Research productivity and gender disparities: a look at academic plastic surgery

Representation of Women Authors in the 100 Most-Cited Facial Plastic and Reconstructive Surgery Articles

OBJECTIVE

This study aims to determine the representation of women among most-cited facial plastic and reconstructive surgery articles.

STUDY DESIGN

A bibliometric analysis of the most-cited articles from 9 high-impact facial plastic surgery journals.

SETTING

Online database.

METHODS

A retrospective analysis of the 100 most-cited articles in facial plastic surgery was conducted using the Elsevier Scopus database. The representation of women among first, senior, and corresponding authors was assessed using the US Social Security Baby Names Database. Accredited websites were utilized for further clarification of gender, professional background, and title. A 2-tailed t-test was performed to compare the average number of citations by gender, while chi-square analysis was used to compare the relative number of women authors between 5-year intervals, citation rank, and nationalities. A significance level of 0.05 was used.

RESULTS

The top 100 most-cited articles had the highest total number of citations between 2000 and 2004. US institutions published 71% of these articles. The gender of 99% of first authors, 94% of senior authors, and 94% of corresponding authors was identified. Among these, 11% of first authors, 14% of senior authors, and 10% of corresponding authors were women. Of the 19 women authors, 11 were physicians. No statistically significant difference in the relative number of first, senior, and corresponding women authors was observed between years of publication, citation quartile, and article nationality.

CONCLUSION

Despite increasing women facial plastic surgery trainees, women's academic contributions continue to trail. Additional efforts are needed to support and highlight academic achievements of women facial plastic surgeons.

An Investigation of Gender Representation and Collaboration in Academic Plastic Surgery Research

Background: Gender disparities in academic leadership positions may be influenced by several factors, including research productivity. We aimed to describe the publication gender gap in major plastic surgery journals, assess gender-related and gender-neutral research publications, and identify any potential gender disparities associated with publication characteristics. Methods: For this cross-sectional study, we reviewed all original research publications in Plastic and Reconstructive Surgery, JAMA Facial Plastic Surgery, and Aesthetic Surgery Journal from 2014 through 2018. Genderize.io was used to identify the gender of all authors. Each publication was classified as either gender-neutral, transgender health, women's health, or men's health-related based on the article's content. Results: Of the 12,718 authors across 2234 publications analysed, females were first authors in 30%, last authors in 17%, and all authors in 27%. Among the publications, 1782 (79.8%) were focused on gender-neutral, 419 (18.8%) on women's health, 18 (0.8%) on transgender health, and 15 (0.7%) on men's health. Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI]  =  1.4 [1.1-1.8] and OR [95% CI]  =  51.0 [47-55], p < .001) and had a higher mean number of citations compared to gender-neutral articles (p < .001). Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI]  =  1.4 [1.1-1.8] and OR [95% CI]  =  51.0 [47-55], p < .001) and had a higher mean number of citations compared to gender-neutral articles (p < .001). Conclusion: The publication gender gap persists in academic plastic surgery. The academic community should continue to prioritize addressing gender disparity from the perspective of research productivity.

Essential Reads in Rhinology: A Bibliometric Analysis

Aims

Rhinology is a progressive subspecialty within otolaryngology. Bibliometric analysis is a powerful method to survey the landscape of literature on a specific topic and identify publication trends. We aimed to analyze the 50 most impactful English-language rhinology manuscripts of all time to create a targeted reading list for otolaryngologists.

Material and Methods

The Journal Citation Report within the Web of Science database was utilized to identify articles relating to rhinology. Web of Science Research categories were restricted to otolaryngology. The articles were then ranked by number of citations. The top 50 articles of all time ranked by number of citations were analyzed. The articles were analyzed for publication year, journal impact factor, citation density, first author (FA), and senior author (SA) name, country, and institution. Statistical analyses were performed.

Results

Most articles were published in the 2000s (N = 22, 44%) and 1990s (N = 11, 22%). Male FA (N = 37, 74%) and SA (N = 43, 86%) published most articles. Most articles were clinical studies (N = 36, 72%) followed by clinical guidelines/expert opinions. Most articles were published in the United States (N = 28, 56%) and England (N = 9, 18%). There were more female FAs of guidelines/position papers than basic lab, reviews, and clinical studies. England had more female FAs than other countries, and the United States had more female SA. There was an average of 585.2 citations per study.

Conclusion

This investigation highlights the most influential literature within rhinology. The most impactful studies are consensus statements, large multicenter studies, and technique studies. Significant gender disparities in authorship exist.

Utilizing Relative Citation Ratio to Compare Academic Productivity by Gender in Plastic Surgery

INTRODUCTION

The relative citation ratio (RCR) is a bibliometric index utilized to assess research productivity. Mean relative citation ratio (m-RCR) and weighted relative citation ratio (w-RCR) can be utilized to assess individual research quality as well as career-long productivity, respectively. We sought to determine differences in academic productivity between genders and identify demographic variables associated with increased academic productivity.

METHODS

A list of Plastic and Reconstructive Surgery residency programs was compiled utilizing the American Council of Academic Plastic Surgeons website. Each program department's website was utilized to generate a list of practicing surgeons and respective demographic information. Both mean and weighted RCR were obtained using the iCite, a National Institutes of Health bibliometric tool. Surgeons were excluded if any demographic or RCR data was not accessible. Chi-squared test, Mann-Whitney U test, Kruskal-Wallis test, and multivariable linear regressions were performed.

RESULTS

A total of 785 academic plastic surgeons met the criteria and were included in the analysis, 186 of whom were women and 599 men. Both academic rank and model of residency training were significantly associated with gender in chi-squared analysis (P < 0.05). Mean relative citation ratio was higher among men in departments. Mean w-RCR was higher among men of assistant professor status, chief/chairperson status, integrated model of residency training, faculty size ≥six and in departments and divisions. Academic rank and faculty size were associated with higher w-RCR upon multivariable linear regression.

CONCLUSIONS

Although differences exist in mean w-RCR between men and women in plastic surgery, gender is not a predictor of increased academic productivity. RCR is an accurate means of assessing gender differences in academic productivity as it comprehensively considers both quality and quantity of research and may be superior to other, older bibliometric indices.

Gender Representation Among Major Plastic Surgery Society Achievement Award Recipients

Purpose: Professional achievement awards are an important factor in recruitment, promotion, and faculty review within academic institutions. Studies have shown that subconscious, gender-based assumptions of individuals and their work in traditionally male-dominated fields lead to more positive evaluations of men than women, a phenomenon present among scientific and medical award committees. This study examined gender representation among recipients of major North American plastic surgery society awards over the last 50 years. Methods: Recipient lists of major achievement awards bestowed by ten American and Canadian plastic surgery societies between 1970 and 2020 were accessed online or by direct contact with the society. Awardee gender, institution affiliation, graduation year, fellowship status, and additional major awards received were recorded. Comparisons were made between gender representation among society presidents, board membership, general society memberships, attending physicians, and plastic surgery residency enrolment. Results: Thirty-two major awards given by ten plastic surgery societies were included. Six hundred and twenty-five awards were conferred, of which 47 recipients were female (7.5%). Of the 121 individuals that received multiple major awards, 8 were female. Two-thirds of female awardees (72%) were clinical plastic surgeons and the remainder were scientists. Over the past 50 years, there has been a gradual increase in the proportion of female award winners. Conclusions: Despite a gradual increase in the proportion of female awardees in major plastic surgery societies, female plastic surgeons remain underrepresented among awardees, with less than 10% of major awards conferred to females.

Factors Associated with Research Productivity and National Institutes of Health Funding in Academic Otology

OBJECTIVES

Bibliometrics, such as the Hirsch index (h-index) and the more recently developed relative citation ratio (RCR), are utilized to evaluate research productivity. Our study evaluates demographics, research productivity, and National Institutes of Health (NIH) funding in academic otology.

METHODS

Academic otologists were identified, and their demographics were collected using institutional faculty profiles (N = 265). Funding data were obtained using the NIH Research Portfolio Online Reporting Tools Expenditures and Reports Database. The h-index was calculated using Scopus and mean (m-RCR) and weighted RCR (w-RCR) were calculated using the NIH iCite tool.

RESULTS

H-index (aOR 1.18, 95% CI 1.10-1.27, p < 0.001), but not m-RCR (aOR 1.50, 95% CI 0.97-2.31, p = 0.069) or w-RCR (aOR 1.00, 95% CI 0.99-1.00, p = 0.231), was associated with receiving NIH funding. Men had greater h-index (16 vs. 9, p < 0.001) and w-RCR (51.8 vs. 23.0, p < 0.001), but not m-RCR (1.3 vs. 1.3, p = 0.269) than women. Higher academic rank was associated with greater h-index and w-RCR (p < 0.001). Among assistant professors, men had greater h-index than women (9.0 vs. 8.0, p = 0.025). At career duration 11-20 years, men had greater h-index (14.0 vs. 8.0, p = 0.009) and w-RCR (52.7 vs. 25.8, p = 0.022) than women.

CONCLUSION

The h-index has a strong relationship with NIH funding in academic otology. Similar h-index, m-RCR, and w-RCR between men and women across most academic ranks and career durations suggests production of similarly impactful research. The m-RCR may correct some deficiencies of time-dependent bibliometrics and its consideration in academic promotion and research funding allocation may promote representation of women in otology.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:3786-3794, 2024.

Trends in Gender Authorship of Abstract Presentations at Plastic Surgery the Meeting: A Decade Long Analysis

ABSTRACT

Current literature fails to examine gender differences of authors presenting abstracts at national plastic surgery meetings. This study aims to assess the ratio of female to male abstract presentations at Plastic Surgery The Meeting (PSTM).The gender of all abstract presenters from PSTM between 2010 and 2020 was recorded. The primary outcome variable was authorship (first, second, or last). Trends in gender authorship were assessed via Cochran-Armitage trend tests. Chi-square was utilized to evaluate the association between author gender and presentation type and author gender and subspecialty.Between 2010 and 2020, 3653 abstracts were presented (oral = 3035, 83.1%; poster = 618, 16.9%) with 19,328 (5175 females, 26.8%) authors. Of these, 34.5%, 32.0%, and 18.6% of first, second, and last authors were female, respectively. The total proportion of female authors increased from 153 (20.4%) in 2010 to 1065 (33.1%) by 2020. The proportion of female first, second, and last authors increased from 21.8% to 44.8%, 24.0% to 45.3%, and 14.3% to 22.1%, respectively, and demonstrated a positive linear trend ( P < 0.001 ). The proportion of female first authors in aesthetics (23.9%) was lower than that for breast (41.8%), cranio/maxillofacial/head & neck (38.5%), practice management (43.3%), and research/technology (39.4%) ( P < 0.001 ).Our study demonstrates a significant increase in female representation as first, second, and last authors in abstract presentations at PSTM within the last decade, although the absolute prevalence remains low.

A Comparison of Plastic Surgery Authorship Trends Under Single Versus Double-Blinded Review

INTRODUCTION

Research is key to academic advancement in plastic surgery. However, access to publication opportunities may be inequitable as seen in other fields. We compared authorship trends of plastic surgery manuscripts that underwent single-blinded review (SBR) versus double-blinded review (DBR) to identify potential disparities in publication opportunities.

METHODS

Publications from two plastic surgery journals using SBR and two using DBR from September 2019 to September 2021 were evaluated. Name and institution of the article's first and senior author and journal's editor-in-chief (EIC) were recorded. Chi-squared and Fisher's exact analyses were used to compare author characteristics between SBR and DBR articles.

RESULTS

Of 2500 manuscripts, 65.7% underwent SBR and 34.3% underwent DBR. SBR articles had higher percentages of women as first authors (31.9% versus 24.3%, P < 0.001) but lower percentages of first (50.7% versus 71.2%, P < 0.001) and senior (49.6% versus 70.3%, P < 0.001) authors from international institutions. First (26.0% versus 12.9%, P < 0.001) and senior (27.9% versus 18.0%, P = 0.007) authors of SBR articles tended to have more plastic surgery National Institutes of Health funding. Journals using SBR tended to have higher rates of authorship by EICs or authors sharing institutions with the EIC (P ≤ 0.005).

CONCLUSIONS

While associated with greater female first authorship suggesting potential efforts toward gender equity in academia, SBR of plastic surgery articles tends to favor authors from institutions with higher National Institutes of Health funding and disadvantage authors from international or lower-resourced programs. Careful consideration of current peer-review proceedings may make publication opportunities more equitable.

Gender Authorship Trends Among Craniofacial Publications: A 20-Year Analysis

This study aims to identify gender disparities within the subspecialty of craniofacial surgery as women surgeons remain underrepresented in academia and leadership, arenas heavily dictated by research productivity.

All craniofacial articles published in 3 major research journals from 2000 to 2020 were reviewed and evaluated in 5-year increments.

Information regarding author gender, authorship distribution, geographic origin, and publication type was collected. ANOVA, χ2, and logistic regression modeling were used for analysis.

In total, there were 3684 articles with 15 206 total authors-3128 (20.6%) were women, including 665 (21.3%) first authors, 1980 (63.2%) middle authors, and 487 (15.7%) senior authors. Mean women authorship increased significantly from 2000 to 2020 (0.33 vs 1.22 P < .001) with corresponding significant increases in first and senior authorship (8.63% vs 27.02; 5.65% vs 16.13%; P < .001). Statistically significant trends across time were observed for first and senior authorships (P < .001). Women were more likely to publish original publications as first and senior authors (OR: 1.83, P < .001; OR: 1.37, P = .0012). Women were less likely to publish editorial articles (OR 0.6, P < .001). The United States ranked third in publication output by female first authors but was behind all regions except Africa for output by female senior authors.

Although female authorship has increased significantly over the last 2 decades, women remain a minority within the craniofacial literature. Further research is needed to elicit the root of these disparities.

Gender and Racial Representation of Invited Speakers From The Aesthetic Society Annual Meetings Over a 5-Year Period

BACKGROUND

Increased representation from both women and non-White ethnicities remains a topic of discussion in plastic surgery. Speakers at academic conferences are a form of visual representation of diversity within the field. This study determined the current demographic landscape of aesthetic plastic surgery and evaluated whether underrepresented populations receive equal opportunities to be invited speakers at The Aesthetic Society meetings.

METHODS

Invited speaker's names, roles, and allotted time for presentation were extracted from the 2017 to 2021 meeting programs. Perceived gender and ethnicity were determined by visual analysis of photographs, whereas parameters of academic productivity and professorship were collected from Doximity, LinkedIn, Scopus, and institutional profiles. Differences in opportunities to present and academic credentials were compared between groups.

RESULTS

Of the 1447 invited speakers between 2017 and 2021, 20% (n = 294) were women and 23% (n = 316) belonged to a non-White ethnicity. Representation from women significantly increased between 2017 and 2021 (14% vs 30%, P < 0.001), whereas the proportion of non-White speakers did not (25% vs 25%, P > 0.050) despite comparable h-indexes (15.3 vs 17.2) and publications (54.9 vs 75.9) to White speakers. Non-White speakers oftentimes had more academic titles, significant in 2019 ( P < 0.020).

CONCLUSIONS

The proportion of female invited speakers has increased, with room for further improvement. Representation from non-White speakers has not changed. However, significantly more non-White speakers holding assistant professor titles may indicate increased ethnicity diversity in years to come. Future efforts should focus on improving diversity in positions of leadership while promoting functions that target young minority career individuals.

Examination of the Novel National Institutes of Health-Supported Relative Citation Ratio, a Measure of Research Productivity, Among Academic Plastic Surgeons

BACKGROUND

Considerable interest has been devoted to quantifying research productivity for the purposes of academic appointment and promotion in plastic surgery. A novel bibliometric, the relative citation ratio (RCR), integrates features unavailable in prior metrics, such as the h-index, including the ability to compare researchers in distinct fields. This investigation examines the RCR in relation to established measures of academic productivity and provides the benchmark data in plastic surgery.

METHODS

Online sources were queried to identify the characteristics of 955 academic plastic surgeons from 94 programs, ie, academic rank, gender, degrees, and fellowships. Bibliometric data were acquired using the iCite and Scopus databases. Comparative and correlational analyses of variables were performed.

RESULTS

Academic plastic surgeons were exceptionally productive, with a mean RCR of 1.20 (interquartile range, 0.79-1.67) and a weighted RCR of 17.68 (interquartile range, 5.14-52.48). Increased mean RCR was significantly associated with advanced academic rank and fellowship training. Increased weighted RCR was significantly associated with advanced academic rank, male gender, PhD acquisition, publication experience, and fellowship training. The h-index was weakly correlated with mean RCR but strongly correlated with weighted RCR and publication experience.

CONCLUSIONS

The RCR was associated with established markers of academic productivity, indicating its validity as a reliable field-normalized measure for the evaluation of plastic surgery faculty. Because scholarly output is a potential factor with respect to decisions of hiring, promotion, and allocation of funding, this modality of standardized comparison is paramount for plastic surgeons who exist within a larger general surgery department.

A Glass Ceiling in Orthopedic Surgery: Publication Trends by Gender

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

Nationwide Bibliometric Analysis of Integrated Plastic Surgery Program Directors

Studies have linked bibliometric indices with the academic level of plastic surgeons, but this relationship has not been explored with residency program directors (PDs). As teachers of the next generation, PDs' academic performance is an important component of residency program success. We sought to identify distinguishing characteristics of integrated plastic surgery programs, focusing on their PD bibliometric indices.

METHODS

We identified plastic surgery programs based on 2021 Doximity reputation and research output rankings, respectively, and then divided them into four quartiles (Q1-Q4). PD academic history and bibliometric indices (h-index, the number of publications, and citations) were collected through Doximity profiles and program websites: PubMed, Scopus, Google Scholar, American Society of Plastic Surgeons, and Accreditation Council for Graduate Medical Education.

RESULTS

Eighty-four programs were identified. There was a significant positive relationship between h-index, the number of publications, and type of research with reputation ranking (P < 0.05). After adjusting for years of experience post-training, h-index (OR = 1.24; P < 0.001) and the number of publications (OR = 1.05, P < 0.001) were significantly associated with reputation ranking. There was a statistically significant relationship between PD research fellowship completion and research output ranking (P < 0.01). After adjusting for years of experience post-training, h-index (OR = 1.05; P = 0.047) and the number of publications (OR = 1.01; P = 0.04) were significantly associated with research output ranking.

CONCLUSION

Higher ranked programs tend to have PDs who have a strong record of scholarly activity, as evidenced by certain bibliometric indices.

The Standardized Inclusive Numeric Academic Index: An Index to Measure Academic Productivity in Plastic Surgery

PURPOSE

Academic productivity is a poorly defined metric that is commonly used to determine faculty career advancement. While various indices incorporate scholarly activity, no specific index assimilates the perceived importance of a variety of academic accomplishments a physician may make. Herein, the development and validation of an algorithm to generate an academic productivity score based on surveying physicians nationwide are described.

METHODS

From 2016 to 2018, an online cross-sectional survey was distributed to faculty members at an academic institution and plastic surgeons from different academic levels nationwide. Respondents were presented with randomized, binary comparisons of 42 different achievements of an academic physician and asked to choose the more important achievement. Descriptive statistics of demographics and "win rates" of each achievement were reported and an algorithm for academic productivity scoring was designed. To validate the proposed index, 30 curricula vitae of academic surgeons were anonymized and ranked in order of increasing academic achievement by 6 volunteers. Interrater reliability was assessed by Krippendorff α (α ≥ 0.800).

RESULTS

Survey respondents completed an average of 116 (SD, 97.6) comparisons each, generating a total of 14,736 ranked comparisons. Of the 42 variables, the highest win rates were attained by being the dean of a medical school (0.90) and editor of a medical journal (0.88). The lowest win rates were attained by industry spokesperson (0.1) and members of the local medical society (0.1). Initial validity evidence found the interrater reliability for the 6 rankers to have a Krippendorff α value of 0.843. The interrater reliability between the average rater ranking and the algorithm-generated ranking had a Krippendorff α value of 0.925.

CONCLUSIONS

The present study demonstrates that the standardized inclusive numeric academic index may be used as a valid, comprehensive measure of academic productivity. Future studies should assess its application across different medical specialties.

Racial and Gender Diversity Among Students and Faculty in EHAC-Accredited Environmental Health Sciences Programs: Trend Analysis from 2009 to 2021

Diversity in the environmental health sciences (EHS) workforce is crucial in providing culturally sensitive services to diverse communities. This may be influenced by academic faculty training a diverse student body in the field of environmental health. This study aimed to characterize the diversity of students and faculty in EHS programs accredited by the National Environmental Health Science and Protection Accreditation Council (EHAC). A retrospective analysis was conducted on secondary data obtained from annual surveys administered to program directors in EHAC-accredited academic programs that included both undergraduate and graduate EHS degrees. The database covered surveys on gender and race that were conducted by EHAC for 12 academic years spanning 2009-2010 to 2020-2021. Results show most students (undergraduate and graduate) were female (54.4% and 52.1%, respectively) and white (61.0% and 50.7%, respectively). Increasing trends were observed over the last 12 years (2009-2021) in female undergraduate (from 53.7% to 59.8%) and graduate (from 47.1% to 60.3%) students and in non-white undergraduate students (from 40.0% to 48.2%). Most faculty (teaching in undergraduate and graduate programs) were male (64.4% and 64.3%, respectively) and white (77.9% and 92.1%, respectively). Increasing trends were observed from 2009 to 2021 in female faculty teaching undergraduate (from 27.7% to 42.2%) and graduate (from 31.3% to 42.1%) students. Native American, Alaska Native, Native Hawaiian, and Pacific Islander are consistently the most underrepresented racial groups in both undergraduate and graduate students and faculty. This study provides baseline data on the diversity of students and faculty in EHAC-accredited programs, which is important in informing future research and efforts to increase such diversity. Gender and racial disparity in EHS students and faculty needs to be addressed to provide necessary support to women and non-White constituents by institutional change in culture through active recruitment and by stronger collaboration between professional organizations and minority groups.

Orthopaedic Society Leadership Diversity and Academic Participation: Where Do We Stand Now?

BACKGROUND

In the United States, female and minority representation in the field of orthopaedic surgery remains low, and there are few reports regarding orthopaedic society leadership composition, selection criteria, and academic participation. We aimed to determine the demographic composition of national orthopaedic societies and report the academic participation metrics of leadership.

METHODS

This was a mixed-methods study using surveys and publicly available data from national orthopaedic societies for the 2020 to 2021 year. Twenty-four orthopaedic society websites were queried for their transparency in leadership selection and demographic information, including sex, racial, and ethnic composition of overall society and board membership. Data were collected regarding the academic participation of board leadership.

RESULTS

In total, 19 (79%) of the 24 national orthopaedic societies publish survey data regarding sex and racial demographics. One society elected not to participate, and there was no response from 4 others. Sixteen (89%) of the societies collect sex-related data from their membership, and 19 (100%) report sex-related data for their board members. Five (28%) collect data regarding the race and ethnicity of their general membership, and 10 (53%) report data regarding the race and ethnicity of board members. The average membership was 89% male and 11% female, and the leadership boards were 86% male and 14% female. In the societies that reported on race and ethnicity, on average, 80% of the members were White and 85% of the board members were White. Few societies (13%) publicly list their presidential nominating criteria, and none list their criteria for nonpresidential-line positions. Female sex and ≤10 years in practice were significantly associated with lower Hirsch index (h-index) scores, but these differences dissipated beyond 10 years.

CONCLUSIONS

There is a lack of sex, racial, and ethnic diversity in orthopaedic society leadership. More robust recording of these data by societies can help track improvements in diversity among members and leaders. Academic participation may be one component of leadership selection, but other factors play an important role. Overall transparency of leadership selection criteria could be clarified among orthopaedic societies.

Disparities in Research during Plastic Surgery Training: How Can We Level the Playing Field?

Background:

Methods:

Results:

Conclusions:

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

RATIONALE AND OBJECTIVES

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

KEY RESULTS

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

Academic medicine's glass ceiling: Author's gender in top three medical research journals impacts probability of future publication success

INTRODUCTION

In December 2017, Lancet called for gender inequality investigations. Holding other factors constant, trends over time for significant author (i.e., first, second, last or any of these authors) publications were examined for the three highest-impact medical research journals (i.e., New England Journal of Medicine [NEJM], Journal of the American Medical Association [JAMA], and Lancet).

MATERIALS AND METHODS

Using randomly sampled 2002-2019 MEDLINE original publications (n = 1,080; 20/year/journal), significant author-based and publication-based characteristics were extracted. Gender assignment used internet-based biographies, pronouns, first names, and photographs. Adjusting for author-specific characteristics and multiple publications per author, generalized estimating equations tested for first, second, and last significant author gender disparities.

RESULTS

Compared to 37.23% of 2002 - 2019 U.S. medical school full-time faculty that were women, women's first author publication rates (26.82% overall, 15.83% NEJM, 29.38% Lancet, and 35.39% JAMA; all p < 0.0001) were lower. No improvements over time occurred in women first authorship rates. Women first authors had lower Web of Science citation counts and co-authors/collaborating author counts, less frequently held M.D. or multiple doctoral-level degrees, less commonly published clinical trials or cardiovascular-related projects, but more commonly were North American-based and studied North American-based patients (all p < 0.05). Women second and last authors were similarly underrepresented. Compared to men, women first authors had lower multiple publication rates in these top journals (p < 0.001). Same gender first/last authors resulted in higher multiple publication rates within these top three journals (p < 0.001).

DISCUSSION

Since 2002, this authorship "gender disparity chasm" has been tolerated across all these top medical research journals. Despite Lancet's 2017 call to arms, furthermore, the author-based gender disparities have not changed for these top medical research journals - even in recent times. Co-author gender alignment may reduce future gender inequities, but this promising strategy requires further investigation.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

The Association Between H-Index and Publication of Plastic Surgery Meeting Presenters From 2014 to 2017

BACKGROUND

Plastic surgery is a competitive specialty that values research productivity among members of the field. The Hirsch index has been shown to measure a researcher's scientific impact. This study sought to determine whether an association exists between H-indices and the probability of and speed to publication.

METHODS

Using Scopus, Google Scholar, PubMed, and the Plastic Surgery the Meeting (PSTM) website, first author (FAHi) and senior author (SAHi) H-indices (n = 1048) from Plastic Surgery the Meeting (PSTM) abstracts from 2014 to 2017 were collected. Whether or not an abstract was ultimately published in a peer-reviewed journal was noted. If published, number of days between PSTM presentation and publication date were recorded. Logistic regression model was used for statistical analysis.

RESULTS

In total, 592 out of 1048 total abstracts were published as manuscripts. FAHi and SAHi had significant positive correlations with odds of publication. Both FAHi and SAHi showed positive correlation with the odds of abstract publication (P < 0.001 and P = 0.033). Impact of FAHi on likelihood of publication was greater than that of SAHi. The correlation between FAHi and SAHi with the number of days until abstract publication was not significant (P = 0.333 and P = 0.856). For abstracts published before the PSTM presentation date (15.9% of published), only FAHi (P = 0.008) showed positive correlation of publication before presentation.

CONCLUSIONS

The Hirsch index provides an objective method for evaluating the probability that an abstract will lead to manuscript publication, in addition to its traditional application in gauging the impact of research. The findings of this study support that both FAHi and SAHi have a positive, direct correlation with the probability of publication.

Gender Disparities Among Craniofacial Surgeons

To delineate career differences between genders of practicing plastic surgeons who have completed craniofacial fellowship given the known disparities in surgeons' professional and personal lives and an already lengthy residency training, there is concern that less women may commit to further fellowship training.

Craniofacial fellowship programs were contacted to identify graduates and an internet search was attempted where information was not available. Surgeon profiles and literature databases were used to obtain practice demographics and publications.

Accredited fellowships were identified through the American Society of Craniofacial Surgeons directory.

Program responses along with internet searches identified 201 graduates from 26 programs, of which 132 (66%) were men and 69 (34%) were women. On average, male graduates had 7.1 years in practice versus 6.6 years for females graduates (P = .176). There were significant differences between average number of publications (24.7 publications for males vs 14.1 for females, P = .009) and academic practice (46% males vs 64% females, P = .018). A similar percentage of males and females held leadership positions (13% males vs 16%, P = .552).

Despite similar years in practice, men had significantly higher publications while women were significantly more likely to practice in an academic setting. Females are increasing their representation in academia and leadership within the craniofacial community. However, efforts must still be directed at increasing exposure to craniofacial surgery and supporting research and leadership pursuits earlier on during their careers.

Trends in Female Plastic Surgery Resident Authorship - Signs of Changing Times?

OBJECTIVE

Gender discrepancies exist in academia for leadership positions, advancement opportunities, and research. As of 2019, the ratio of total male-to-female attending plastic and reconstructive surgeons was 4.8:1. However, the ratio of male-to-female residents in integrated plastic surgery programs fell to 1.3:1, indicating rising female representation. With more balanced gender distributions of residents, the authors sought to determine whether this translates to greater equality of opportunities and achievements. Specifically, this study compares the academic productivity of male and female integrated plastic surgery residents.

METHODS

A list of integrated plastic surgery residency programs was obtained from the Accreditation Council for Graduate Medical Education website and ranked by reputation using the Doximity Residency Navigator. Integrated plastic surgery residents from 2019 to 2020 were identified via program websites and social media accounts. Works published during residency were identified through PubMed and Scopus from July 1 of each resident's intern year through August 10, 2020. Demographic variables for residents, including training class and medical school, as well as for programs, including geographic region, Doximity ranking, and medical school affiliation, were collected. Medical schools were ranked according to US News by research. Research productivity was assessed through the number of total research articles with authorship position (first, second, or last), the number of articles published in plastic surgery journals with the highest impact factors (Plastic and Reconstructive Surgery and Aesthetic Surgery Journal), and H-indices. Chi-Squared tests and Mann-Whitney U-tests were used to make comparisons between male and female residents (α = 0.05).

RESULTS

In total, 931 residents in 81 integrated plastic surgery programs were identified, including 534 (57.4%) male and 397 (42.6%) female residents. There were no differences between male and female residents in terms of training year or program geography. Female residents were more likely to come from a top-50 medical school than males (54.7% vs. 48.1%, p = 0.049). There were no significant differences in gender distribution of residents from top-20 programs or programs affiliated with a top-20 medical school. The median (IQR) number of publications in total, and for each gender, was 3 (1-6). There was no difference in the number of total publications by training year by gender, besides the second-year resident class where male residents had a median (IQR) of 2 (1-4) compared to 1 (0-3) (p = 0.028). Male and female residents did not differ with regards to authorship position or proportion of times publishing in top journals. The distribution of H-indices for male residents was slightly higher than female residents (p = 0.003), but the median (IQR) was the same at 3 (1-5).

CONCLUSIONS

Currently, male and female integrated plastic surgery residents have similar levels of academic productivity. This suggests that female representation is slowly increasing along the pipeline in academia, representing a paradigm shift from previous trends of gender inequality in plastic surgery.

Research Productivity of Foot and Ankle Fellowship Faculty

BACKGROUND

Contribution to literature is critical for progress in the field of orthopaedics. No previous study has yet examined the academic productivity of foot and ankle surgery fellowship faculty.

PURPOSE

To evaluate the publishing productivity of foot and ankle fellowship faculty.

METHODS

Faculty and program characteristics of orthopaedic foot and ankle fellowship programs across the United States and Canada were collected from American Orthopaedic Foot and Ankle Society (AOFAS) and program websites. Faculty publication productivity measures, including publications, number of publications in specific journals, number of citations, and Hirsch index (h-index) were gathered using the Scopus database.

RESULTS

A total of 48 AOFAS foot and ankle surgery fellowship programs were identified with an associated 185 faculty members. The mean number of publications per faculty member was 44.9 (SD = 53.0; range = 0-323), with a mean h-index of 11.9 (SD = 10.6; range = 0-54). A total of 144 (77.8%) academic-affiliated faculty had a significantly greater number of publications (P < .01), total citations (P < .05), and publications in Foot and Ankle International (P < .05), Journal of Bone and Joint Surgery (P < .05), Clinical Orthopaedics and Related Research (P < .05), and Journal of the American Academy of Orthopaedic Surgeons (P < .05) compared to the 41 (22.2%) nonacademic faculty. There were no significant differences between measures of publication productivity between male and female faculty, except for maximum citations in a single article (67.1 vs 142.3; P < .05).

CONCLUSIONS

Academic-affiliated foot and ankle fellowship faculty have higher research productivity than nonacademic surgeons. The mean h-index of foot and ankle fellowship faculty was 11.9, which is lower than that reported in sports, joints, and spine fellowship faculty but higher than that reported for hand fellowship faculty.

LEVEL OF EVIDENCE

Level IV.

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.

Research Productivity among Plastic Surgeons in the State of Israel: h-index and M-quotient Assessment

The h-index has been proven in the US and Canada to be a solid tool to assess the quality and impact of individual scientific work in the field of plastic surgery. M-quotient is an additional metric that mitigates the h-index's inherent bias toward more seasoned researchers. The objective of this study was evaluating the relationship between h-index and M-quotient and research productivity among plastic surgeons in the state of Israel.

Methods

A list of all Israeli board-certified plastic surgeons registered in the Israeli Society of Plastic and Aesthetic Surgery was obtained from the organization's website. Relevant demographic and academic factors of each surgeon were retrieved. The Scopus database was queried to determine each surgeon's h-index and M-quotient, among other bibliometric parameters.

Results

Our study included 173 plastic surgeons, 90% of whom were men. In total, 49.7% were working in academically affiliated hospitals; 14.4% of the surgeons had an academic rank. The mean h-index was 6.13; mean M-quotient was 0.27. Statistical analysis demonstrated a positive correlation between total number of publications (P < 0.0001), total number of citations (P < 0.0001), the surgeon's seniority (P < 0.0001), academic rank (P = 0.007), appointed as past/present plastic surgery department director (P < 0.0001), and working in an academic affiliated hospital (P < 0.025). The same parameters were found to have a positive correlation with M-quotient.

Conclusions

The h-index is an effective measure to compare plastic surgeons' research productivity in Israel. M-quotient is an ancillary tool for the assessment of research productivity among plastic surgeons, with the advent of neutralizing the surgeon's seniority.

The State of Diversity in Academic Plastic Surgery Faculty across North America

BACKGROUND

Gender and racial disparity is prevalent in all surgical subspecialties with women and racial groups historically underrepresented in academic plastic surgery. This study evaluated gender and racial profiles of academic plastic surgery faculty in North America and correlated both with research productivity and its effect on academic ranks of faculty in plastic surgery.

METHODS

In this cross-sectional study, we compiled a list of accredited medical schools that offer plastic surgery training for residency. Data were collected on demographics, academic rank, and research output using the Doximity, LinkedIn, and Scopus databases. Data analyses were performed with a Mann-Whitney U test and a Kruskal-Wallis test.

RESULTS

Women who were black, indigenous, and/or other color occupied only 6.25% of plastic surgery faculty leadership positions in North America. There are more women and underrepresented minorities in leadership positions in Canada, when compared with the USA, relative to each country's demographic. In both countries, women and underrepresented minority plastic surgeons had fewer publications, citations, and years of active research. Interestingly, having women in leadership positions was associated with a higher number of women faculty members.

CONCLUSIONS

Gender and racial disparity exist in academic plastic surgery in North America. Several changes are required in order for women and underrepresented minorities in medicine to have an equal chance at career advancement. Better representation and diverse leadership have the potential to bring about equity, diversity, and inclusion in academic plastic surgery.

Research productivity of radiation therapy physics faculty in the United States

Purpose

Research productivity metrics are important for decisions regarding hiring, retention, and promotion in academic medicine, and these metrics can vary widely among different disciplines. This article examines productivity metrics for radiation therapy physicists (RTP) in the United States.

Methods and materials

Database searches were performed for RTP faculty at US institutions that have RTP residencies accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP). Demographics, academic rank, number of publications, academic career length, Hirsch index (h‐index), m‐quotient, and history of National Institutes of Health (NIH) funding as a principal investigator (PI) were collected for each RTP. Logistic regression was performed to determine the probability of academic rank as a function of h‐index and m‐quotient. Statistical tests used included the Wilcoxon ranked sum test and the Pearson χ² test.

Results

A total of 1038 faculty and staff were identified at 78 institutions with CAMPEP‐accredited residencies. The average RTP academic career duration is 13.5 years, with 46.7 total publications, h‐index of 10.7, and m‐quotient of 0.66. Additionally, 10.5% of RTP have a history of NIH funding as a PI. Large disparities were found in academic productivity of doctoral‐prepared physicists compared to those with a terminal master's degree. For differences in junior and senior faculty, statistical tests yielded significance in career duration, number of publications, h‐index, and m‐quotient. Gender disparities were identified in the overall distribution of RTP consistent with the membership of the American Association of Physicists in Medicine. Further gender disparities were found in the number of doctoral‐prepared RTP and physicists in senior faculty roles.

Conclusions

This manuscript provides objective benchmark data regarding research productivity of academic RTP. These data may be of interest to faculty preparing for promotion, and also to institutional leadership.

Gender Disparities Among Burn Surgery Leadership

Gender disparities have been described in the plastic surgery and general surgery literature, but no data have been reported in burn surgery. The aim of this study is to determine gender disparities among burn surgery leadership. A cross-sectional study was performed. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers, past presidents of the ABA, and International Society for Burn Injuries (ISBI), and editors of the Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma. Training, age, H-index, and academic level and leadership position were compared among surgeons identified. Among the 69 ABA and ISBI past presidents, 203 burn journals' editorial board members, and 71 burn unit directors, females represented only 2.9%, 10.5%, and 17%, respectively. Among burn unit directors, females completed fellowship training more recently than males (female = 2006, male = 1999, P < .02), have lower H-indexes (female = 8.6, male = 17.3, P = .03), and are less represented as full professors (female = 8.3%, male = 42.4%, P = .026). There were no differences in age, residency, research fellowship, or number of fellowships. Gender disparities exist in burn surgery and are highlighted at the leadership level, even though female surgeons have a similar age, residency training, and other background factors. However, gender diversity in burn surgery may improve as females in junior faculty positions advance in their careers.

Representation of Women on Plastic Surgery Journal Editorial Boards in the United States

BACKGROUND

During the past decade, a growing number of women have pursued medical careers, including in plastic surgery. However, female physicians have tended to be underrepresented in a variety of leadership roles in their respective specialties.

OBJECTIVES

The authors sought to evaluate the representation of female plastic surgeons on the editorial boards of high-impact plastic surgery journals.

METHODS

The gender of editorial board members on 3 high-impact plastic surgery journals was evaluated from 2009 and 2018. The number of women on each editorial board was then compared with the number of board-certified female plastic surgeons (BCFPS) and board-certified female academic plastic surgeons (BCFAPS), a subgroup of BCFPS.

RESULTS

There were 555 unique editorial board members from Plastic and Reconstructive Surgery, Aesthetic Surgery Journal, and Annals of Plastic Surgery from 2009 to 2018. During that period, 72 editors (13.0%) were women. At the beginning of the study, there were significantly fewer female editors than expected based on proportionate representation of BCFPS and BCFAPS to all board-certified plastic surgeons (P = 0.007 and 0.007, respectively). During the study, there was a 177% increase in women holding editorial board positions. At study end, women were adequately represented on all 3 editorial boards compared with their population data (BCFPS and BCFAPS).

CONCLUSIONS

During the 10 years of this study (2009-2018), editorial boards have overcome the underrepresentation of women on, and female plastic surgeons are currently adequately represented on the top 3 high-impact journal editorial boards.

Leaders of the Pack: A Comparison of Chairs and Chiefs to Other Surgeons in American Academic Plastic Surgery

ABSTRACT

Chairs/chiefs of plastic surgery departments/divisions are responsible for directing activities at academic institutions and thus help determine the direction of academic plastic surgery. Other studies have characterized this group but have not shown which characteristics separate them from other surgeons in the field. To study this relationship, a cross-sectional analysis of plastic surgery faculty affiliated with United States residency training programs (n = 99) was initiated. Data were collected from public online websites. Univariate and multivariate logistic regression were used to identify factors independently associated with chairs/chief status. Sub-analyses were performed within Tiers stratified by residency program rank of chair/chief's current institution. Among 943 plastic surgeons, 98 chairs/chiefs were identified. In accordance with prior literature, most are male (89%) and fellowship-trained (62%), and they have a median H-index of 17. Compared to other surgeons, chair/chiefs have more years in practice (odds ratio [OR]: 1.026, confidence interval [CI]: 0.002-0.049, P = 0.034), higher H-index (OR: 1.103, CI: 0.048-0.147, P < 0.001), and more citations (OR: 1.000, CI: -0.000 to -0.001, P = 0.006). Chair/chiefs were also more likely to be journal editorial board members (OR: 1.728, CI: -0.033 to 1.127, P = 0.046) and national society/organization presidents (OR: 1.024, CI: 0.008-0.039, P = 0.003). No notable differences were found between department chairs versus division chiefs or across Tiers. Overall, scholarly achievement and significant years of experience distinguish chairs/chiefs in American academic plastic surgery. Criteria for achieving this leadership role may not differ between departments and divisions. Further research is needed to evaluate whether these characteristics translate into more effective leadership.

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

IMPORTANCE

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

DATA EXTRACTION AND SYNTHESIS

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

MAIN OUTCOMES AND MEASURES

The primary study outcome was the h-index.

RESULTS

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

CONCLUSIONS AND RELEVANCE

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

Diversifying Researchers and Funding in Otolaryngology

Research productivity is a key metric used in evaluation for advancement and promotion in academic medicine. There are known gender, race, and ethnicity disparities in otolaryngology research and funding. Female academic otolaryngologists have been shown to lag in scholarly productivity, representation at national meetings, leadership positions on journal editorial boards, and National Institutes of Health and industry funding. Underrepresented minorities have been shown to be less successful at obtaining Centralized Otolaryngology Research Efforts grant funding. Directed approaches, such as research funding for women and minorities or targeted recruitment and retention of underrepresented faculty, may move the field toward parity.

Diversity in Plastic Surgery: Trends in Female Representation at Plastic Surgery Meetings

BACKGROUND

Prior studies have shown that roadblocks exist for women to achieve higher career levels in plastic surgery. The authors evaluate female representation as lecturers, panelists, and moderators at national and regional plastic surgery meetings.

METHODS

The annual meetings between January 2014 and January 2019 for 12 national and regional plastic surgery societies were included in this study. Data regarding sex of speakers were extracted from meeting programs. Binomial distribution analysis was used to compare female representation at meetings as compared with female representation among plastic surgeons. Analysis of variance with Tukey post hoc analysis was used to evaluate for differences in female representation among regions and subspecialties.

RESULTS

Females comprised 14.8% of speakers, including instructors, moderators, and panelists, at all included plastic surgery meetings. There has not been a significant increase in the representation of females at plastic surgery meetings in the past 5 years (P = 0.08). Five of 12 societies had significantly lower female representation as speakers than expected by the proportion of female plastic surgeons (P < 0.05). American Society for Craniofacial Surgeons had significantly lower representation as compared with other subspecialty meetings (P < 0.01), and Texas Society of Plastic Surgeons had significantly lower representation among regional meetings (P < 0.05).

CONCLUSIONS

Female representation among plastic surgery residents and faculty has increased, yet women remain disproportionately underrepresented on the podium at educational meetings. Providing women the opportunity to serve as speakers, moderators, and panelists at meetings will ultimately enhance the diversity of our plastic surgical leadership.

Gender Disparity in Abstract Presentation at Plastic Surgery Meetings

BACKGROUND

Medical and surgical fields continue to be marred by gender disparities. The "leaky pipeline" effect, representing a gradual decline in female representation along the academic ladder, has been well documented in plastic surgery. However, gender differences in abstract presentation at national plastic surgery meetings and subsequent publications remains elusive.

METHODS

We reviewed abstracts presented at the 2014 and 2015 annual meetings of the American Association of Plastic Surgeons (AAPS); American Society of Plastic Surgeons (ASPS), and the Plastic Surgery Research Council (PSRC). Several abstract characteristics including the names of the first and last authors were extracted. Genderize.io and Google search were used to identify the authors' gender.

RESULTS

We identified 1174 abstracts presented at the three identified meetings. Females comprised 29% of the presenters and 16% of abstract senior authors (ASAs). No gender differences were identified between the meetings, type of presentation (oral versus poster), and year of presentation. The only difference was in the subspecialty of the abstracts. Successful conversion to full-text articles was similar for male and female presenters (68% versus 62%, P = 0.065) but higher for male ASAs (68% versus 59%, P = 0.01). When an author change occurred, female presenters and ASAs were more likely to be replaced by males (P < 0.001).

CONCLUSION

Gender differences continue to be evident in academic plastic surgery with women constituting a minority of both presenters and senior authors on abstracts presented at national plastic surgery meetings. Future work should assess whether flexible and supportive work policies can foster greater female representation in academic plastic surgery.

Assessment of the Academic Productivity of Plastic Surgeons in Saudi Arabia Using the h-index

Hirsch-index (or h-index) is a bibliometric measure calculated for researchers based on number of publications and their citations. This study examined the h-index of board-certified plastic surgeons in Saudi Arabia and the different factors that may influence it.

METHOD

In this cross-sectional study, an electronic questionnaire was sent to 156 board-certified plastic surgeons practicing in Saudi Arabia. Using their names, we conducted an online search on Scopus, Semantic scholar, and Google scholar to calculate their h-index. Bivariate and multiple regression analyses were conducted to determine the relationship of those factors with the index.

RESULTS

A total of 84 surgeons participated in this study, of whom 83.3% were men. Our sample scored a mean index of 1.7 and published a mean of 5 articles. More publications and a higher academic rank predicted a higher h-index, (β = 0.79, P < 0.001) and (β = 0.14, P 0.017), respectively. On the other end of the spectrum, the country of residency training (P 0.33), the year of training completion (P 0.95), attaining fellowship training (P 0.95), the number of fellowships (P 0.20), interest in research (P 0.74), working in an academic hospital (P 0.44), or attaining a higher degree (P 0.61) were not significant independent predictors of the index.

CONCLUSIONS

More publications and a higher rank predicted increased academic productivity among the plastic surgeons in Saudi Arabia. Despite its limitations, h-index is a useful measure that can be considered in promotions and applications to prestigious plastic surgery centers in adjunct to other factors.

Effects of institutional policies and characteristics on research productivity at Vietnam science and technology universities

This study aimed to evaluate the impact of institutional research promoting policies and organizational characteristics on research productivity in Vietnam universities. The authors employed a dataset surveying faculty staff from 115 universities across the country and used multivariate data analysis to analyse data and test hypotheses. It was found that institutional characteristics such as size, time in operation and advantageous location were positively associated with research productivity. Specifically, universities located in the big cities with longer time in operation and larger size had higher level of international publication. Institutional policies such as management and infrastructure had a positive impact on research productivity while human resource policies had a positive impact on faculty research outcomes. The study also provided some suggestions to promote research productivity of Vietnam universities.

Characteristics and Academic Productivity Among Pediatric Plastic Surgeons in the United States

BACKGROUND

The characteristics that predispose plastic surgeons to a career in pediatric plastic surgery remain unclear. Therefore, the aim of this study is to analyze the characteristics of current pediatric plastic surgeons and to determine their academic productivity.

METHODS

Pediatric plastic surgeons were identified through an internet search of all academic children's hospitals affiliated with an Accreditation Council for Graduate Medical Education-accredited integrated or independent plastic surgery program. Demographics, training background, institutional and leadership positions, and academic productivity were determined.

RESULTS

A total of 304 pediatric plastic surgeons were identified. The majority of pediatric plastic surgeons were white (n = 217, 71.8%) males (n = 235, 77.6%). Clinical fellowships were completed by 86.8% (n = 263) of the cohort, with craniofacial (n = 181, 59.7%) being the most common followed by hand (n = 54, 17.8%); 41.1% had clinical fellowship training at 10 institutions, with the top 3 most represented programs being University of Pennsylvania (n = 19, 6.2%), University of California-Los Angeles (n = 16, 5.3%), and Harvard University (n = 15, 4.9%); 25.7% (n = 78) held leadership positions within their institutions. A significant higher academic productivity was found among research fellowship-trained surgeons, chiefs of pediatric plastic surgery, fellowship directors, and members of departments of plastic surgery. Those who completed an independent residency had a significant higher H-index and number of citations.

CONCLUSION

Pediatric plastic surgery is represented by surgeons of diverse training background. An elite cohort of programs has trained the most pediatric plastic surgeons. Lastly, high academic productivity was found to be correlated with certain demographic and leadership variables highlighting its impact on career advancement.

Follow the money: Investigating gender disparity in industry payments among senior academics and leaders in plastic surgery

Introduction

Differences in academic qualifications are cited as the reason behind the documented gender gap in industry sponsorship to academic plastic surgeons. Gendered imbalances in academic metrics narrow among senior academic plastic surgeons. However, it is unknown whether this gender parity translates to industry payments.

Methods

We conducted a cross-sectional analysis of industry payments disbursed to plastic surgeons in 2018. Inclusion criteria encompassed (i) faculty with the rank of professor or a departmental leadership position. Exclusion criteria included faculty (i) who belonged to a speciality besides plastic surgery; (ii) whose gender could not be determined; or (iii) whose name could not be located on the Open Payment Database. Faculty and title were identified using departmental listings of ACGME plastic surgery residency programs. We extracted industry payment data through the Open Payment Database. We also collected details on H-index and time in practice. Statistical analysis included odds ratios (OR) and Pearson’s correlation coefficient (R).

Results

We identified 316 senior academic plastic surgeons. The cohort was predominately male (88%) and 91% held a leadership role. Among departmental leaders, women were more likely to be an assistant professor (OR 3.9, p = 0.0003) and heads of subdivision (OR 2.1, p = 0.0382) than men. Industry payments were distributed equally to male and female senior plastic surgeons except for speakerships where women received smaller amounts compared to their male counterparts (median payments of $3,675 vs $7,134 for women and men respectively, p<0.0001). Career length and H-index were positively associated with dollar value of total industry payments (R = 0.17, p = 0.0291, and R = 0.14, p = 0.0405, respectively).

Conclusion

Disparity in industry funding narrows at senior levels in academic plastic surgery. At higher academic levels, industry sponsorship may preferentially fund individuals based on academic productivity and career length. Increased transparency in selection criteria for speakerships is warranted.

Implications of Training Pathways on Future Academic Plastic Surgeon Employment

BACKGROUND

The limited supply of academic plastic surgery positions has led to increased demand and strong competition for these desired positions. Residents and students now seek out academic opportunities earlier in their training to account for this employment shortage. Training pathways and locations play an extremely important role in obtaining an academic position at most institutions. This study aimed to evaluate the training patterns of academic plastic surgeons in an attempt to elucidate its value and role for trainees interested in pursuing future academic careers.

METHODS

All full-time faculty members at currently accredited integrated and independent plastic surgery programs were included in the study; clinical affiliates were excluded. These institutions' websites were then queried to obtain the training history of the surgeons meeting inclusion criteria. Data were entered into a centralized database from which descriptive statistics were obtained.

RESULTS

In the 741 surgeons included in the study, 514 (69.4%) completed the independent plastic surgery track and 227 (30.6%) completed the integrated pathway. Residents completing the independent track had 20.8% and 31.7% employment at the same institution where they finished their general and plastic surgery residency, respectively. Of those completing the integrated pathway, 33.9% are employed at the same institution where they graduated from residency. In addition, 47.9% of the surgeons included in the study completed medical school, residency, or fellowship at the current institution at which they are employed. Lastly, 512 surgeons (69.4%) completed at least 1 postresidency fellowship.

CONCLUSIONS

Academic surgeons commonly complete a postresidency fellowship and are often employed at institutions where they have formerly trained. Trainees considering an academic career should consider these patterns when planning their future careers.

Academic Productivity in Plastic Surgery: A Comparison of US and International Medical Graduates

INTRODUCTION

International medical graduates (IMGs) make up nearly 10% of plastic surgeons in the United States, yet there is little information regarding their relative contributions to the field of academic plastic surgery. This study compares the research productivity and academic rank of IMG academic plastic surgeons and their US medical graduate (USMG) counterparts.

METHOD

A cross-sectional study was performed to include all IMG and USMG full-time academic plastic surgeons in the United States. For each IMG and USMG academic plastic surgeon, bibliometric variables such as the Hirsch index (h-index), i10-index, total number of publications, total number of citations, and greatest number of citations for a single published work were computed.

RESULTS

One-hundred and forty-four full-time IMG and 828 USMG academic plastic surgeons met inclusion criteria. There were no significant differences between IMGs and USMGs regarding h-index, i10-index, total number of publications, and total number of citations. Both IMGs and USMGs have higher numbers of publications following graduation from a plastic surgery residency or fellowship as compared to pre-residency or fellowship (37.2 ± 71.5 versus 8.0 ± 19.2 and 45.0 ± 73.1 versus 9.1 ± 15.5, respectively).

CONCLUSIONS

IMG and USMG plastic surgeons have nearly equivalent research productivity. Both cohorts continue to have high research outputs following graduation from a plastic surgery residency or fellowship.

Gender Disparity Among American Medicine and Surgery Physicians: A Systematic Review

BACKGROUND

Disparity exists between men and women physicians. We aimed to examine changes in gender disparity in the medical profession over the last two decades. The study reviewed publications on gender differences and the measures which have been implemented or suggested to rectify these disparities.

METHODS

Pubmed, Embase, Scopus, and The Cochrane Library were searched in December 2019 using ("gender disparity" OR "gender gap" OR "pay gap" OR "gender discrimination") from 1998-2019. The sources list of reviewed articles was also used to retrieve more relevant articles. Articles about physicians in the United States were included, and Critical Appraisal Skills Programme (CASP) was used to evaluate the quality of the articles.

RESULTS

In this systematic review that includes 49 studies, there is still disparity and discrimination in research, leadership, and pay between male and female physicians. Women have less leadership roles and progress at a slower rate to associate and full professor. Women publish less articles and have a lower h-index than men. Men earn $20,000 more a year after salary adjustment. More women than men experience negative comments about their gender (36% vs 4%), experience gender discrimination (65% vs 10%) and sexual harassment (30% vs 6%).

CONCLUSIONS

Although substantial research exists on this topic, there remains significant room for improvement to achieve gender equality. Institutions and individuals should implement interventions to rectify this disparity .

Analysis of academic publishing output among 1634 successful applicants in the 2011-2018 neurosurgery residency match

BACKGROUND

Research productivity is a key criterion for applicant selection reported by residency program directors. Research volume reported on neurosurgery residency applications has risen steadily over the past decade.

OBJECTIVE

Perform retrospective bibliographic searches of successful applicants who matched into U.S. neurosurgery residency programs from 2011 to 2018, and assess the relationship between academic publishing and residency placement.

METHODS

Gender, MD/PhD status, U.S. News research ranking of medical school, and international medical graduate status (IMG) were determined for 1634 successful applicants from 2011 to 2018. Indexed publications before and after the start of residency were tabulated by Scopus®. Publication counts were stratified by first author, basic/clinical science, case reports, reviews, or other research. We then compared publishing trends across demographic variables and match cohorts.

RESULTS

Average pre-residency publications increased from 2.6 [1.7, 3.4] in 2011 to 6.5 [5.1, 7.9] in 2018. Men, PhD-holders, Top 20 and Top 40 U.S. medical school graduates, and IMGs had higher pre-residency publication counts overall. After stratifying by match cohort, however, there was no significant effect of gender on pre-residency publications. Applicants matching into residency programs with highly ranked affiliated hospitals had significantly higher pre-residency publications.

CONCLUSION

Publishing volume of successful neurosurgery applicants in the U.S. has risen recently and is associated with the stature of matched residency programs. Given the gap between verifiable and claimed research on residency applications, attention is needed to objectively evaluate research credentials in the selection process. The impending phase out of USMLE step 1 scores may increase emphasis on academic productivity.

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

The Glass Ceiling in Plastic Surgery: A Propensity-Matched Analysis of the Gender Gap in Career Advancement

BACKGROUND

Gender parity remains elusive in academic plastic surgery. It is unknown whether this disparity is attributable to differences in qualifications or to the glass ceiling of gender bias. To parse this, the authors compared academic titles and departmental leadership of female academic plastic surgeons to a matched group of their male counterparts.

METHODS

The authors conducted a cross-sectional analysis of academic plastic surgeons. The authors identified faculty, sex, academic rank, and leadership positions from plastic surgery residency program websites. The authors then collected details on training institution, advanced degrees, years in practice, and h-index for use as independent variables. The authors performed a propensity score analysis to 1:1 match male and female academic plastic surgeons.

RESULTS

A total of 818 academic plastic surgeons were included. The cohort was predominately male [n = 658 (81 percent)], with a median 12 years in practice and a median h-index of 9. Before matching, men had more years in practice (13 years versus 9 years; p < 0.0001), a greater h-index (11 versus 5; p < 0.0001), were more likely to be professors (34 percent versus 13 percent; p < 0.0001), and held more leadership positions than women (41 percent versus 30 percent; p = 0.0221). Following matching, gender parity was demonstrated in academic rank and departmental leadership.

CONCLUSIONS

Differences in training, qualifications, career length, and academic productivity may account for the leadership gap in academic plastic surgery. Gendered difficulties in reaching qualification benchmarks must be addressed before gender parity in promotion can be achieved.

Gender Representation at Conferences, Executive Boards, and Program Committees in Otolaryngology

OBJECTIVE

Women represent approximately 28.0% of academic otolaryngologists. Previous studies have shown that women in academic medicine, including surgical subspecialties, have disparate career advancement opportunities and grant funding compared to male counterparts. Representation at major academic meetings is an important career advancement opportunity. In this study, we assess the representation of women at otolaryngology conferences.

STUDY DESIGN

Cross-sectional analysis of otolaryngology conference programs.

METHODS

All publicly available scientific programs from The American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting (AAO-HNSF), the Triological Society Annual Combined Sections Meeting (TS), and the Triological Society Annual Meeting at Combined Otolaryngology Spring Meetings (TS-COSM) were obtained and analyzed. Name and gender were collected, along with the type of role: speaker, panelist, oral session moderator, and other leadership positions. Yearly trends were analyzed and compared between the conferences and in aggregate.

RESULTS

AAO-HNSF had available scientific programs from 2012-2017, while TS and TS-COSM had programs available from 2003-2018. Across all conferences and years, 16.9% of recorded opportunities were occupied by women, with an upward trend from 2005 to 2018. Program committees had the highest proportion of women (21.4%) and presidential citation and guest of honor recipients had the lowest (9.1%). Of all panels, 87.5% did not have any women panelists in 2003, but by 2018 only 24.0% panels were male-only. There was marked repetition among women occupying roles, with only 423 unique women occupying a total of 1,733 filled spots.

CONCLUSION

Measured representation of women in academic otolaryngology conferences has improved from 2003-2018. Despite this improvement, gender disparity still exists.

LEVEL OF EVIDENCE

5 Laryngoscope, 131:E373-E379, 2021.