Women Physicians and Promotion in Academic Medicine

The medical student's case for TikTok

With the future of TikTok's fate remaining uncertain in the United States, two US medical students, one of whom is a content generator with over 68,000 followers, reflect on the impact of this social media app for medical trainees. In particular, they discuss the benefits on student wellbeing and the how the impact has helped those from disadvantaged backgrounds pursue a career in medicine.

Association Between Specialty-Specific Physician Salaries and Percentage of Women in the Workforce

PURPOSE

Several studies have demonstrated that female physicians within specific specialties are compensated less than their male counterparts. Academic institutions seek to address this using Association of American Medical Colleges (AAMC) data for benchmarking and starting salary standardization. However, few studies address whether there is an association between percentage of women across specialties and mean salary for each specialty. The purpose of this study was to examine whether there is an association between mean salary and percentage of women in various specialties.

METHOD

This cross-sectional study used AAMC Faculty Salary Report data for fiscal year 2022. Surveys were sent to 155 U.S. accredited medical schools, of which 153 schools participated (99% response rate). Univariable and multivariable analyses were performed to assess the association between mean specialty salary, calculated as the weighted mean of male and female salaries for each specialty, and the percentage of women in each specialty using a generalized linear gamma mixed model.

RESULTS

Analysis using data from 124,480 full-time faculty at 153 accredited U.S. medical schools indicated that as the percentage of women in a specialty increases, mean salary decreases. This finding was true for all specialties ( r = -0.65), medical specialties ( r = -0.83), pediatric specialties ( r = -0.80), and surgical specialties ( r = -0.73). Multivariable analysis accounting for rank, pediatric vs nonpediatric specialties, procedural vs nonprocedural vs mixed specialties, and years of training showed that every 10% increase in percentage of women in a specialty was associated with a 7% decrease in salary independent of other factors.

CONCLUSIONS

An inverse correlation between percentage of women in a specialty and mean salary for that specialty was observed even when controlling for confounding factors. This trend is worth noting because AAMC data are often used as a benchmark to establish physician starting salaries.

Female Representation Among Head and Neck Surgical Oncology Publications

BACKGROUND

There is lower female representation within academic medicine. We aimed to investigate female authorship (FA) and female-held chair or program director (PD) positions within head and neck oncology (HNO).

METHODS

Articles authored by females about microvascular and reconstructive surgery (MRS) and transoral robotic surgery (TORS) were identified. A sub-analysis was performed by investigating the gender of HNO fellows, PDs, and chairpersons. These were collected, and FA reported.

RESULTS

There were 1227 publications, 656 on MRS and 567 on TORS. Females authored 299 (24%) publications, 139 (23%) about MRS and 160 (30%) about TORS. There was no significant increase in FA or fellowship trends over time (p > 0.05). In our sub-analysis, we identified four HNO chairwomen (3%), and eight (6%) female HNO PDs. HNO chairwomen authored an average of 97 publications, PDs authored 37.

CONCLUSION

FA in MRS and TORS remained stable between 2001 and 2022. Although few HNO females hold program chair or PD positions they perform quality research and serve as senior authors on a large proportion of publications.

Gender-Based Disparities in Academic Orthopaedic Surgery Physician Compensation in 2023

BACKGROUND

Orthopaedic surgery remains one of the least diverse specialties in medicine. Parity in opportunity and recognition are key factors in attracting and retaining a diverse group of individuals in the field. The primary purpose of this study was to assess gender-based discrepancies in total salary compensation by rank for academic orthopaedic surgery faculty.

METHODS

Aggregate data were obtained from the Association of American Medical Colleges for fiscal year 2023. Mean compensation was compared for orthopaedic surgery faculty and total surgery faculty at all academic ranks based on gender and race.

RESULTS

Men received markedly higher total compensation for all ranks except chair within orthopaedic surgery. At the instructor level, men earned an average annual income of $554,245 while women received $229,204, demonstrating a significant pay gap ( P = 0.0019). At the assistant professor (men: $628,346; women: $475,857), associate professor (men: $732,381; women: $575,877), and professor (men: $743,822; women: $472,140) levels, there existed significant pay disparities ( P < 0.0001 for all three academic levels, respectively). At the chief position, men earned an average of $1,185,873 annually while women received $596,270 ( P = 0.0006). Aggregate data for other surgical specialties demonstrated similar results, with women receiving lower total compensation at all ranks compared with men.

CONCLUSION

This analysis of the 2023 American Medical Colleges Faculty Salary Report demonstrates a notable pay differential between men and women in orthopaedic surgery and surgical specialties, in general, across multiple academic levels including instructor, assistant professor, associate professor, professor, and chief of division. Although there has been increasing awareness of gender-based compensation disparities within surgical specialties, particularly in orthopaedic surgery, these disparities are still clearly present.

Gender and racial diversity in leadership roles within academic surgery internationally: a retrospective cross-sectional study pre-COVID-19

OBJECTIVE

Journal editorial and society executive boards have widespread impacts, however, the associated leadership diversity remains underexplored. Our study evaluated such diversity across four surgical specialties before the influences of COVID-19.

METHODS

This retrospective, cross-sectional study obtained perceived gender and race of identified leaders from publicly available websites. Leadership of the top three journals and journal-affiliated societies based on the 2021 Journal Citation Reports journal impact factor was evaluated for subspecialties within neurosurgery, orthopaedic, general, and plastic surgery.

RESULTS

Leadership diversity within 58 journals and 55 societies were reviewed. Orthopedics had a significantly lower proportion of females (p ​< ​0.05) and intersectional minorities (p ​< ​0.05). Higher journal impact factor and a greater proportion of intersectional minorities were significantly related (p ​= ​0.0009).

CONCLUSION

We assessed leadership diversity amongst both journal editorial and society executive boards and identified differences with respect to proportions of females, minorities and intersectional minorities across specialties.

Asian American Female Residents' Perceptions of Facilitators and Barriers to Leadership in Medicine

Importance

When their proportion of faculty positions are accounted for, Asian American women are the most underrepresented group among academic medicine leadership. Despite the importance of diversity and representation in academic medicine leadership, no study to date has explored the specific factors that hinder or support Asian American women's advancement to leadership roles in academic medicine.

Objective

To characterize perceptions of facilitators and barriers to academic medicine leadership for Asian American women.

Design, Setting, and Participants

In this qualitative study, Asian American female residents were interviewed between December 1, 2023, and April 30, 2024, using an online video platform. Data were analyzed using thematic content analysis. Eligible participants were recruited through word of mouth, social media groups, cold emailing, and snowball sampling. A purposive sampling strategy ensured diversity in ethnicity, geographic locations of past and current institutions, postgraduate years, and specialties.

Main Outcomes and Measures

Key themes related to the perceptions of Asian American female residents on facilitators and barriers to leadership in academic medicine.

Results

Fifteen participants (age range, 25-32 years) who self-identified as female and Asian American (3 [20%] Asian Indian, 6 [40%] Chinese, 2 [13%] Korean, 1 [7%] Punjabi, 1 [7%] Taiwanese, and 2 [13%] Vietnamese) were interviewed. Participants were enrolled in residency programs geographically distributed across the US. Training levels ranged from postgraduate year 1 to postgraduate year 6, spanning 9 residency program specialties. This analysis revealed 4 key themes: (1) role models of leadership, especially the representation of Asian American women in leadership positions; (2) multifactorial development of professional identity, specifically through peers, mentors, and formalized institutional programming; (3) the othering nature of workplaces and institutional cultures, including the exclusionary "boys' club," discrimination from patients and colleagues, and burden of familial responsibilities imposed on women; and (4) leadership discordance, including differing ideas of leadership and sociocultural perceptions of Asian American women influencing perceptions of leadership potential.

Conclusions and Relevance

This qualitative study of Asian American female resident physicians' perceptions of facilitators and barriers to academic medicine leadership found 4 key themes and identified opportunities for intervention, paving the way for enhanced representation of Asian American women in academic medicine leadership.

Balancing High Clinical Volumes and Non-RVU Generating Activities in Radiology, Part ll: Future Directions

The Radiology Research Alliance (RRA) of the Association of Academic Radiology (AAR) creates task forces to study emerging trends shaping the future of radiology. This article highlights the findings of the AAR-RRA Task Force on Balancing High Clinical Volumes and non-relative value unit (Non-RVU)-Generating Activities. The Task Force's mission was to evaluate and emphasize the value of non-RVU-generating activities that academic radiologists perform. The work of this Task Force is presented in two separate manuscripts: Part I outlines the current landscape, while this manuscript, Part II, explores future directions for academic radiology departments seeking a better balance between high clinical workloads and non-RVU-generating opportunities for their faculty.

Differences in primary total shoulder arthroplasty volume, reimbursement, practice styles, and patient populations based on surgeon gender: a temporal analysis

BACKGROUND

Orthopedic surgery has previously been shown to have a shortage of female physicians and a gender pay gap. However, this has not been thoroughly evaluated in the setting of shoulder surgery. The primary purpose of this study was to evaluate differences in total shoulder arthroplasty (TSA) volume, reimbursement, surgeon billing practices, and patient populations between male and female surgeons from 2013 to 2021.

METHODS

The Medicare Physician and Other Practitioners database, a publicly available dataset that includes 100% of services billed to Medicare Part B, was utilized. The database was queried for all billing episodes of Current Procedural Terminology code 23472, which encompasses both anatomic and reverse primary TSA. Procedural volume, average inflation-adjusted reimbursement per TSA, physician billing information, and the patient demographics of each surgeon who performed TSAs were collected. Welch's t-test and Kruskal-Wallis were utilized to compare male and female surgeons each year between 2013 and 2021.

RESULTS

Between 2013 and 2021, the proportion of TSAs performed by female surgeons nationally increased from 1.8% to 2.9% (+1.1%). This increase was greatest in the Northeast (2.0%-6.1%), while a decrease was seen in the Midwest (1.9%-1.6%). In 2021, there was no significant difference between male and female surgeons in the average inflation-adjusted reimbursement per TSA ($1144.00 vs. $1143.00, P = .792) and the average number of TSAs performed per surgeon (26.6 vs. 23.1, P = .105). Female TSA surgeons, on average, had less Medicare beneficiaries (348 vs. 462, P < .001), performed fewer annual services (1817 vs. 3630, P < .001), and performed fewer unique services (60 vs. 76, P < .001) compared to male surgeons. A higher proportion of female surgeon's patient populations were non-White (24% vs. 22%, P = .028), female (61% vs. 59%, P = .001), and dual enrolled Medicare-Medicaid patients (13% vs. 10%, P < .001). However, there was no difference in the average patient complexity between male and female TSA surgeons based on hierarchical condition category score (1.0783 vs. 1.0732, P = .228).

CONCLUSION

Female representation within TSA surgery is increasing nationally, with the greatest representation in the Northeast and West and the lowest representation in the South and Midwest. Although female TSA surgeons perform a similar number of TSAs, receive comparable reimbursement per TSA, and have a similarly complex patient population as their male counterparts, they perform significantly fewer total and unique billable services annually. Additionally, female TSA surgeons tend to see more non-White, women, and dual Medicare-Medicaid enrolled patients.

Mortality Among US Physicians and Other Health Care Workers

Importance

National estimates of mortality among physicians and other health care workers are lacking. It is also unknown if distinct patterns exist across sex, race, and ethnicity.

Objective

To compare all-cause and cause-specific mortality rates among physicians, health care workers, and non-health care workers by sex, race, and ethnicity.

Design, Setting, and Participants

The National Vital Statistics System, a population-based registry of US death certificates, was used to obtain data on deaths among adults aged 25 to 74 years from January 2020 to December 2022 by usual occupation. Data were analyzed from January 2024 to December 2024.

Exposures

Usual occupation, sex, race, and ethnicity.

Main Outcomes and Measures

Overall and cause-specific mortality rates were calculated for each occupation, as well as sex, race, and ethnicity subgroups, and compared using mortality rate ratios. Mortality estimates were age-adjusted and sex-adjusted, and health care occupations were compared with non-health care occupations with similar income levels (categorized as low income, medium income, and high income based on US Census income terciles).

Results

Most health care workers had lower age-adjusted and sex-adjusted annual mortality rates per 100 000 population than non-health care workers (eg, physicians [269.3], high-income non-health care workers [499.2], and non-health care workers overall [730.6]). While female individuals had lower mortality than male individuals in non-health care occupations overall (female to male ratio, 0.55; 95% CI, 0.55-0.55) and high-income non-health care occupations specifically (0.60; 95% CI, 0.60-0.60), this advantage was absent for several health care occupations, including physicians (0.97; 95% CI, 0.93-1.01). In particular, female physicians experienced higher mortality than male physicians of neoplasms and chronic lower respiratory diseases, despite lower mortality of these causes among female individuals in high-income non-health care occupations. Black workers had higher mortality than White workers across all occupations, although the Black to White mortality ratio was largest for physicians (2.13; 95% CI, 1.99-2.29), with the largest differences due to neoplasms, heart disease, and COVID-19. Black female physicians had higher mortality rates than all other physician subgroups and White female individuals in non-health care occupations. While Hispanic workers had lower mortality than White workers in non-health care occupations overall (Hispanic to White ratio, 0.83; 95% CI, 0.83-0.83) and high-income non-health care occupations specifically (0.90; 95% CI, 0.90-0.91), this pattern was reversed for several health care occupations, including physicians (1.18; 95% CI, 1.09-1.27).

Conclusions and Relevance

The results of this cross-sectional study suggest that although physicians and most health care workers experienced lower mortality rates compared with the general population, this benefit did not fully extend to female individuals or racial and ethnic minority groups. Renewed efforts are needed to address health inequities within the health care workforce.

Patients Use Different Words to Describe Satisfaction with Female versus Male Primary Care Physician Visits

OBJECTIVES

Female physicians' reputations are more vulnerable, salaries are lower, and rates of burnout are higher compared with their male counterparts. Patient satisfaction metrics can affect reputation, reimbursement, incentives, and burnout. We hypothesized that patients may have gender-based expectations of primary care physicians (PCPs) that could differentially affect patient satisfaction for female PCPs. Because patient satisfaction surveys generate physician-specific data, we analyzed free-text patient satisfaction survey comments about outpatient visits with female and male PCPs.

METHODS

We conducted a retrospective cross-sectional analysis of publicly available Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group survey responses from 2015 to 2019 attributed to 456 PCPs affiliated with one large healthcare system. Natural language processing identified frequencies of word use after stratification by "rate provider" scores and physician sex. We calculated overall and relative rates of word use between groups using Wald tests.

RESULTS

Free-text responses were contained in 112,076 surveys. The mean "rate provider" score was high (9.6/10) and did not differ by physician sex. Among the 92.8% highly rated visits, words used more often for female PCPs included time, caring, feel, concerns, and like and for male PCPs, the words included care, good, excellent, staff, and office.

CONCLUSIONS

When comparing high-rated PCP visits, patients used different words to describe satisfaction with their female versus male PCP visits, which may suggest that patients hold stereotyped gender expectations for PCPs. We propose that female PCP responses to stereotyped expectations-to achieve "top box" patient satisfaction scores, which affect compensation, reputation, and job satisfaction-may provide a perspective on sex-based differences in physician pay and burnout.

Gender and Pathways to Leadership in Academic Anesthesiology: A Qualitative Content Analysis of US Chairpersons' Curricula Vitae

BACKGROUND

Women are underrepresented in medicine and academic anesthesiology, and especially in leadership positions. We sought to characterize career achievement milestones of female versus male academic anesthesiology chairs to understand possible gender-related differences in pathways to leadership.

METHODS

We conducted a retrospective observational cross-sectional analysis. In November 2019, curricula vitae (CVs) were requested from then-current members of the US Association of Academic Anesthesiology Chairs. Data reflecting accomplishments up to the time of chair appointment were systematically extracted from CVs and analyzed using a mixed methods approach with qualitative content analysis supplemented by descriptive statistics and bivariate statistical testing. Missing data were not imputed.

RESULTS

Seventy-two CVs were received from eligible individuals (response rate 67.3%). The respondent sample was 12.5% women (n = 9), 87.5% men (n = 63), and no transgender or nonbinary people; this is similar to the known gender balance in anesthesiology chairs in the United States. No statistically significant differences in objective markers of academic achievement at the time of chair appointment were evident for female versus male chairs, including time elapsed between the first faculty appointment and assumption of the chair role (median 25 vs 18 years, P = .06), number of publications at the time the chair was assumed (101 vs 69, P = .28), or proportion who had ever held a National Institutes of Health (NIH) grant as principal investigator (44.4% vs 25.4%, 0.25). Four phenotypes of career paths were discernible in the data: the clinician-administrator, the educator, the investigator, and the well-rounded scholar; these did not differ by gender.

CONCLUSIONS

Female chairpersons who were members of the Association of Academic Anesthesiology Chairs in the United States demonstrated similar patterns of academic achievement as compared to male chairpersons at the time the position of chair was assumed, suggesting that they were equally qualified for the role as compared to men. Four patterns of career achievements were evident in the chairperson group, suggesting multiple viable pathways to this leadership position.

Neurointervention-from entry to expertise: Examining gender bias across different training access routes in Europe

Background/purposeGender bias in academic medicine has been widely described. In Europe, training and career pathways in neurointervention (NI) are heterogeneous. We hypothesize that the access route to neuroradiology specialty and NI subspecialty may correlate with the proportion of women in the field and with their career progression.MethodsAn online survey consisting of 18 questions was distributed through European professional societies and several online social platforms. A total of 422 responses from 54 different countries were collected and statistically evaluated.ResultsAccess routes to specialty and subspecialty did not correlate with the number of women practicing NI. However, men were significantly more likely to have children, to occupy leading positions, to have more clinical experience and higher weekly workload both in diagnostic and interventional neuroradiology. Female gender significantly affected career progression.ConclusionThis study reflects a positive change in European reality concerning gender bias. Distinct training access routes do not seem to affect the proportion of female neurointerventionalists. However, gender differences still negatively impact women NI careers, leading to lower workload, having less children, and a limited access to leading positions in NI.

Gender Differences in Salary Compensation for Academic Hand Surgery Faculty at US Medical Schools

PURPOSE

This study investigated gender differences in salary compensation for hand surgery faculty at US medical schools.

METHODS

Salary compensation benchmarks were analyzed from 154 US medical schools in the 2023 American Association of Medical Colleges Faculty Salary Survey. Median salaries were extracted for assistant professors, associate professors, and full professors. Net present value (NPV) calculations were used to determine the impact of gender on total salary compensation assuming different academic scenarios including promotion timelines and career longevity.

RESULTS

Compensation data were available for 157 full-time academic hand surgeons, and 34 were women (22%). There were 70 assistant professors (45%), 49 associate professors (31%), and 38 full professors (24%). Most faculty were men across academic ranks (range, 70% to 88%). Gender differences in annual salary compensation were greatest at the assistant professor level. Women hand surgeons earned less than men hand surgeons at each academic rank including at assistant professor ($432,500, 74% of salaries of men), associate professor ($587,439, 89% of salaries of men), and full professor ($567,230, 82% of salaries of men). Gender differences in annual salary translated to a NPV difference of $2.0 to $2.6 million in lifetime salary compensation.

CONCLUSIONS

Gender differences in salary exist across academic ranks for hand surgery faculty at US medical schools. These differences are highest among assistant professors. More investigation is needed to determine reasons for these differences and create strategies that promote gender equity in academic hand surgery.

CLINICAL RELEVANCE

Promoting gender diversity, inclusion, and equity is a strategic imperative held by multiple professional societies in academic surgery. Understanding reasons for gender differences in salary compensation may lead to strategies that promote gender equity in hand surgery.

Lurking in the shadows: time as an actor in the narratives of pregnancy within graduate medical education

Previous studies suggest that time factors heavily into trainees' decision-making around issues of pregnancy within graduate medical education (GME). Trainees are often dissatisfied with parental leave policies and tension exists as they navigate training interruptions. However, our understanding is limited because prior studies have conceptualized only two main actors involved in this negotiation, program directors (PDs) and trainees. This study aimed to understand the role of a third ever present character that has been overlooked - Time. We recruited 13 pairs of residents/fellows who had been pregnant during GME training and their PDs. We conducted semi-structured interviews on trainee and PD experiences, which were then analyzed utilizing narrative analysis to interrogate how individuals assigned meaning to time. Time loomed in the background of all trainees' and PDs' experiences as they negotiated pregnancy. Depending on context, time was positioned either as an ally, assisting trainees with achieving their personal and professional goals, or as a foil, sabotaging their experience. As an ally, time was positioned as a malleable commodity that was flexed to meet the individual trainee's needs. As a foil, time was an immovable barrier exerting rigid constraints. How time was experienced by the trainee was strongly influenced by the attitudes and actions of the PD. This study positions time as a main actor in trainees' narratives of pregnancy. The role time plays largely reflects the value assigned to conformity with traditional timelines and whether a program has revised their perspectives to position time as a side character.

Trends in Academic Radiology Faculty Promotion in US Medical Schools

BACKGROUND

Faculty promotion is important for retention in academic medicine and has implications for diversity.

PURPOSE

We aimed to assess faculty promotion trends in academic radiology in US medical schools over time and assess variations based on gender and race or ethnicity.

MATERIALS AND METHODS

Using the Association of American Medical Colleges faculty roster, full-time faculty appointed between January 1, 2020, and December 31, 2009 (primary cohort), were followed for 14 years till January 1, 2024. Promotion rates and average time to promotion were compared by faculty track, gender, and race or ethnicity using bivariate analyses. Recent trends in promotions were assessed by comparing 7-year promotion end points between the primary cohort and a secondary cohort appointed between January 1, 2010, and December 31, 2016.

RESULTS

The primary cohort included 2,497 faculty (182 instructors, 1,589 assistant professors, and 726 associate professors) from academic radiology departments, appointed between January 1, 2020, and December 31, 2009. Clinical educator-track faculty had a marginally higher promotion rate (39.6% versus 36.4%, P = .116) but a significantly longer time to promotion (8.25 versus 7.4 years, P < .0001) versus those on traditional track. For clinical educator-track faculty, promotion rates over 14 years tended to be greater for women (42.3%) than men (38.3%, P = .12) across all ranks. The average time to promotion was significantly greater for women (8.9 years) assistant professors compared with men (8.2 years) (mean difference of 0.65 years, P = .013). For the more recent faculty cohort, rates of promotion over a 7-year period were higher (26% versus 15% for assistant professors, P < .001), and average time to promotion was shorter (5.7 versus 6.0 years for assistant professors, P = .002) across all ranks and for both men and women.

CONCLUSION

Over time, promotion rates in US academic radiology departments have gone up and time to promotion has declined. Promotion rates for men and women are similar.

Gender Composition of Invited Speakers and Session Chairs at American Society for Apheresis Annual Meetings Between 2019 and 2024

Disparities persist throughout medicine, including among conference speakership invitations. The National Institutes of Health have highlighted the importance of diversity at academic conferences. We assessed the gender composition of speakers at the American Society for Apheresis (ASFA) annual meeting. We assessed all session chairs and speakers at the annual ASFA meeting from 2019 to 2024. Two authors independently assessed individuals' genders. The primary outcome was the gender composition of all session chairs and speakers by position. Subset analyzes were performed to assess the gender composition of unique individuals (i.e., examining the total number of unique men and women, independent of the number of sessions at which they spoke) and by professional degree. 820 positions (665 speaker positions and 155 chair positions) were identified; women comprised significantly more positions than men [64.3%, 528/820 (95% CI 61.1%-67.6%) vs. 35.6% 292/820 (32.4%-38.9%); p < 0.0001]. 52.7% (432/820) of all session positions were held by physicians, with no significant difference in the gender composition [women 47.5%, 205/432 (42.8%-52.2%) vs. men 52.6%, 227/432 (47.8%-57.2%); p = 0.31]. When limited to unique physician individuals, women were significantly outnumbered by men [40.1%, 71/177 (33.2%-47.5%) vs. 59.9%, 106/177 (52.5%-66.8%); p = 0.01]. This analysis demonstrated mixed findings, with more women across all positions overall but significantly more men when limited to unique physicians. Diversity in conference positions begets a broader array of perspectives, knowledge, and expertise, and can aid in realizing greater diversity in related areas. Thus, academic conference diversity should be prioritized and thoughtfully pursued.

Intent to Leave Associated More Strongly with Workplace Belonging Than Leadership Behaviors of Supervisor in Women Health Care Professionals

Background: The attrition of health care professionals from institutions has historically been high, with reports of higher rates in women than men. High attrition jeopardizes the institution's financial stability, quality of patient care, and scholarly contributions to advancing health care. The disproportionate loss of women reduces the diversity of perspectives and skills needed to meet patient needs. Attrition risk has been demonstrated to relate to both the leadership behaviors of supervisors and the sense of belonging in the workplace. Toward informing health care institutions about strategies for curtailing high attrition, we sought to assess the relative strength of the association of attrition risk with leadership behaviors of supervisors versus workplace belonging. Methods: Attendees of a continuing education course on women's leadership skills in health care were surveyed about the intent to leave (ITL) their institution within 2 years, perceived leadership behaviors of their supervisor, and experiences of workplace belonging. Dimensions of workplace belonging were identified by factor analysis. The strength of association of ITL with supervisor's leadership behaviors and each workplace belonging dimension was analyzed in a multivariable ordinal logistic regression model. Results: Women comprised 94% of survey participants. In the regression analysis, lower ITL was associated strongly with more frequent experiences of institutional culture supporting workplace belonging, modestly with more favorable perceptions of supervisor's leadership behaviors, and not with frequency of experiences of interpersonal relationships supporting workplace belonging. Conclusions: An institutional culture that supports workplace belonging is particularly important for reducing attrition risk in health care professionals. For health care institutions seeking to improve retention of its professionals and women in particular, our findings point to investing in a culture of workplace belonging that involves a diverse workforce, an environment in which its professionals feel heard, supported, and empowered and are provided strong career advancement opportunities.

Gender Inequity in Institutional Leadership Roles in US Academic Medical Centers: A Systematic Scoping Review

Importance

Academic medical centers have focused their efforts on promoting gender equity in recent years, but the positive outcomes associated with those efforts remain to be seen in recruiting and retaining diverse institutional leadership.

Objective

To evaluate the current state of gender inequity in institutional leadership roles, such as deans, department chairs, and residency and fellowship program directors, at US academic medical centers.

Evidence Review

A search for articles published from January 1, 2019, to August 5, 2022, on gender inequity in institutional leadership roles at academic medical centers was performed using the PubMed, CINAHL, and ERIC databases. Studies were screened for inclusion by sets of 2 independent reviewers (with disagreements resolved by a third reviewer) and evaluated for risk of bias. The Methodological Expectations of Cochrane Intervention Reviews Standards were followed for conducting the review, and the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline was followed for reporting results.

Findings

A total of 8120 articles were retrieved, of which 6368 were screened by title and abstract, 6166 were excluded, and 202 underwent full-text review. Ultimately, 94 studies reported on institutional leadership roles, including deans (5 studies [5.3%]), department chairs (39 studies [41.5%]), division chiefs (25 studies [26.6%]), and program directors (67 studies [71.3%]), with some overlap. A total of 678 participants were deans (564 men [80.5%] and 132 women [19.5%]), 8518 were department chairs (7160 men [84.1%] and 1358 women [15.9%]), 3734 division chiefs (2997 men [80.3%] and 737 women [19.7%]), and 9548 program directors (7455 men [78.1%] and 2093 women [21.9%]). Even in specialties with 50% or more female faculty, none had equal representation of women as department chairs and division chiefs. Gender inequities were particularly pronounced in surgical specialties.

Conclusions and Relevance

This systematic scoping review suggests that even though emphasis has been placed on addressing gender inequities in academic medicine, considerable disparities remain at the leadership level. While certain positions and specialties have been observed to have more female leaders, niches of academic medicine almost or completely exclude women from their leadership ranks. Importantly, even female-dominated specialties, such as obstetrics and gynecology, have substantial inequity in leadership roles. It is past time for organizational and systems-level changes to ensure equitable gender representation in academic leadership.

Proposed Framework for Setting Practical and Ethical Boundaries in Medicine

This essay describes a rational and stepwise framework for considering whether to accept requests to take on extra work for physicians, especially women and minoritized physicians.

Students' and educators' perceptions of clinical academic pathways in the UK: a qualitative study

OBJECTIVES

This study aimed to understand the experiences and perceptions of medical students and medical educators regarding barriers and facilitators for pursuing clinical academic pathways.

DESIGN

A qualitative study using semistructured interviews and focus groups was conducted. A reflexive thematic analysis was used for data analysis. Theoretical and snowball sampling approaches were applied for participant recruitment.

SETTING

University of Manchester and NHS Trusts in the Greater Manchester region.

PARTICIPANTS

The sample of this study was composed of 43 participants, including medical and dental students, clinical academics, clinicians and stakeholders.

RESULTS

Three themes were identified: Theme 1: Knowledge of the CA pathway; Theme 2: The costs linked to pursuing a clinical academic pathway; Theme 3: Exposure to and time for research.

CONCLUSIONS

While institutions offer opportunities for research experience, there is a need for extended and more tailored opportunities and information, and the overall cost of training for students reduces the attractiveness of the clinical academic pathway.

Women's Leadership Development at the Yale School of Medicine: Preliminary Evaluation of an Innovative Program

Background

Despite strong data indicating women leaders' proven efficacy as catalysts for organizational change, there is significant attrition for women across the advancement, promotion, and leadership pathways within academic medicine. To help early-career women faculty build a network of support, enhance leadership capacity and agility, and gain the skills necessary for career advancement and fulfillment, we created the Women's Leadership Development Program (WLDP) at our medical school in 2020.

Methods

From 2023 to 2024, we collected retrospective survey data from all interested prior participants to gauge the impact of the WLDP on faculty members' confidence, sense of belonging at Yale School of Medicine, and acquisition of leadership skills.

Results

Findings indicate the WLDP's positive impact on women faculty members' sense of leadership efficacy and skills, with participants reporting enhanced appreciation of their leadership potential, knowing how to lead with their strengths, improved leadership vision, and increased confidence in making an impact in academic medicine going forward.

Conclusion

The importance of leadership development programming for the professional development of early-career women faculty in academic medicine is explored. The article concludes with implications of these findings for our ongoing programming and leadership development initiatives for women in academic medicine more broadly.

Women physicians' experiences in the workplace in Lebanon: a qualitative study

BACKGROUND

Over the past several decades, the number of female physicians entering the medical and healthcare workplace has increased. Despite their skills and qualifications, they face several challenges in their career including gender discrimination, work-life balance, sexual harassment, limited career advancement opportunities, and burnout. The purpose of this study is to assess perceived challenges encountered by women physicians in the workplace and identify coping strategies to overcome these challenges and achieve professional success.

METHODS

A qualitative research design with an inductive approach was used to collect the data from female physicians' experiences at their workplace between July and December 2023 through a semi-structured one-on-one interview with open-ended questions. Purposive and snowball techniques were used to recruit female physicians working in private and/or public Lebanese hospitals. The interviews were conducted in Arabic, recorded, transcribed, and translated into English. Thematic analysis was used to analyze data.

RESULTS

A total of 12 women physicians participated in the interviews. The analysis identified three main themes: (1) personal challenges faced by women in medicine, (2) institutional challenges faced by women in medicine, and (3) Solutions for issues faced by women in medicine.

CONCLUSIONS

Participants highlighted personal challenges such as work-life balance, and burnout, as well as institutional obstacles like gender discrimination, limited career advancement opportunities, and sexual harassment. By uncovering these barriers this research provides a critical foundation for the development of targeted policies and interventions aimed at fostering a more equitable and supportive environment for women in the medical profession.

Optimizing Diversity to Improve Perioperative Team Performance

We consciously and subconsciously judge each other every day using demographic characteristics (such as gender and race/ethnicity), and these social identities shape our lives in profound ways. Demographic diversity impacts perioperative teams yet is poorly understood, and mixed results are reported in other team-based work settings. Drawing from decades of organizational behavior literature, the authors review their model of critical factors related to interplays between diversity, communication, and conflict, existing within a hierarchical environment influenced by power differences. Evidence-based recommendations are provided, aimed at maximizing the benefits of diversity in perioperative teams while minimizing negative consequences.

Mapping the Void: Understanding Diversity, Equity, and Inclusion Training in Medicine

OBJECTIVE

To delineate how identity-based bias exposure evolves with rank and/or context among health care workers, and assess their attitudes toward existing diversity, equity, and inclusion (DEI) education.

BACKGROUND

Although DEI training is widely mandated for health care workers, few studies examine how clinicians' needs evolve across a career, how context impacts recipients' ability to respond, or how well existing programs adapt to individual contexts.

METHODS

A 54-question electronic survey was distributed during Morbidity and Mortality conferences beginning in December 2020. Descriptive statistics were performed regarding respondents' bias exposure across rank, perceptions regarding existing training's fidelity to recipients' lived experience, and ability to confer useful response strategies.

RESULTS

This study included 648 individuals (65.6% White; 50.2% women) practicing in mostly academic medical centers (70.6%). Respondents affirmed that discrimination was common, with half (320, 49.4%) reporting that they experienced bias at least monthly. Among people of color, the proportion reporting monthly exposure decreased with rank. Women of color experienced the biggest drop (74% as residents/fellows down to 11% in late career). Broadly, participants reported the greatest discomfort in addressing subtle bias from patients or high-ranked individuals, and this did not uniformly improve with seniority. Finally, although 478 (73.8%) individuals reported receiving DEI training, 51.3% of respondents reported online DEI modules had little utility. Shortcomings included that training focused on individual rather than structural solutions and that it did not confer response strategies users could reliably employ.

CONCLUSIONS

Identity and context strongly influence both clinicians' exposure and ability to respond to bias in the hospital environment, independent of seniority. Existing DEI training fails to account for this nuance, ultimately diminishing its utility to clinicians.

Physician Gender and Patient Perceptions of Interpersonal and Technical Skills in Online Reviews

Importance

Prior studies have revealed gender differences in workplace assessments of physicians, but little is known about differences by physician gender in patients' online written reviews.

Objective

To analyze whether patients' perceptions of their physicians' interpersonal manner and technical competence differ by physician gender and practicing specialty and are associated with review star ratings.

Design, Setting, and Participants

This cross-sectional study sampled written reviews submitted by patients between October 16, 2015, and May 27, 2020, for physicians across the US from a commercial physician rating and review website. Physicians included primary care physicians (PCPs) listed under family medicine, internal medicine, and pediatrics and surgeons listed under general surgery; orthopedic surgery; and cosmetic, plastic, and reconstructive surgery. Hand-coded reviews were used to fine-tune a natural language processing algorithm to classify all reviews for the presence and valence of patients' comments of physicians' interpersonal manner and technical competence. Statistical analyses were performed from July 2022 to December 2024.

Exposure

Female or male physician gender.

Main Outcomes and Measures

Outcomes included the presence and valence of interpersonal manner and technical competence comments and receipt of high star ratings. Multilevel logistic regressions analyzed differences by female or male physician gender in interpersonal manner and technical competence comments and whether those comments were associated with review star ratings.

Results

The analysis included 345 053 written reviews of 167 150 physicians (mean [SD] age, 55.16 [11.40] years); 60 060 physicians (35.9%) were female, and 36 132 (21.6%) were surgeons. Female physicians overall had higher odds than males of receiving any (odds ratio [OR], 1.19; 95% CI, 1.16-1.22) or negative (OR, 1.22; 95% CI, 1.18-1.26) patient comments for their interpersonal manner. Among PCPs, females had higher odds than males of receiving a negative comment for interpersonal manner (OR, 1.22; 95% CI, 1.18-1.27) and, when receiving that negative comment, had disproportionately lower odds of receiving a high star rating (OR, 0.62; 95% CI, 0.53-0.73). Female physicians overall (OR, 1.09; 95% CI, 1.05-1.13) and female PCPs (OR, 1.08; 95% CI, 1.04-1.13) had higher odds than their male counterparts of receiving a negative comment for their technical competence. When receiving a negative comment for technical competence, both female PCPs (OR, 0.60; 95% CI, 0.50-0.73) and female surgeons (OR, 0.67; 95% CI, 0.50-0.89) had disproportionately lower odds of receiving a high star rating compared with their male counterparts. Female PCPs also had lower odds than male PCPs of receiving a high star rating when receiving a positive comment for technical competence (OR, 0.82; 95% CI, 0.70-0.96).

Conclusions and Relevance

In this cross-sectional study of online written reviews, female and male physician gender were differently associated with patients' perceptions of their physicians' interpersonal manner and technical competence. The findings suggest that patients harbored negative gender biases about the interpersonal manner of female physicians, especially female PCPs, and also assessed disproportionate penalties related to technical competence for both female PCPs and female surgeons.

Trends in Faculty Advancement for Underrepresented groups in Academic Radiology

RATIONALE AND OBJECTIVES

The aim of this study was to analyze demographic data of academic radiology faculty to assess rank equity by gender and race/ethnicity and trends from 2000 to 2023.

METHODS

Data was collected from the AAMC Faculty Salary Roster, which collects information for self-reported gender and race/ethnicity for faculty at different ranks in U.S. medical schools. To determine parity between faculty ranks across gender and race/ethnicity, rank equity index (REI) was calculated for associate/assistant, professor/associate, and professor/assistant professor comparisons.

RESULTS

The percentage of women faculty increased from 23.6% in 2000 to 30% in 2023. REI increased steadily for women, and White women reached parity in 2023 for Associate/Assistant comparison but not for Professor/Assistant. REI remained low for Asian and URM women (0.67-0.69 for Professor/Assistant comparison). Only Asian men reached parity for Professor/Assistant comparison, and REI decreased for URM men over the study period. Black faculty had a modest improvement in REI from 2000 (0.41) to 2009 (0.67) but remained unchanged since then (0.67 in 2023).

CONCLUSION

Advancement along the academic ladder has been uneven in academic radiology. While rank equity for women has improved over time, for URM and Asian women it remains substantially below parity. URM men have actually seen a decline in rank equity across ranks. Further efforts are needed to identify barriers to recruitment, retention, and promotion for these sub-groups in academic radiology and create interventions that diversify radiology faculty at all ranks.

Gender equity in authorship of emergency medicine publications in Australasia

OBJECTIVE

To evaluate gender authorship trends in the official journal of the Australasian College for Emergency Medicine (ACEM), Emergency Medicine Australasia (EMA).

METHODS

A bibliometric review of author gender in EMA during the 10-year period 2013-2022. The gender of first/last authors were determined by www.genderize.io, or a manual internet search where gender was not determined with at least 90% certainty. Descriptive statistics were used with percentages of women as first and last author compared to current percentages of ACEM Fellows (FACEMs) who identify as women.

RESULTS

The final analysis included 1703 articles. Women accounted for 27.4% fewer authors than men (36.3% vs 63.7%). Women were outnumbered by men by 20.0% among first authors (40% vs 60%), and 36.2% (31.9% vs 68.1%) for last authors. When the last author was a woman, there was a similar rate of women (49.2%) and men (50.8%) as first authors. However, when the last author was a man, first authors were 37.1% women versus 62.9% men. If the last author was a woman, there was a 60% greater probability that the first author was also a woman (odds ratio 1.6, 95% CI 1.3-2.1). First authorship rate by women was equal to or exceeds the proportion of women FACEMs, however, last authorship by women still lags behind.

CONCLUSION

The emergency medicine community in Australasia must continue to tackle existing gender disparities which exist in our specialty. A creative and active strategy on the part of publishers, editors, academics and authors is needed to redress this balance.

Principal investigator gender and clinical trial success: analysis of over 3000 obstetrics and gynecology trials

BACKGROUND

In obstetrics and gynecology (OBGYN) research, gender disparities permeate through leadership, funding, promotion, mentorship, publishing, compensation, and publicity. Few studies have investigated OBGYN clinical trial leadership as it relates to investigator gender. Thus, we undertook an investigation of principal investigator (PI) gender and clinical trial success.

OBJECTIVE

To characterize United States (US) OBGYN clinical trials by PI gender and analyze the association between PI gender and features of trial success.

STUDY DESIGN

This is a cross-sectional study of all US-based obstetric and gynecologic clinical trials registered on ClinicalTrials.gov (2007-2020). We examined associations between PI gender (ie, led by women, men, or both) and four primary outcomes that capture clinical trial success: early discontinuation (ie, absence of early discontinuation is a feature of success), reporting of complete trials to ClinicalTrials.gov, publication in a peer-reviewed journal, and clinical trial participant diversity (reporting of racial and ethnic diversity data and representation of diverse cohorts). Multivariable analyses controlled for subspecialty, multiple PI status, source of funding, primary purpose, phase, number of arms, enrollment, year of trial registration, blinding, oversight by a Data Safety Monitoring Committee, and number of study sites. Sensitivity analysis accounted for individual PI who led multiple clinical trials. Univariable and multivariable logistic regression analysis models were applied. We conducted multiple imputation for missing covariable data. There were no missing exposure or outcome data in the final cohort.

RESULTS

We reviewed 12,635 clinical trials focused on OBGYN. Of the 4342 trials with at least one site in the US, PI names were available for 3087 trials (71.1%). The majority of OBGYN trials were women-led (women 1696, 54.9%; men 1272, 41.2%, coled 119, 3.9%). A greater proportion of obstetrics trials (617, 60.0%) were women-led than gynecology trials (1079, 52.4%). Family planning had the greatest proportion of women-led trials (145, 74.7%), whereas reproductive endocrinology and infertility had the lowest (50, 30.9%). A greater proportion of industry-funded trials were led by men (123, 64.7%). In adjusted analysis, women-led trials had lower odds of early discontinuation (men-led reference; women-led adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.44, 0.77). Women-led trials reported results less frequently (men-led reference; women-led aOR 0.52, CI 0.40-0.62) but no significant difference was seen in publication (men-led reference; women-led aOR 1.02, CI 0.57, 1.81). Women-led trials had greater odds of reporting race and ethnicity participant data (men-led reference; aOR 1.87, CI 1.27-2.47) but there was no difference in cohort diversity by PI gender.

CONCLUSION

Women investigators lead approximately half of OBGYN clinical trials in the US. Women-led trials discontinue less frequently, publish at similar rates, and include data on diversity more frequently than men-led trials. Women are as successful as men in conducting clinical trials and, in certain domains, more successful. Our findings place the impetus on the OBGYN professional ecosystem to support women's academic careers.

Development of the Big Ten Academic Alliance Collaborative for Women in Medicine and Biomedical Science: "We Built the Airplane While Flying It"

Unlabelled

Women-identifying and women+ gender faculty (hereto described as women+ faculty) face numerous barriers to career advancement in medicine and biomedical sciences. Despite accumulating evidence that career development programming for women+ is critical for professional advancement and well-being, accessibility of these programs is generally limited to small cohorts, only offered to specific disciplines, or otherwise entirely unavailable. Opportunities for additional, targeted career development activities are imperative in developing and retaining women+ faculty. Our goal was the development of a new collaborative of Big Ten Academic Alliance (BTAA) institutions to support gender equity for women+ faculty in medicine and biomedical sciences, with two initial aims: (1) hosting an inaugural conference and establishing a foundation for rotation of conference hosts across BTAA schools, and (2) creating an infrastructure to develop programming, share resources, conduct environmental scans, and promote networking. In 2022, leaders from The Ohio State University College of Medicine Women in Medicine and Science envisioned, developed, and implemented a collaborative named CommUNITYten: The Big Ten Academic Alliance for Women in Medicine and Biomedical Science. Conference program development occurred through an iterative and collaborative process across external and internal task forces alongside industry partners. We developed a fiscal model to guide registration fees, budget tracking, and solicitation of conference funding from academic and industry sponsors. Attendees completed postconference surveys assessing speaker or workshop effectiveness and suggestions for future events. Finally, we developed an environmental scan survey to assess gender equity needs and existing programming across BTAA institutions. In June 2024, The Ohio State University hosted the inaugural CommUNITYten conference in Columbus, Ohio, featuring 5 keynote presentations, 9 breakout sessions, and networking opportunities across one and a half days of curated programming. Nearly 180 people attended, with representation from 9 BTAA institutions, 6 industry companies, staff, and trainees. Postconference surveys showed 50% (n=27) of respondents were likely to attend another in-person conference and suggested future conference topics. The environmental scan survey launched in October 2024. We successfully established the CommUNITYten collaborative and hosted the inaugural conference. Establishing key stakeholders from each BTAA institution, obtaining sponsorship, and detailed conference planning and partnerships were critical in ensuring realization of this collaborative. The conference brought together leaders, faculty, staff, trainees, and industry partners from across the country and met the initial goal of networking, sharing resources, and building community for women+ faculty. These efforts lay a robust foundation for the BTAA CommUNITYten collaborative to foster ongoing collaboration, innovation, and progress in the years to come. Given the importance of steady improvements, this viewpoint may further guide the efforts of other individuals, groups, and leadership supporting women+ as they consider approaches and strategies advocating for gender equity at the national level.

Gender Differences in Self-Assessment Among Clerkship Medical Students Despite Equivalent Academic and Clinical Performance

OBJECTIVE

The authors aimed to determine if medical students' self-assessment of abilities and performance differed by gender during the psychiatry clerkship and if these differences were reflected objectively in test scores or clinical evaluations from educators.

METHODS

Data from mid-clerkship self-assessments completed during the psychiatry core clerkship were reviewed from two classes of medical students. Students rated their performance on 14 items across five domains: knowledge/clinical reasoning, differential diagnosis, data presentation, studying skills, and teamwork as "below," "at," or "above expected level." Ratings were coded numerically, and statistical analysis was performed using Student's T-test. National Board of Medical Examiners (NBME) Subject Exam scores and clinical evaluations served as measures of actual performance.

RESULTS

Female students (n = 123) rated their performance significantly below male peers (n = 114) in medical knowledge (female - 0.05 vs male 0.13), clinical reasoning (- 0.02 vs 0.06), differential diagnosis (- 0.09 vs 0.00), balancing work and studying (- 0.02 vs 0.11), keeping up with clerkship assignments (0.03 vs 0.13), understanding role on the team (0.11 vs 0.23), interacting with other team members (0.15 vs 0.31), and functioning as part of the team (0.13 vs 0.25). Clinical evaluation scores and NBME Subject Exam scores showed no significant difference (evaluation scores 138.1 vs 136.0; NBME scores 163.8 vs 162.2) in performance between students.

CONCLUSIONS

Female medical students tend to underrate their performance compared to male peers in clinical knowledge, studying skills, and teamwork, despite equivalent academic and clinical performance. This study highlights gender disparities in self-assessment during medical training.

"Equal pay for equal work": Exploring the gender pay gap in radiology

Among the enduring disparities confronting the United States is the gender pay gap. Women experience lower wages than their male peers in nearly every major occupation, including medicine, and this further underscores how gender-based inequities within the practice of radiology are wide regarding pay, promotion opportunities, and leadership representation in diagnostic and interventional radiology. This review article analyzes the historical and current data for the gender pay gap in radiology relative to other medical specialties, as well as the influence of other intersecting factors, such as race or ethnicity. The manuscript identifies key root causes of the pay discrepancies, including underrepresentation of women in leadership positions, deeply held biases, stereotypes, and inequities in promotion practices. Several strategies have been explored to tackle these challenges, encompassing enhancing pay transparency, reinforcing the commitments of institutions to pay equity, and advocating for systemic changes.

International medical graduates representation in pathology academic workforce, departmental leadership and society leadership

Compared with the overall physician workforce, pathologist workforce in the United States has significant representation of international medical graduates (IMGs). IMG representation in the academic pathology workforce, as well as in departmental and pathology societal leadership, has not been documented. In this cross-sectional study, we surveyed a sample of 20 North American academic pathology departmental publicly available websites. Each faculty was recorded according to the location of their medical school training as either US or Canadian medical graduateor IMG (country of medical school graduation any other than US or Canada). Past and present presidents of four major North American pathology societies [American Society for Clinical Pathology (ASCP), Association for Academic Pathology (AAPath), College of American Pathologists (CAP), United States and Canadian Academy of Pathology (USCAP)] were also recorded. A total of 1455 pathologists were retrieved in our search: 924 (63.5 %) were USCMGs and 531 (36.5 %) IMGs. Likewise, 65 % of pathology chairs were USCMGs and 35 % IMGs. These data mirror the 2022 Association of American Medical Colleges distribution in the pathology workforce (65.6 % USCMGs and 34.4 % IMGs). In contrast, historic data from 1993 to 2024 show that only 8 (8 %) past or current presidents of the major US pathology societies were IMGs (USCAP = 6, ASCP = 1, AAPath = 1, CAP = none). While the academic pathology community has proportional representation of physicians based on location of their medical school training, there is historical underrepresentation of IMGs in societal leadership. Unveiling the causes of this disparity and identifying any potential obstacles for faculty engagement is paramount.

Gender, Racial, and Ethnic Diversity in Plastic Surgery: Evaluating Effective Initiatives and Identifying Areas for Improvement

ABSTRACT

Women and racial and ethnic minorities have historically been underrepresented in medicine, making up a minority of all physicians and a smaller subset of plastic surgeons. Furthermore, these groups represent an even smaller fraction of plastic surgeons in research and leadership roles. Parallel to the general recognition of the importance of increasing diversity in the medical field, there has been a surge in the literature detailing current issues and highlighting potential areas for intervention within plastic surgery. Various initiatives have been piloted to address the underrepresentation of certain demographic groups in the field. These have largely targeted the medical student level, with a focus on increasing mentorship, targeted recruitment, exposure to the field, and scholarly opportunities. With the growing body of research conducted in this realm, this review seeks to synthesize our understanding of the modern landscape of gender, racial, and ethnic diversity within plastic surgery, with an emphasis on identifying successful initiatives that have positively impacted representation and inclusivity.

Improving Academic Promotion Success via Implementation of Targeted Preparation Strategies and Coaching Processes

PROBLEM

Academic promotion is important for faculty career development and retention in academic medicine. However, the promotion process is time consuming, with little guidance offered to ensure successful outcomes. The authors describe their institution's standardized approach to providing clear and reliable academic promotion support and share associated outcomes.

APPROACH

An academic promotion support process, comprising 4 targeted preparation strategies and 3 coaching processes, was implemented in 2020 at Children's Mercy Kansas City to prepare faculty to submit promotion applications. Targeted preparation strategies include communication plans, an intent to apply process, how-to guides and templates, and institutional promotion committee review. Coaching processes include structured conversations with an immediate faculty leader, an Office of Faculty Development director, and, after committee review of applications, an institutional promotion committee reviewer. Descriptive statistics and promotion outcomes were compared preimplementation (2012-2019) and postimplementation (2020-2023).

OUTCOMES

In 2012-2019 (8 promotion cycles), prior to implementation of the academic promotion support process, 247 faculty applied for academic promotion. After implementation, in 2020-2023 (4 cycles), 196 faculty applied. From pre- to postimplementation, the mean volume of applications per cycle significantly increased from 31 to 49 (P = .03), and the proportion of approved promotion applications significantly increased from 89.5% (221/247) to 99.0% (194/196) (P < .001). No significant differences were observed in the proportions of applicants who were female (P = .77) or non-White (P = .51).

NEXT STEPS

Creation of an institutional academic promotion support process can be effective in increasing the volume of applications and the likelihood of successful outcomes. Future research should focus on increasing the proportions of non-White faculty and female faculty who apply for promotion and analyzing longer-term outcomes for faculty who are promoted, such as progression to leadership roles.

Examining Gender Representation in US News and World Report Top 25 Urology Departments: Female Faculty Hold Lower Professorial Levels and Publication Rates Than Male Counterparts

OBJECTIVES

To examine female representation in US News and World Report (USNWR) top 25 US Urology departments and identify trends of female representation in institutional roles.

METHODS

Using the 2022 USNWR, we collected data from each institution's websites along with a compared geographically local cohort to evaluate the presence of female residents, female attendings, and professorial levels. First or last author faculty publications numbers were found using PubMed and Scopus in fiscal year 2022.

RESULTS

The top 25 institutions averaged ~32.3% female residents and 18.7% female attendings, which was not significantly different from the comparison cohort. Of the total publications of fiscal year 2022, female attendings contributed ~14% (p < 0.001), also not significantly different from the comparison cohort. Only 20.4% of listed female attendings in top 25 programs are full Professors, compared to 41.1% of the listed men (p < 0.05). The most common level of female professorship is Assistant Professor (53.4%). Level of female professorship between cohort was significantly different, with female urologists more likely to hold a title of full Professor in the top 25 cohort compared to the nontop 25 cohort regardless of similar publication output (p < 0.05).

CONCLUSIONS

Female faculty in Urology continue to be underrepresented in the top Urology departments, with significant difference in equitable female professorship appointments between top 25 and nontop 25 departments. Future directions include examining the impact of early mentorship and sponsorship on representation over time.

Women in Radiology Education (WIRED): An actionable step towards closing the gender gap in radiology

As the representation of women in medicine has grown and reached parity in some specialties over the past two decades, radiology has not only lagged behind, but has remained stagnant. To strengthen the pipeline, the field must institute policies and practices to retain women in radiology and must effectively recruit and mentor women in medical school to enter the field. Women in medical school who are pursuing radiology, however, often struggle to find women mentors, opportunities for research, leadership, and service, and critically, often struggle to find a community that speaks to their experience. WIRED (Women in Radiology Education) is a student-led group dedicated to community building and advancing radiology mentorship, research, and service opportunities for women in medical school. This step-by-step guide to founding a WIRED chapter with examples of successful chapter events can enable radiology programs to provide targeted mentorship to women in medical school, and ultimately, increase the representation of women in radiology.

Revisiting a Faculty Career Management Life Cycle Model: Anticipating and Navigating Career Transitions in Academic Medicine

Career management models are valuable tools for faculty pursuing a career in academic medicine. These models help faculty transition through various stages of their careers, including commonly pursued academic advancements from assistant professor to full professor, as well as less common transitions like moving from full-time to part-time status, taking sabbaticals, going on medical leave, or assuming executive leadership roles. The success of faculty members across these stages is influenced by both environmental factors and individual-level characteristics. Recognizing career stages and transitions, as well as the impact of personal and environmental factors on career growth, is crucial. The proposed Faculty Career Self-Management Model (FCSM) provides a visual and descriptive framework to guide individual faculty and the professionals who support them in understanding, preparing for, and navigating career stages and professional transitions to build and sustain meaningful careers in academic medicine. The FCSM serves as a framework to explore, develop, and share best practices in supporting faculty vitality across the career lifespan.

Is there an editorial glass ceiling? Editorial leadership in nephrology and transplantation journals: A gender-based cross-sectional analysis

AIM

Editors-in-Chief (EiC) play a key role as gatekeepers in academic medicine, often shaping research agendas. Women have historically been underrepresented in editorial leadership roles in academic medicine. The purpose of this study was to examine gender representation among EiC of contemporary transplantation and nephrology journals.

METHODS

This cross-sectional study evaluated gender disparities among EiC of transplantation and nephrology medical journals. The study population was drawn from journals in two subject categories (1) 'Transplantation' and (2) 'Urology and Nephrology' in the 2023 Journal Citation Reports. Binary gender classification (woman/man) was determined by the names/pronouns used to describe the EiC on the journal or institutional webpage. The primary outcome was the proportion of women EiC. Secondary outcome was the proportion of women EiC based on journal topic, location and metrics. Descriptive statistics were used. Gender differences were compared using students t-test or Fisher's exact test.

RESULTS

A total of 79 EiC were identified of which 16 (20%) were women and 63 (80%) were men (p < .001). Transplantation and nephrology journals had 21% and 20% women EiC, respectively. The proportion of women to men EiC was not impacted by journal category (p = .93), journal location (p = .61), journal impact factor (p = .71) or quartile (p = .59).

CONCLUSION

There was a disparity in gender representation in EiC in nephrology and transplantation journals, with men holding 80% of all positions. These findings, among growing evidence of gender disparity, highlight a need for targeted efforts to promote gender equity in academic medicine.

More women than ever are entering MD-PhD programs. What lies ahead for them?

The earliest MD-PhD programs were small and enrolled mostly men. Here, we show that since 2014 there has been a steady increase in the number of women in MD-PhD programs, the number of women reaching parity with men in 2023. This change was due to an increase in female applicants, a decrease in male applicants, and an increase in the acceptance rate for women, which had previously been lower than that for men. Data from the National MD-PhD Program Outcomes Study show that training duration has been similar for men and women, as have most choices of medical specialties and workplaces. However, women were less likely to have full-time faculty appointments, fewer had NIH grants, and those in the most recent graduation cohort at the time of the survey reported spending less time on research than men. Previously cited reasons for these differences include disproportionate childcare responsibilities, a paucity of role models, insufficient recognition, and gender bias. Institutions can and should address these obstacles, but training programs can help by preparing their graduates to succeed despite the systemic obstacles. The alternative is a persistent gender gap in the physician-scientist workforce, lost opportunities to benefit from diverse perspectives, and a diminished impact of valuable training resources.

Race and Ethnicity, Gender, and Promotion of Physicians in Academic Medicine

Importance

The ranks of academic physicians do not reflect the diversity of the US population. To create a diverse and effective medical workforce, it is important to know the extent to which gender, race and ethnicity, and the intersection of these factors are associated with career advancement.

Objective

To assess whether race and ethnicity and gender are associated with appointment to or promotion within academic medicine.

Design, Setting, and Participants

This cohort study used Association of American Medical Colleges data on graduates of all US MD-granting medical schools from 1979 to 2019 merged with faculty appointment data since 2000. Data for this study are based on a February 19, 2021, snapshot. The analysis was performed from March 8, 2021, to May 5, 2023.

Exposure

Gender and race and ethnicity among physician graduates.

Main Outcomes and Measures

The main outcome was full-time faculty appointments and promotions to the ranks of instructor, assistant professor, associate professor, full professor, and department chair. Cox proportional hazards models were used to examine the differences in likelihood of appointment and promotion for racial and ethnic minority men and women compared with White men.

Results

The analytic sample included 673 573 graduates (mean [SD] age at graduation, 28.1 [3.2] years; 59.7% male; and 15.2% identifying as Asian, 6.1% as Black, and 69.6% as White). White men accounted for the largest subgroup of graduates (43.8%). Asian men, Asian women, Black women, and White women were more likely than White men to be appointed to entry-level positions. Among physicians graduating both before and after 2000, White men were more likely to be promoted to upper ranks compared with physicians of nearly every other combination of gender and race and ethnicity. Among physicians graduating prior to 2000, Black women were 55% less likely (HR, 0.45; 95% CI, 0.41-0.49) to be promoted to associate professor (n = 131 457) and 41% less likely (HR, 0.59; 95% CI, 0.51-0.69) to be promoted to full professor (n = 43 677) compared with White men. Conversely, Black men (HR, 1.29; 95% CI, 1.03-1.61) were more likely to be appointed as department chair (n = 140 052) than White men.

Conclusions and Relevance

These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.

Analysis of Faculty Gender and Race in Scholarly Achievements in Academic Neurology

Background: Intersection of gender and race and/or ethnicity in academic medicine is understudied; we aim to understand these factors in relation to scholarly achievements for neurology faculty. Methods: Faculty from 19 US neurology departments completed a survey (2021-2022) to report rank, leadership positions, publications, funded projects, awards, and speaker invitations. Regression analyses examined effects of gender, race, and their intersectionality on these achievements. Women, Black/Indigenous/People of Color (BIPOC), and BIPOC women were comparator groups. Results: Four hundred sixty-two faculty responded: 55% women, 43% men; 31% BIPOC, 63% White; 21% BIPOC women, 12% BIPOC men, 36% White women, 31% White men. Men and White faculty are more likely to be full professors than women and BIPOC faculty. The number of leadership positions, funded projects, awards, and speaker invitations are significantly greater in White compared to BIPOC faculty. Relative to BIPOC women, the number of leadership positions is significantly higher among BIPOC men, White women, and White men. Publication numbers for BIPOC men are lower, number of funded projects and speaker invitations for White women are higher, and number of awards among White men and White women is higher compared to BIPOC women. Discussion: Our study highlights that inequities in academic rank, award number, funded projects, speakership invitations, and leadership roles disproportionately impacted BIPOC women. More studies are needed to evaluate gender and race and/or ethnicity intersectionality effects on faculty achievements, reasons for inequities, recognition, and potential solutions.

Unveiling the Invisible: Challenges Faced by Arab Women International Medical Graduates in U.S. Academia

PURPOSE

The Arab experience is understudied because until 2024 Arabs were categorized as White on the U.S. Census, leading to diminished documentation of their personal experiences. There is also little understanding of the Arab experience and its intersectionality with gender, being an international medical graduate (IMG), and working in academia. The authors studied the experience of Arab women IMGs working in the U.S. academic system.

METHOD

This qualitative study used interpretative phenomenological analysis to analyze in-depth interview data from 20 first-generation U.S. immigrant Arab women who were IMGs. Interpretative phenomenologicalanalysis involved data familiarization, immersion, and coding. Codes were grouped into potential themes on the participants' experience. The authors explored connections between the themes and engaged in reflexive practice through memo writing and team meetings. The study was performed from November 2022-May 2023.

RESULTS

The experiences of the 20 first-generation U.S. immigrant Arab women IMGs were as diverse as the Arab identity itself but congruent with some documented IMG experiences. Political turmoil, desire for new opportunities, and career goals were all reasons that led them to emigrate, but cultural differences, isolation from their home countries, and missing family were central to their experiences. Muslim women wearing the hijab or those with heavy accents faced more microaggressions and xenophobia in academic clinical settings. Those in environments that embraced their differences and supported them described less discrimination. They all felt, nonetheless, that they benefited from training in the United States. However, they noted room for improving cultural humility in residencies and the need for a more inclusive workplace.

CONCLUSIONS

This study highlights the visible and invisible challenges that affect Arab women IMGs' experience in the United States. Program directors and department leaders should try to learn about the backgrounds of IMGs and current geopolitical events that might affect IMGs and extend support.

Success and opportunities of the American Academy of Pediatrics Marshall Klaus research grant program in neonatal-perinatal medicine

BACKGROUND

Physician-scientists are a crucial link between clinical practice and research. The American Academy of Pediatrics (AAP) initiated the Marshall Klaus Perinatal Research Award to enhance the development of research skills among physicians training in Neonatal-Perinatal Medicine.

METHODS

In this study, we sought to identify trends in funding along with geographical and demographic variables of the applicants and mentees and assess the applicants' scholarly productivity and funding from the National Institutes of Health (NIH). We reviewed the data of applicants and awardees from 2015-2024.

RESULTS

We found that basic science applications had a higher funding likelihood than clinical/translational applications. The geographical distribution of awardees is skewed. There was a significant association between awardee status and K08 or K23 funding attainment.

CONCLUSIONS

Future efforts should support more equitable award distribution and a diverse research landscape in neonatal-perinatal medicine.

Stress and career aspirations: a longitudinal study with medical students

Background

The psychological well-being of medical students has often been studied in relation to various factors and typically exhibits poorer scores than comparable student groups. This diminished well-being can have far-reaching implications, like impact on career or academic engagement. While there are some studies on specialty choice or academic performance few studies have examined the effects of stress at the beginning of medical school on career ambitions and the associated interest in research. Given the anticipated future shortage of healthcare professionals and the goal of gender equality in higher positions, it is crucial to examine this relationship as early as medical education. The question arises whether medical education and the demands of studying influence the career ambitions of different student groups.

Method

As part of a longitudinal survey, students from a medical cohort are surveyed over three consecutive years. A total of 297 students participated in the surveys, of which 66.4% were women. Stress experiences during medical school and career aspirations are assessed and analyzed using Generalized Estimating Equation (GEE) modeling.

Results

The results indicate that early academic stress is a negative predictor of the career ambitions of medical students (B = 1.637; p = 0.009). Also, female students report lower career goals than male students (B = 1.168; p = 0.018). In addition, gender moderates the impact of stress on career ambitions (p = 0.046). Finally, stress levels are highest when starting the medical program (p = 0.022) and decrease over time.

Discussion

Stress during the initial medical training impedes students to pursue higher career ambitions. Future research as well as medical programs need to elaborate more on and consider structural stress prevention interventions in order to promote well-being and strengthen also scientific career goals at an early stage, specifically for female students.