of the review process. Therefore, the current representation of women on the editorial boards of orthopaedic journals, particularly compared with peer-reviewed surgical and medical journals, is of interest.

QUESTIONS/PURPOSES

(1) What is the representation of women as members of editorial boards of prominent orthopaedic surgery journals? (2) How does it compare with representation on the editorial boards of journals in general surgery and internal medicine?

METHODS

The top 15 journals with a strong clinical emphasis based on Impact Factor (Clarivate Analytics) calculated by the 2018 Journal Citation Reports were identified for orthopaedic surgery, general surgery (and all general surgical subspecialties), and internal medicine (with representative internal medicine subspecialties). Clinical publications with their primary editorial office located in the United States led predominantly by physicians or basic scientists were eligible for inclusion. The members of an editorial board were identified from the journals' websites. The gender of editors with gender-neutral names (and editors whose gender we considered uncertain) was identified by an internet search for gender-specific pronouns and/or pictures from an institutional profile. Fisher exact tests and t-tests were used to analyze categorical and continuous variables, respectively. Significance was set at p < 0.05.

RESULTS

Of the editors analyzed, women made up 9% (121 of 1383) of editorial boards in the orthopaedic journals with the highest Impact Factors, compared with 21% (342 of 1665) of general surgery journals (p < 0.001) and 35% (204 of 587) of internal medicine journals (p < 0.001). The overall mean composition of editorial boards of orthopaedic journals was 10% ± 8% women, compared with that of general surgery, which was 19% ± 6% women (p < 0.001), and that of internal medicine, which was 40% ± 19% women (p < 0.001).

CONCLUSION

Women make up a smaller proportion of editorial boards at orthopaedic surgery journals than they do at general surgery and internal medicine journals. However, their representation appears to be comparable to the proportion of women in orthopaedics overall (approximately 6%) and the proportion of women in academic orthopaedics (approximately 19%). Ways to improve the proportion of women on editorial boards might include structured mentorship programs at institutions and personal responsibility for championing mentorship and diversity on an individual level.

CLINICAL RELEVANCE

Increasing representation of women on editorial boards may improve the diversity of perspectives and quality of future published research, generate visible role models for young women considering orthopaedics as a career, and improve patient care through enriching the diversity of our specialty.

Establishing a Women in Radiology Group: A Toolkit From the American Association for Women in Radiology

Despite increasing representation in medical schools and surgical specialties, recruitment of women into radiology has failed to exhibit commensurate growth. Furthermore, women in radiology are less likely to advance to leadership roles. A Women in Radiology (WIR) group provides a robust support system that has been shown to produce numerous benefits to the group's individual participants as well as the group's institution or practice. These benefits include development of mentorship relationships, guidance of career trajectories, improved camaraderie, increased participation in scholarly projects, and increased awareness of gender-specific issues. This article describes a recommended pathway to establishing a WIR group, with the goal of fostering sponsorship and promoting leadership, recruitment, and advancement of women in radiology. Barriers to implementation are considered, and resources to facilitate success, including a range of resources provided by the American Association for Women in Radiology, are reviewed. By implementing the provided framework, radiologists at any career stage can start a WIR group, to promote the advancement of their female colleagues.

A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey

BACKGROUND

Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees.

METHODS

A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05.

RESULTS

There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees' career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included "futility" (29 percent) and "fear" (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001).

CONCLUSIONS

Gender bias and sexual misconduct negatively affect female trainees' attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.

The Role of Race and Gender in the Career Experiences of Black/African American Academic Surgeons: A Survey of the Society of Black Academic Surgeons and a Call to Action

OBJECTIVE

To determine the role of race and gender in the career experience of Black/AA academic surgeons and to quantify the prevalence of experience with racial and gender bias stratified by gender.

SUMMARY OF BACKGROUND DATA

Compared to their male counterparts, Black/African American women remain significantly underrepresented among senior surgical faculty and department leadership. The impact of racial and gender bias on the academic and professional trajectory of Black/AA women surgeons has not been well-studied.

METHODS

A cross-sectional survey regarding demographics, employment, and perceived barriers to career advancement was distributed via email to faculty surgeon members of the Society of Black American Surgeons (SBAS) in September 2019.

RESULTS

Of 181 faculty members, 53 responded (29%), including 31 women (58%) and 22 men (42%). Academic positions as a first job were common (men 95% vs women 77%, P = 0.06). Men were more likely to attain the rank of full professor (men 41% vs women 7%, P = 0.01). Reports of racial bias in the workplace were similar (women 84% vs men 86%, not significant); however, reports of gender bias (women 97% vs men 27%, P < 0.001) and perception of salary inequities (women 89% vs 63%, P = 0.02) were more common among women.

CONCLUSIONS AND RELEVANCE

Despite efforts to increase diversity, high rates of racial bias persist in the workplace. Black/AA women also report experiencing a high rate of gender bias and challenges in academic promotion.

Assessment of Gender-based Qualitative Differences within Trainee Evaluations of Faculty

Rationale: Recent studies of trainee evaluations of medical faculty have demonstrated subtle gender-based word choice differences. However, it is not known if this manifests in major contextual differences in written comments.Objectives: To characterize qualitative differences in narrative evaluations of female and male pulmonary and critical care medicine faculty.Methods: We performed a single-center, retrospective cohort analysis of trainee narrative evaluations of pulmonary and critical care medicine faculty at the Hospital of the University of Pennsylvania, written from 2015 to 2016. Directive and summative content analysis was performed by four raters. Major contextual themes were identified using constant comparative techniques. Thematic differences based on faculty gender were identified, with statistical significance determined using χ² analysis (P < 0.05). Effect sizes were calculated using Cramér's V.Results: A total of 1,216 total narrative evaluations were analyzed, representing 62 faculty members (17 women and 45 men), with analysis continued for the full cohort beyond achieving saturation of themes. Five overarching themes emerged: teaching skills, clinical skills, supervision, interpersonal and communication skills, and leadership skills. Within subthemes, we found no significant gender differences in reference to general teaching skills, learning environment, enthusiasm for teaching, or interpersonal concern. We identified subtheme differences between male and female faculty evaluations in regard to mentions of learner autonomy, clinical learning environment, humor, and motivating the trainee for patient care. Although the mention of constructive criticisms did not differ between genders, constructive criticisms of female faculty were more likely to mention demeanor (P = 0.06).Conclusions: Our data suggest minimal thematic differences in trainee narrative evaluations of male and female pulmonary and critical care medicine faculty. However, we noted several subtheme contextual differences between male and female faculty, which warrants further investigation.

Trends in Anti-VEGF Injection Medicare Part B Claims among Male and Female Ophthalmologists from 2012-2016

Background: Compared to male ophthalmologists, female ophthalmologists have significantly reduced salaries, fewer faculty roles and authored publications, garnered less federal research funding, and achieved less editorial advancement. We aimed to use the most recently available Centers for Medicare and Medicaid Services data to characterize trends and differences in anti-VEGF reimbursements coded for by male and female ophthalmologists.Methods: We used Medicare Fee-For Service Provider Utilization and Payment Data: Part B Provider public use files for 2012-2016 to quantify service and reimbursement patterns for anti-VEGF injections between male and female ophthalmologists. Five outcome variables were studied: number of providers, average Medicare payment amount, total payment, number of services, and number of Medicare beneficiaries.Results: Number of services performed per female provider was 71.2% that of a male ophthalmologist in 2012, and this percentage did not change from 2012 to 2016 (95%CI [0.63, 0.804], [0.984, 1.04], respectively). Female providers had 76.1% of beneficiaries as males in 2012, and this percentage stayed constant throughout the years (95%CI [0.69, 0.84] and [0.99, 1.03], respectively). The total payment difference between female and males was $102,175 per provider in 2012, and this gap widened by $18,292 yearly (95% CI [-162599.17, -41760.47], [-33060.35, -3524.38], respectively).Conclusion: While male and female providers saw considerable increases in aflibercept services and payments in the 5-year period, the gap between male and female reimbursements widened significantly. Moving forward, analysis of large-scale Medicare datasets provides a tangible report card on how effective our attitudes and policies are in cultivating equal opportunity.

Equity for women in medicine-neonatologists identify issues

OBJECTIVE

Inequity between genders with regards to leadership achievement, compensation, scholarly productivity, and grant funding exist among physicians. This study explores whether similar inequities exist among board certified neonatologists within the USA.

STUDY DESIGN

A voluntary anonymous survey was distributed to 3575 members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with 560 respondents (15.7% response rate). The survey contained questions assessing clinician characteristics, work environment, compensation, professional productivity, and social factors. Statistical analysis was done using JMP Pro 15.0.0 by SAS.

RESULTS

Female neonatologists, compared to male peers, were less likely to hold leadership positions (OR 0.36, p = 0.005), received lower compensation by an average of $34,916 or 12.47% (p < 0.001), and had 6.71 fewer primary authored publications (p = 0.025) after adjusting for several confounding factors.

CONCLUSION

Gender remains a significant independent factor influencing leadership attainment, compensation, and academic productivity in this cohort of neonatologists.

Physical Medicine and Rehabilitation Faculty Diversity Trends by Sex, Race, and Ethnicity, 2007 to 2018 in the United States

INTRODUCTION

Sex and race/ethnicity disparities persist in academic Physical Medicine and Rehabilitation (PM&R). This study contributes to the current body of knowledge by demonstrating changes in academic PM&R by sex and race/ethnicity in multiple categories over a 12-year period.

OBJECTIVE

To evaluate workforce disparities in academic PM&R by measuring sex and race/ethnicity diversity in academic degree, rank, and tenure status.

DESIGN

Surveillance study.

SETTING AND METHODS

Self-reported data for PM&R from the Association of American Medical Colleges (AAMC) annual Faculty Roster report from 2007 to 2018.

MAIN OUTCOME MEASURES

The 12-year average percentage composition in academic degree, rank, and tenure status was calculated to compare the overall distribution. Counts and proportion changes were plotted to depict the temporal trends. Absolute changes in racial percentage composition were graphed to highlight the progress.

RESULTS

From 2007 to 2018, the increase by sex was roughly equal (male = 216; female = 236), whereas most of the increase was in White faculty (207). The representation of female and Underrepresented in Medicine (URiM) faculty decreased as academic level advanced. Instructors is the only category with a higher proportion of female faculty, from 2007 (53%) to 2018 (59.3%), whereas male faculty occupied over 75% of the full professor positions at any time. Among the non-White faculty, Asian faculty had the greatest increase in proportion of full professors (3.7% to 10%) and Hispanic/Latino faculty in associate professors (2% to 7.1%), whereas full professors who were Black/African American decreased from 4 persons (2.5%) to 2 persons (0.8%).

CONCLUSION

An increase in total number of female and URiM faculty was observed in academic PM&R over 2007 to 2018, but sex and ethnicity/race disparities persisted, especially in higher ranks and leadership positions. For non-White faculty, greater disparities existed, pointing toward the need to target challenges faced by URiM race/ethnicity status.

Seeking racial and ethnic equity among neonatologists

OBJECTIVE

Racial and ethnic inequities in leadership achievement, compensation, scholarly productivity, and grant funding exists among physicians. This study explores whether similar inequities exist among neonatologists within the United States.

STUDY DESIGN

A voluntary anonymous survey was distributed to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with 560 respondents. Logistic regression and ordinary least squares were used to assess whether racial and ethnic identity is associated with clinical time, leadership, compensation, publication, grant funding, or academic rank.

RESULTS

As compared to non-Hispanic White neonatologists, statistical differences were found for underrepresented minorities in medicine in: regions of the country where they worked, total cash compensation received, being awarded an NIH grant, and location of graduate medical education. Fewer differences were found for Asian neonatologists and included location of graduate medicine education.

CONCLUSION

Racial and ethnic identity remains a significant independent factor influencing professional achievement and compensation.

Are Women Disadvantaged in Academic Radiology?

RATIONALE AND OBJECTIVES

Women remain underrepresented in leadership positions in radiology. We sought to determine if 1) women are equitably represented in the senior author positions in radiology journals and 2) if women's contributions to the radiology literature and their individual productivity are proportional to their representation at senior academic rank.

MATERIALS AND METHODS

The gender of 3,702 first and last authors listed for manuscripts published in nine high-impact American radiology journals was assessed between 2002-2017. For the same years, the gender composition of academic faculty and ranks based on AAMC data was queried. Statistical tests were employed to detect discrepancies and changes over time.

RESULTS

First authorship by women grew from 26.9% to 37.4% and from 15.7% to 23.9% as senior author between 2002-2017 (P<.0001). Although the index of manuscript productivity rate was nearly equal for men and women over the 16-year study period, women remained under-represented in senior radiology faculty rank over the same period.

CONCLUSIONS

Although women have proportionally increased their contribution to the radiology literature over the years, commensurate increased representation of women in senior authorship and faculty positions was not observed. Despite increased involvement of women in research over time, they remain disproportionately at junior faculty positions.

Examining Gender Disparity in Academic Abdominal Radiology in North America

BACKGROUND

Gender disparity exists in nearly every medical specialty, particularly in leadership roles and academia. Radiology is not exempt from this phenomenon, with women making up less than a third of radiology residents in the United States (US). This can have long-lasting effects on the career progression of female radiologists. Our search did not reveal any study on gender composition in academic abdominal radiology.

PURPOSE

To evaluate the academic productivity and career advancement of female academic abdominal radiology faculty in the United States and Canada.

MATERIALS AND METHODS

Parameters of academic achievement were measured, including the number of citations and publications, years of research, as well as H-index. Information regarding academic and leadership ranking among academic abdominal radiologists in the United States and Canada was also analyzed.

RESULTS

In academic abdominal radiology, there were fewer females than males (34.9% vs 65.1%; p-value 0.256). Among the female radiologists, the greatest proportion held the rank of assistant professor (40%). Female representation decreased with increasing rank. Females had a lower H-index than males (P-value = 0.0066) and significantly fewer years of research than males (P-value = 0.0243).

CONCLUSION

Male predominance in academic abdominal radiology is similar to many other medical specialties, and encompasses senior faculty rank, leadership roles and research productivity.

Gender Disparity in Awards in General Surgery Residency Programs

IMPORTANCE

Women are disproportionately underrecognized as award winners within medical societies. The presence of this disparity has not been investigated in training programs.

OBJECTIVE

To determine the presence of a gender disparity in award winners in general surgery residency programs.

DESIGN, SETTING, AND PARTICIPANTS

In this retrospective survey study, 32 geographically diverse academic and independent general surgery residency programs were solicited for participation. The 24 participating programs (75.0%) submitted deidentified data regarding the gender distribution of residents and trainee award recipients for the period from July 1, 1996, to June 30, 2017. Data were analyzed from September 11, 2017, to December 21, 2018.

EXPOSURES

Time and the proportion of female trainees.

MAIN OUTCOMES AND MEASURES

The primary outcome was the percentage of female award winners. A multilevel logistic regression model accounting for the percentage of female residents in each program compared the odds of a female resident winning an award relative to a male resident. This analysis was repeated for the first and second decades of the study. Award winners were further analyzed by type of award (clinical excellence, nonclinical excellence, teaching, or research) and selection group (medical students, residents, or faculty members).

RESULTS

A total of 5030 of 13 760 resident person-years (36.6%) and 455 of 1447 award winners (31.4%) were female. Overall, female residents were significantly less likely to receive an award compared with male residents (odds ratio [OR], 0.44; 95% CI, 0.37-0.54; P < .001). During the first decade of the study, female residents were 70.8% less likely to receive an award compared with male residents (OR, 0.29; 95% CI, 0.19-0.45; P < .001); this improved to 49.9% less likely in the second decade (OR, 0.50; 95% CI, 0.42-0.61; P < .001). Female residents were less likely to receive an award for teaching (OR, 0.33; 95% CI, 0.26-0.42; P < .001), clinical excellence (OR, 0.44; 95% CI, 0.31-0.61; P < .001), or nonclinical excellence (OR, 0.69; 95% CI, 0.48-0.98; P = .04). No statistical difference was observed for research award winners (OR, 0.76; 95% CI, 0.42-1.12; P = .17). The largest discrepancies were observed when award recipients were chosen by residents (OR, 0.23; 95% CI, 0.14-0.39; P < .001) and students (OR, 0.32; 95% CI, 0.25-0.42; P < .001) compared with faculty members (OR, 0.52; 95% CI, 0.42-0.66; P < .001).

CONCLUSIONS AND RELEVANCE

This study found that female residents were significantly underrepresented as award recipients. These findings suggest the presence of ongoing implicit bias in surgery departments and training programs.

A Call to Action: Black/African American Women Surgeon Scientists, Where are They?

OBJECTIVE

To determine the representation of Black/AA women surgeons in academic medicine among U.S. medical school faculty and to assess the number of NIH grants awarded to Black/AA women surgeon-scientists over the past 2 decades.

SUMMARY OF BACKGROUND DATA

Despite increasing ethnic/racial and sex diversity in U.S. medical schools and residencies, Black/AA women have historically been underrepresented in academic surgery.

METHODS

A retrospective review of the Association of American Medical Colleges 2017 Faculty Roster was performed and the number of grants awarded to surgeons from the NIH (1998-2017) was obtained. Data from the Association of American Medical Colleges included the total number of medical school surgery faculty, academic rank, tenure status, and department Chair roles. Descriptive statistics were performed.

RESULTS

Of the 15,671 U.S. medical school surgical faculty, 123 (0.79%) were Black/AA women surgeons with only 11 (0.54%) being tenured faculty. When stratified by academic rank, 15 (12%) Black/AA women surgeons were instructors, 73 (59%) were assistant professors, 19 (15%) were associate professors, and 10 (8%) were full professors of surgery. Of the 372 U.S. department Chairs of surgery, none were Black/AA women. Of the 9139 NIH grants awarded to academic surgeons from 1998 and 2017, 31 (0.34%) grants were awarded to fewer than 12 Black/AA women surgeons.

CONCLUSION

A significant disparity in the number of Black/AA women in academic surgery exists with few attaining promotion to the rank of professor with tenure and none ascending to the role of department Chair of surgery. Identifying and removing structural barriers to promotion, NIH grant funding, and academic advancement of Black/AA women as leaders and surgeon-scientists is needed.

Race, ethnicity, and gender in academic obstetrics and gynecology: 12-year trends

BACKGROUND

Diversity among healthcare teams enhances team function and improves the quality of patient care and outcomes. Women and racial minorities are historically underrepresented in medicine. However, the representation of gender and racial or ethnic groups in academic obstetrics and gynecology in the United States has not been described in recent years.

OBJECTIVE

This study aimed to describe the recent state and trends in gender and racial or ethnic disparities in academic obstetrics and gynecology.

STUDY DESIGN

Data from the Association of American Medical Colleges between 2007 and 2018 were analyzed to describe the trends in the representation of women and racial (white, Asian, black) or ethnic (Hispanic) groups. The 12-year trends in representation by academic ranks (all academic physicians, full professor, associate professor, instructor), leadership positions (chairperson), and tenure (not on track for tenure, on track for tenure, or tenured) were depicted. The 12-year trends were assessed using linear regression to determine whether the slope depicting the change in representation of each group from 2007 to 2018 was significantly nonzero. In addition, average representation of each group across the 12-year period was compared using a Student t test (for gender) or analysis of variance (for race and ethnicity).

RESULTS

In 2018, there were 152 institutions and 6302 academic physicians included in the data set. On average across the 12-year period, academic physicians in obstetrics and gynecology were 43% male, 57% female, 68% white, 12% Asian, 8% black, and 5% Hispanic. Across the 12-year period, there was an increase in the total number of physicians from 4755 to 6302 (+166 per year; 95% confidence interval, 146-186; P<.0001), a 15% increase in the proportion of women (+1.38% per year; 95% confidence interval, 1.08%-1.68%; P<.0001), and an increase in the proportion of physicians from racial minorities (Asian, +0.11% per year; 95% confidence interval, 0.08-0.15; P<.0001; black, +0.07% per year; 95% confidence interval, 0.04-0.09; P=.0002; Hispanic, +0.06% per year; 95% confidence interval, 0.02-0.1; P=.0039). There was a greater proportion of white physicians in higher academic ranks (eg, full professor), leadership positions (eg, chairperson), and tenure than the proportion of white physicians overall, whereas the opposite was true for black and Hispanic physicians. Although women now make up 64% of all academic physicians in obstetrics and gynecology, there remains a far higher proportion of males in leadership positions (chairperson) and higher academic ranks (full professor). Similarly, a greater proportion of males were tenured than females.

CONCLUSION

Across the 12-year period, the representation of women and racial minorities has increased in academic obstetrics and gynecology in the United States. There is now a predominance of women, but there remains a trend for a predominance of white and male physicians in higher academic ranks, leadership positions, and tenure. It will be important to assess how these groups are represented in the coming years as the changing demographics of incoming cohorts progress through their careers to more senior positions. Promoting diversity in medical schools, leadership positions, and higher academic ranks may be an important area of focus.

Gender inequality in leadership and academic rank in academic reproductive endocrinology programs

PURPOSE

To identify gender differences in leadership and academic rank within academic reproductive endocrinology (REI) programs with fellowships in the USA.

METHODS

Official institutional websites of the 2017-2018 American Board of Obstetrics and Gynecology (ABOG)-accredited reproductive endocrinology fellowship programs were reviewed, and gender representation at each leadership position and academic rank (Division and Fellowship Director and Full, Associate, and Assistant Professor) was recorded. Univariate comparisons were performed using Chi-square tests, with significance at p < 0.05.

RESULTS

Among 49 ABOG-accredited reproductive endocrinology programs, 263 faculty were identified, 129 (49.0%) male and 134 (51.0%) female. Division directors were 69.3% male and 30.7% female (p = 0.006). Similarly, fellowship directors were 65.3% male and 34.6% female (p = 0.03). Full professors (n = 101) were more frequently male (70.3% vs. 29.7%, p < 0.001). There was no difference in gender among associate professors (n = 60, 51.7% male vs. 48.3% female, p = 0.79), while significantly more assistant professors were female than male (n = 102, 73.6% vs. 26.4%, p < 0.001).

CONCLUSION

While a majority of residents in obstetrics and gynecology and half of reproductive endocrinology academic faculty are female, women are still underrepresented among leadership positions and full professors in academic reproductive endocrinology programs with fellowship programs.

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

BACKGROUND

Gender inequities are documented in academic medicine. Within General Internal Medicine (GIM), there are fewer female division directors and first and last authors on publications. With gender parity in US medical school graduates and with Academic Hospital (AH) medicine being a relatively newer discipline, one might postulate that AH would have less gender inequity.

DESIGN

A national survey of AH programs was developed via literature review and expert recommendations. Domains included program and faculty information. Gender of the leader was determined via website or telephone call.

PARTICIPANTS

Leaders of AH programs associated with the American Association of Medical Colleges (AAMC). Programs without a primary teaching hospital or hospitalist program and those not staffed by university-affiliated physicians were excluded.

MAIN MEASURES

Description and characteristics of leaders and programs including a multivariable analysis of gender of hospitalist leaders and the portion of female faculty.

KEY RESULTS

59% response rate (80 of 135); there were no differences between responders/non-responders in NIH funding (p = 0.12), type of institution (p = 0.09), geographic region (p = 0.15), or year established (p = 0.86). Reported number of female and male faculty were approximately equal. 80% of hospitalist leaders were male; 37% of male hospitalist leaders were professors, no female leaders were professors. In univariate and multivariate analysis only the number of hospitals staffed was a significant predictor of having a female hospitalist leader. There were no significant predictors of having fewer female faculty.

CONCLUSION

This study demonstrated gender inequality in academic hospital medicine regarding leadership and rank. Though there was equal gender distribution of faculty, among leaders most were men and all "full professors" were men. As diversity benefits the tripartite mission research on methods, initiatives and programs that achieve gender equity in leadership are needed.

Promotion of Women Physicians in Academic Medicine

Women currently represent nearly half of all medical school graduates and assistant professors at academic institutions. Despite the large pool of women in the academic medicine pipeline, relatively few ascend to top leadership positions and women remain grossly underrepresented among full professors, permanent department chairs, and highest-level deans/interim deans. Considerable evidence suggests that the gender imbalance observed at the top tiers of academic medicine is, in part, due to gender differences in promotional rates, with women being promoted more slowly than their male colleagues. The well-documented gender gaps in publications, grant support, recognition awards, speaker invitations, and leadership positions contribute to the slow progression of women in medicine, as promotions committees rely heavily upon these traditional measures of academic success to select candidates for career advancement. Additionally, implicit biases, which have been shown to favor men over women in science and leadership, influence decision-making processes relevant to the promotion of women in academia. With the large number of highly qualified women entering medicine, it is imperative that organizations, academic institutions, and leaders in the medical community address the systemic inequities that are preventing half the workforce from reaching its full potential.

Gender Can Influence Student Experiences in MD-PhD Training

Background: Female physician-scientists have led major advances in medicine broadly and particularly in women's health. Women remain underrepresented in dual MD-PhD degree programs that train many physician-scientists despite gender parity among medical and biomedical research students. Materials and Methods: To explore how the training environment might be experienced differently for male and female students in one MD-PhD program, the authors analyzed gender differences in annual symposium speakers with exact binomial tests, student participation as question-askers at a weekly seminar with logistic regression, and number of publications with quasi-Poisson generalized linear models. They compared male and female students' perceptions of gender-based discrimination using a survey, including qualitative analysis of free text responses. The program consisted of 71 total students in the 2017-2018 and 2018-2019 academic years. Female students comprised 42.0% (81/191) of program matriculants from 1997 to 2019. Results: Male and female students were equally likely to present at the annual program symposium, but faculty (p = 0.001) and keynote (p = 0.012) presenters were more likely to be male. Compared with male counterparts, female students asked fewer seminar questions (p < 0.005) and female speakers received more questions (p = 0.03). Female students perceived less support and differed from men in reasons for asking or not asking seminar questions. Free text responses described repeated small acts of discrimination toward women with cumulative impact. Positive program changes followed presentation of findings to program leaders and students. Conclusions: The authors identified several aspects of one MD-PhD program that could discourage career or training persistence of female students. Increasing awareness of these issues was temporally related to positive programmatic changes.

Common Types of Gender-Based Microaggressions in Medicine

PURPOSE

Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions.

METHOD

The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional "control" versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016 to 2018.

RESULTS

A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve range: 0.60-0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants' age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy- and child care-related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized.

CONCLUSIONS

Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.

The proportion of male and female editors in women's health journals: A critical analysis and review of the sex gap. Int J Womens Dermatol 2020;6:7-12. [PMID: 32025554 PMCID: PMC6997826 DOI: 10.1016/j.ijwd.2019.11.005]

BACKGROUND

Historically, women have been underrepresented in leadership positions in medicine. The reasons for this are multifactorial. In recent years, women's representation in medicine has improved. However, inequities in the proportion of men and women in medical leadership remain, especially with regard to editorial journal boards.

OBJECTIVE

This study aimed to explore current trends of women in leadership positions on journal editorial boards.

METHODS

A comprehensive search for women's health journals was performed in collaboration with university librarians in February 2019 using EMBASE, Scopus, SciFinder, and MEDLINE records for journals with relevance to women's health. Each journal was e-mailed to verify the accuracy of the journal editorial boards listed on their respective webpages. Five categories, as well as the totals for each journal, were analyzed for the proportion of women versus men: editor-in-chief, associate editor, deputy editor, and section editor, and other.

RESULTS

Women comprised the minority of positions on women's health editorial boards. Of the total 1440 board members included, 602 members (42%) were women and 838 members (58%) were men. Women occupied 54 of 132 editor-in-chief positions (41%), 257 of 596 associate editor positions (43%), 13 of 42 deputy editor positions (30%), 46 of 120 section editor positions (38%), and 232 of 549 other editor positions (42%).

CONCLUSION

Although the sex gap in leadership in medicine is improving, it is still present. Our findings suggest that women are underrepresented as editors at most levels in women's health journals centered on topics such as reproductive health, obstetrics and gynecology, perinatology, gynecological oncology, and breastfeeding. With sponsorship/mentorship for women, flexible scheduling, and considerate thought in leadership appointment, this sex gap will continue to improve.

Gender and academic promotion of Canadian general surgeons: a cross-sectional study

BACKGROUND

Gender disparities in faculty rank have yet to be studied among Canadian physicians. The purpose of this study was to determine whether differences in region, training, research productivity and years in practice explain gender differences in academic promotion among Canadian general surgeons.

METHODS

We developed a cross-sectional database of faculty-appointed general surgeons practising in the hospitals affiliated with the 17 universities within the Association of Faculties of Medicine of Canada in 2017 using publicly available directories, university and hospital websites, and direct communication. The data were collected between October and December 2018 and included gender, residency completion year, graduate education, fellowships, number of publications and Scopus h-index; faculty lists and professorship status were verified by program administrators or division heads of their respective divisions. The dependent variable was binary: full professor or not. A combined outcome of associate or full professor was also analyzed. We analyzed all variables in a multivariable logistic regression model.

RESULTS

Of the 17 institutions contacted, all but 1 confirmed the faculty lists and professorship status. A total of 405 surgeons were included, of whom 111 (27.4%) were women. Sixty-eight women (61.3%) and 120 men (40.8%) were assistant professors, and 9 women (8.1%) and 75 men (25.5%) were full professors. Although on average women had completed residency more recently than men (15.2 yr v. 19.2 yr, p < 0.001), there was no difference between men and women in the mean number of publications as residents (2.98 v. 2.74, p = 0.7) or per year of practice (3.12 v. 2.09, p = 0.2), number of fellowships pursued (p = 0.7) or graduate education (p = 0.2). In the multivariable model (C-statistic = 0.88), gender remained significantly associated with full professorship (odds ratio 2.79, 95% confidence interval 1.13 to 6.92), along with years in practice (odds ratio 1.61, 95% confidence interval 1.13 to 2.30).

INTERPRETATION

After controlling for years in practice, training and research productivity measures, we found that female surgeons with faculty appointments in Canada were less likely than their male counterparts to receive promotion to full professor. Pervasive inequities in systems of promotion must be addressed.

Editorial (Spring) Board? Gender Composition in High-impact General Surgery Journals Over 20 Years

OBJECTIVE

To quantify gender composition of 10 high-impact general surgery journals, delineate how board composition has changed over time, and evaluate qualification metrics by gender.

BACKGROUND

Underrepresentation of women on editorial boards may contribute to the gender-based achievement gap in surgery.

METHODS

We performed a cross-sectional analysis of the editorial board gender composition among 10 high-impact general surgery journals in 1997, 2007, and 2017. Univariate and multivariate regression analyses were used to assess differences in editors' H-indices, academic rank, and number of advanced degrees. Differences in editor turnover and multiple board positions were evaluated for each time interval.

RESULTS

Over 20 years, the proportion of women on editorial boards increased from 5% to 19%. After controlling for time since board certification, no differences between men and women's number of advanced degrees, H-indices, or academic rank remained significant. Women and men were equally likely to hold multiple board positions (1997 P = 0.74; 2007 P = 0.42; 2017 P = 0.69), but men's editorial board tenure was longer across each time interval (1997-2007 P = 0.003; 2007-2017 P < 0.001; 1997-2017 P = 0.01).

CONCLUSIONS

Women surgeons have a small but growing presence on surgical editorial boards, and gender-based qualification differences are likely attributable to practice length. Men's longer tenure on editorial boards may drive some of the observed disparity by limiting new appointment opportunities. Strategies such as imposing term limits or instituting merit-based performance reviews may help editorial boards capture the field's changing demographics.

Burnout and attrition: Expanding the gender gap in neurology?

Neurology faces an increasing shortage of neurologists in the United States due to a growing demand for neurologic services. A 7% increase in the supply of neurologists is predicted from 2012 to 2025, whereas the demand will rise by 16%. An increase in the neurology workforce is critical to meet the demands, and a significant gender gap remains within the workforce that must be addressed to further ease the discrepancy between supply and demand. Individual, institutional, and societal factors contribute to this gender discrepancy and potentially result in the burnout or soft attrition of women from neurology. These factors, including earning disparity between male and female neurologists, one of the largest gaps in pay for any medical specialty, and the lack of representation at higher academic levels with only 12% (14 of 113) of neurology department chairs at academic medical centers being women, could lead to increased attrition of women from neurology. Identifying and mitigating these factors may help narrow the gender gap and increase the supply of neurologists to better meet future demand.