Women's Representation Among Members and Leaders of National Medical Specialty Societies

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

BACKGROUND

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

DESIGN

Cross-sectional.

SUBJECTS

Faculty physicians within internal medicine and subspecialties.

MAIN MEASURES

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

KEY RESULTS

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

CONCLUSIONS

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

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.

The Effect of Implicit Bias on the OB/GYN Residency Application Process

Background Medical students from racially minoritized backgrounds receive negative evaluations more frequently, possibly from implicit bias. Objective To determine if a preference for White applicants over Asian and Black applicants exists among resident and attending reviewers of obstetrics and gynecology (OB/GYN) residency applications. Methods In 2021, we sampled academic OB/GYN physicians from 6 academic institutions to randomly receive questionnaire form A or B, each containing 4 contrived Electronic Residency Application Service profiles stratified by United States Medical Licensing Examination scores; institutions attended; and strength of recommendation letters into top-, mid-, and low-tiers. Form A applicants were White top-tier, White mid-tier without resilience, Asian mid-tier with resilience, and White low-tier. Form B applicants were Black top-tier, Asian mid-tier without resilience, White mid-tier with resilience, and White low-tier applicants. Both questionnaires' profiles were identical except for applicants' names and races. The primary outcome was participants' rankings of applicants from most to least desirable. Baseline characteristics of participants were compared with chi-square tests. Rankings were compared using generalized estimating equations to calculate the odds ratio (significance P<.05). Results One hundred and ninety-one were invited to participate; 109 participants started the questionnaire, and 103 ranked applicants (response rate 54%). Fifty-three participants completed form A, and 56 completed form B. No significant differences were found in participants' demographics. Participants frequently ranked White applicants significantly more highly than Black applicants (-3.3, 95% CI -3.5, -3.1) and Asian applicants (-3.3, 95% CI -3.5, -3.1). Conclusions Despite identical qualifications, a stronger preference for White applicants over Black or Asian applicants was found.

Female leadership representation within otolaryngology specialty societies

OBJECTIVES

Determine if women have continued parity in leadership in otolaryngology specialty societies as compared to a paper by Choi and Miller in 2012. Additionally, we wanted insight into obstacles female leaders faced by surveying them directly to better understand their experiences with gender bias.

METHODS

Chi-squared test evaluation was done using the American Academy of Otolaryngology Head and Neck Surgery (AAOHNS) 2020 membership data and directly from various otolaryngology specialty societies. An anonymous survey to assess different experiences of leaders in various Otolaryngology specialty societies was sent to current and past leaders of specialty societies via email. Survey data was assessed using descriptive statistics and multivariate logistical analyses.

STUDY DESIGN

Cross-sectional study and survey study.

RESULTS

Female members comprised 19.3 % of practicing AAOHNS otolaryngologists. All societies had proportionate female leadership representation except for AAOA, which had greater representation. Compared to data from 10 years ago, female representation in all the societies' leadership has not changed significantly. Survey results demonstrated 64.9 % of respondents felt gender bias exists in Otolaryngology. 45.6 % of respondents personally experienced gender bias during their careers. Survey results showed males are less likely to experience gender bias.

CONCLUSION

There is stability in the proportion of women in otolaryngology leadership positions compared to a decade ago largely due to efforts of leaders in the field. However, women leaders note experiencing gender bias and time away from clinical duties are prospective areas where support can be given.

LEVEL OF EVIDENCE: 3

The opportunity to lead facilitates PA professional well-being

OBJECTIVE

Physician associates/assistants (PAs) with mature careers represent an important leadership resource for healthcare employers. This study sought to determine whether PA leadership task responsibility interacted with experience level to predict professional well-being.

METHODS

This quantitative study used an archival dataset from a national sample of PAs. The Professional Fulfillment Index was used to measure well-being and career length was used to represent experience level. PA leadership task responsibility was calculated as an aggregate score. Bivariate linear regression with mediation analysis was conducted to determine the relationship between variables.

RESULTS

An increase in PA experience level predicted higher professional fulfillment and lower burnout, and aggregate leadership task score partially mediated this relationship.

CONCLUSIONS

Granting leadership task responsibility compatible with experience level may enhance PA professional fulfillment, mitigate burnout, and increase PA usefulness for healthcare employers.

Sex disparities in parenteral and enteral nutrition societies' leadership worldwide: a 20-year retrospective analysis

BACKGROUND

Despite advancements in the global dialog surrounding sex and gender equity, an important gap persists with women markedly underrepresented in major roles within health care leadership.

OBJECTIVES

We examined the extent of women's representation in prominent positions within parenteral and enteral nutrition (PEN) societies worldwide over a span of 2 decades.

DESIGN

This retrospective analysis explored the sex distribution of society chairs, conference presidents, and editor-in-chief positions across 64 PEN societies between 2003 and 2022. Additionally, data on the first and last authors of endorsed clinical guidelines were collected from the 2 leading societies.

RESULTS

Over the past 20 y, women held society chair positions in 34.4% of cases. The representation shifted from 30% during the decade from 2003 to 2012 to 40.5% from 2013 to 2022. Throughout these years, the numbers consistently ranged from 0 to 10; however, the median shifted upward from 1 during the first decade to 4 in the subsequent decade (P = 0.04). Of 420 congress presidencies, ∼30% were women. In endorsed guidelines, women were the first authors in 27.1% of cases (P < 0.001) and the last in 28.9% (P < 0.001) compared with men. Of the 123 journal editor-in-chief positions, women occupied 23 (18.7%).

CONCLUSION

Over the last 2 decades, women have been consistently underrepresented in prominent leadership roles in PEN societies globally. Although there has been a noticeable shift toward more women in chair positions, true sex equality remains elusive. Moreover, sex disparities are even more pronounced in positions, such as conference presidents, authors of major guidelines, and editors-in-chief of society-affiliated journals. These data underscore the pressing need to enhance efforts toward sex equality across these domains.

Gender Representation of Editors at Journals Affiliated with Major U.S. Medical Societies

Objectives: To assess the gender composition of upper-level specialty-specific editor positions among United States (U.S.) medical society-affiliated journals and to evaluate the equitable inclusion of women and women physicians. Materials and Methods: The gender composition of upper-level (e.g., editor-in-chief, deputy) specialty-specific editor positions among 39 U.S. medical society-affiliated journals as of January 5, 2023, was analyzed. Editor positions below the level of associate editor were excluded. Parity (50:50 representation) and equity (compared with the proportion of practicing physicians in each medical specialty) benchmarks were utilized to determine if women are underrepresented in editor positions. Results: A total of 862 editor positions among 39 journals were assessed. Women held 32.9% (284/862) of positions (95% confidence interval [CI]: 29.9%-36.2%), significantly less than expected based on the U.S. population (p < 0.001). Physicians comprised 90.8% (783/862) of positions, of whom 30.4% (238/783) were women physicians (95% CI: 27.3%-33.7%), significantly less than expected (p < 0.001). Thirty-three (84.6%, 95% CI: 70.3%-92.8%) journals were below parity for women overall, whereas 34 (87.2%, 95% CI: 73.3%-94.4%) were below parity for women physicians. Fourteen (35.9%, 95% CI: 22.7%-51.6%) journals were below equity for women physicians. Notably, 13 (33.3%, 95% CI: 20.6%-49.0%) journals were below both parity and equity for women overall and women physicians. Conclusions: This study reveals mixed results in the equitable inclusion of women in editor positions of journals affiliated with U.S. medical societies. Despite the equitable inclusion of women in editorial roles being a remediable issue, approximately one third of journals affiliated with major U.S. medical societies remain inequitable.

Gender-gap in randomized clinical trials reporting mortality in the perioperative setting and critical care: 20 years behind the scenes

Background

Women researchers might experience obstacles in academic environments and might be underrepresented in the authorship of articles published in peer-reviewed journals.

Material and Methods

This is a cross-sectional analysis of female-led RCTs describing all interventions reducing mortality in critically ill and perioperative patients from 1981 to December 31, 2020. We searched PubMed/MEDLINE and EMBASE with the keywords RCTs and mortality. The gender of the first author was extracted and descriptive analysis was performed including the year of publication, impact factor, country of the first author, and methodological aspects.

Results

We analyzed 340 RCTs, of which 42 (12%) were led by female researchers. The presence of women increased from 8% (14/172) until 2010 up to 17% (28/168) in 2010 and beyond. The United States, the United Kingdom, and Brazil were the main countries of origin of female researchers. Women authors conducted mainly single-center and single-nation studies as compared to male authors. The median impact factor of the target journal was 6 (3-27) in women vs. 7 (3-28) in men, with a p-value of 0.67; Critical Care Medicine, JAMA, and The New England Journal of Medicine were the most frequent target journals for both women and men.

Conclusion

In the last 40 years, only one out of eight RCTs had a woman as the first author but the presence of women increased up to 17% by 2010 and beyond. The impact factor of publication target journals was high and not different between genders.

Has the Increase of Women in Surgical Training Programs Led to a Concomitant Increase in Female Leadership Positions? A 10-Year Analysis

INTRODUCTION

Women represent greater than 50% of medical students in America and are becoming increasingly well represented in surgical fields. However, parity at the trainee level has yet to be accomplished, and surgical leadership positions have remained disproportionately biased toward men. To date, there have been no comparisons on the progress within plastic surgery and other surgical specialties. This investigates the gender disparity in resident and leadership representation over the past 10 years within surgical specialties and how these disparities compare to plastic surgery.

METHODS

Counts of female and male residents and surgical society leaders were collected from 2008 to 2018. Surgical fields included plastic, vascular, urologic, neurologic, orthopedic, cardiothoracic, and general surgery. Leadership positions were defined as board seats on executive committees of major surgical societies or board associations. Data were acquired from publicly available sources or provided directly from the organizations. Resident data were obtained from the Accreditation Council of Graduate Medical Education residents' reports. Individuals holding more than 1 leadership position within a year were counted only once.

RESULTS

In our aggregated analysis, the proportion of women in surgical leadership lags behind women in surgical residency training across all specialties (13.2% vs 27.3%, P < 0.01). General surgery had the highest proportion of female residents and leaders (35% and 18.8%, P < 0.01), followed by plastic (32.2% and 17.3%, P < 0.01), vascular (28.2% and 11.3%, P < 0.01), urologic (24.3% and 5.1%), and cardiothoracic surgery (20.5% and 7.8%, P < 0.01). Women in surgical leadership, however, increased at a faster rate than women in surgical training (11% vs 7%, P < 0.05). Plastic surgery showed the greatest rate of increase in both residents and leaders (17% and 19%, P < 0.05) followed by cardiothoracic surgery (16% and 9%, P < 0.05) and general surgery (8% and 14%, P < 0.05). For neurologic and orthopedic surgery, neither the difference in proportions between residents and leaders nor the yearly growth of these groups were significant.

CONCLUSIONS

Between 2008 and 2018, women in plastic surgery training and leadership positions have shown the most significant growth compared with other surgical subspecialties, demonstrating a strong concerted effort toward gender equality among surgical professions.

Evaluation of Faculty Parental Leave Policies at Medical Schools Ranked by US News & World Report in 2020

Importance

Physician parents, particularly women, are more likely to experience burnout, poor family-career balance, adverse maternal and fetal outcomes, and stigmatization compared with nonparent colleagues. Because many physicians delay child-rearing due to the rigorous demands of medical training, favorable parental leave policies for faculty physicians are crucial to prevent physician workforce attrition.

Objective

To evaluate paid and unpaid parental leave policies at medical schools ranked by US News & World Report in 2020 and identify factors associated with leave policies.

Design, Setting, and Participants

This cross-sectional national study was performed at US medical schools reviewed from December 1, 2019, through May 31, 2020, and February 1 through March 31, 2021, due to the COVID-19 pandemic. All medical schools ranked by US News & World Report in 2020 were included.

Main Outcomes and Measures

The primary outcome was the number of weeks of paid and unpaid leave for birth, nonbirth, adoption, and foster care physician parents. Institutional policies for the number of weeks of leave and requirements to use vacation, sick, or disability leave were characterized. Institutional factors were evaluated for association with the duration of paid parental leave using χ2 tests.

Results

Among the 90 ranked medical schools, 87 had available data. Sixty-three medical schools (72.4%) had some paid leave for birth mothers, but only 13 (14.9%) offered 12 weeks of fully paid leave. While 11 medical schools (12.6%) offered 12 weeks of full paid leave for nonbirth parents, 38 (43.7%) had no paid leave for nonbirth parents. Adoptive and foster parents had no paid leave in 35 (40.2%) and 65 (74.7%) medical schools, respectively. Median paid parental leave was 4 (IQR, 0-8) weeks for birth parents, 4 (IQR, 0-6) weeks for adoptive parents, 3 (IQR, 0-6) weeks for nonbirth parents, and 0 (IQR, 0-1) weeks for foster parents. About one-third of medical schools required birth mothers to use vacation (29 [33.3%]), sick leave (31 [35.6%]), or short-term disability (9 [10.3%]). Among institutional characteristics, higher ranking (top vs bottom quartile: 30.4% vs 4.0%; P = .03) and private designation (private vs public, 23.5% vs 9.4%; P < .001) was associated with a higher rate of 12 weeks of paid leave for birth mothers.

Conclusions and Relevance

In this cross-sectional national study of medical schools ranked by US News & World Report in 2020, many physician faculty receive no or very limited paid parental leave. The lack of paid parental leave was associated with higher rates of physician burnout and work-life integration dissatisfaction and may further perpetuate sex, racial and ethnic, and socioeconomic disparities in academic medicine.

Gender Differences of Endowed Professorship in Obstetrics and Gynecology Departments at Top Academic Institutions

Background: Gender equity is a critical issue in academic medicine. Whether there is equitable access to the prestige and resources of endowed professorships merits evaluation. We investigated this question in obstetrics and gynecology, a field that focuses on the health of women and in which women are much better represented than other specialties of medicine. Materials and Methods: We compiled a list of the top 25 United States departments of obstetrics and gynecology and contacted department chairs (and used department websites) to obtain lists of faculty and their positions. Scopus, department websites, and National Institutes of Health (NIH) RePORTER were used to collect h-Index, number of publications and citations, graduation year, degrees, gender, and NIH-funding. We conducted a bivariate comparison of endowed professorship attainment by gender using a chi-square test and created a multiple variable regression model. Results: Of the 680 obstetrics and gynecology faculty across 23 departments that had endowed chairs, 64 out of 400 women (16%) and 66 out of 280 men (24%) held endowed chairs (p = 0.01). The multivariable model suggested no independent gender difference in attainment of an endowed chair after adjusting for covariates. Conclusion: To our knowledge, this study is the first to examine gender as a variable in endowed chair allocation in top obstetrics and gynecology academic departments. Our findings suggest a significant gender difference in the allocation of endowed chairs. That difference is driven by gender differences in academic rank, graduation year, publications, and funding. To promote the intraprofessional equity necessary to optimally advance women's health, further research and intervention are necessary.

Gender distribution of editors and authors of reference textbooks in anatomic pathology: further edits are required

Compared to other medical specialties, pathology has a significant number of women in the academic workforce (43%). Gender disparities, particularly those disadvantaging women, are a reality in academic medicine with documented inequalities in salary, leadership opportunities, and faculty promotion. One important element of academic advancement is the recognition obtained when serving as editor or main author of reference textbooks. We aimed to document the gender distribution of editors/authors in anatomic pathology by surveying 205 subspecialty publications over a 20-year period. Gender of each editor/author was recorded after surveying their institutional or other professional biographies. When biography was non-contributory, gender was extracted from the National Provider Identifier Database. A total of 462 editors/authors were identified: 275 (59.5%) men and 187 (40.5%) women. This distribution was similar to the 2015 (39% women) and 2019 (43.4% women) Association of American Medical Colleges (AAMC) benchmark for US academic pathologists. The gender distribution in each of the main anatomic pathology subspecialties was estimated by surveying the websites of 20 North American academic pathology departments (totaling 1893 listed individuals). Compared to this benchmark, some subspecialties had more men in editor/author roles than their representation in academic departments including Dermatopathology (observed vs expected difference, ∆ = 41.3%), Genitourinary Pathology (∆ = 29.4%), Renal & Transplant Pathology (∆ = 22.4%) and Head & Neck Pathology (∆ = 21.6%). Other subspecialties had more women in editor/author roles than their representation in academic departments including Molecular Pathology (∆ = 31.4%), Gastrointestinal Pathology (∆ = 21.4%), and Bone & Soft Tissue Pathology (∆ = 19.4%). Editors/authors of multiple (>1) publications were frequent and skewed gender representation in most specialties. The overall gender distribution of editor/author roles is similar to that of the US pathology workforce. However, significant disparities exist in certain subspecialties affecting both women and men. This landscape can guide efforts by editors, publishers, and academic institutions to bring equity to the academic field by providing fair editorial and authorship opportunities to academic pathologists.

Gender Representation Among United States Medical Board Leadership

Objective: To assess the gender composition of the American Board of Medical Specialties' (ABMS) member boards and evaluate the equitable inclusion of women and a subset of women physicians. Methods: The gender of individuals on 24 boards as of March 1, 2022, was assessed. Two benchmarks-parity (50:50 representation) and equity (compared to the proportion of practicing physicians in each medical specialty)-were utilized to determine if women are equitably represented on medical boards. Results: Four hundred forty individuals hold 449 total positions on the boards examined. Of board the members, 60.7% (267/440) are men, and 92.3% (406/440) are physicians. Physician board members comprised more men (64.0%, 260/406; p < 0.001), whereas more women comprise the 34 nonphysician board members (79.4%, 27/34; p < 0.001). Using specialty representation (equity) as the benchmark, of 22 specialties for which physician gender/sex data are available, women physicians are underrepresented on 36.4% (8/22) of boards. When parity (50%) is the comparator, 72.0% (18/25) of boards comprised less than 50% women. Compared to a 2016 analysis, the proportion of women overall (including non-physicians) increased on 68.0% (17/25), decreased on 24.0% (6/25), and remained unchanged on 8.0% (2/25) of boards in 2022. Conclusions: This study reveals mixed results in the equitable inclusion of women on ABMS boards. Our findings suggest that progress should not be assumed and that it may be subject to setbacks when it occurs. There is a need to continue to monitor the equitable inclusion of women on ABMS boards.

Recognition Awards in Pathology Specialty Societies

OBJECTIVES

Recognition awards build physician reputation and facilitate career advancement. We hypothesize women physicians are underrepresented as award recipients by pathology medical societies compared with representation in the specialty.

METHODS

We analyzed publicly available online information about physician recipients (January 2015 to December 2021) from three general pathology society websites. Recipient gender was determined by pronoun use, first name, and photograph. Representation was compared with Association of American Medical Colleges (AAMC) specialty data from 2015 and 2019, which showed a minimum of 36.7% women pathologists in 2015 and up to 43.4% in 2019.

RESULTS

Twenty-six awards and 230 physician recipients were included in the analysis. A total of 159 (69.1%) men physicians and 71 (30.9%) women physicians received awards. Overall, women physicians were underrepresented in recognition awards compared with AAMC benchmarks. Prestigious awards (defined as those that recognize a person's body of work over time) showed a similar disparity with 22 (30.1%) of 73 recipients being women. Men physicians were more likely to receive multiple awards.

CONCLUSIONS

Women physicians are underrepresented overall for recognition awards by pathology medical societies. Disparities are greater for prestigious awards. Further research is needed to better understand the reasons for these findings and how they affect women physicians' careers.

Gender Diversity in Primary Care Sports Medicine Leadership

ABSTRACT

Diversity, equity, and inclusion have been recognized as important drivers of excellence and innovation in the physician workforce. Given the historical underrepresentation of women in medicine, gender diversity is of interest. In this cross-sectional study, we sought to quantify leadership representation of female physicians in primary care sports medicine settings, including primary care sports medicine fellowship programs, select sports medicine societies, and select sports medicine-related scientific journals. Data were collected by querying the corresponding web site for each fellowship program, society, and journal and analyzed in a descriptive manner. Results showed that fewer female physicians hold primary care sports medicine leadership roles than men do. This work establishes a baseline for female representation in primary care sports medicine leadership; efforts should continue to increase the presence of women in leadership positions.

Leadership Diversity and Development in the Nation's Cancer Centers

The capacity and diversity of the oncology leadership workforce has not kept pace with the emerging needs of our increasingly complex cancer centers and the spectrum of challenges our institutions face in reducing the cancer burden in diverse catchment areas. Recognizing the importance of a diverse workforce to reduce cancer inequities, the Association of American Cancer Institutes conducted a survey of its 103 cancer centers to examine diversity in leadership roles from research program leaders to cancer center directors. A total of 82 (80%) centers responded, including 64 National Cancer Institute-designated and 18 emerging centers. Among these 82 respondents, non-Hispanic White individuals comprised 79% of center directors, 82% of deputy directors, 72% of associate directors, and 72% of program leaders. Women are underrepresented in all leadership roles (ranging from 16% for center directors to 45% for associate directors). Although the limited gender, ethnic, and racial diversity of center directors and perhaps deputy directors is less surprising, the demographics of current research program leaders and associate directors exposes a substantial lack of diversity in the traditional cancer center senior leadership pipeline. Sole reliance on the cohort of current center leaders and leadership pipeline is unlikely to produce the diversity in cancer center leadership needed to facilitate the ability of those centers to address the needs of the diverse populations they serve. Informed by these data, this commentary describes some best practices to build a pipeline of emerging leaders who are representative of the diverse populations served by these institutions and who are well positioned to succeed.

Implementation of a Family Support Grant to Subsidize Caregiving Needs and Support Attendance at American Society for Nutrition's Annual Professional Scientific Conference

Attendance at professional society meetings facilitates networking, collaboration, and success in academic/scientific fields. Insufficient funds, support, or resources for caregiving can inhibit attendance for parents/caretakers, who may become professionally disadvantaged by not attending professional society conferences. The American Society for Nutrition (ASN) offered a family support grant for caregiving needs during the annual conference (maximum: $750); however, the perceived impact of caregiving funds on attendance outcomes is unknown. The objective of this study was to assess the need of family support for attendance to the ASN annual conference among applicants and to assess recipients' experience and usage of funds. Applicants completed a pre-conference survey assessing requested funds, out-of-pocket caregiving expenses to attend the meeting, the influence of receiving the grant on attendance, and additional factors. Recipients completed a post-conference survey assessing use of the funds and impact of the grant on attending/participating. Grant applications (n = 110) were majority women, aged 26-45 y, married, at the trainee or assistant professor level, from diverse racial/ethnic backgrounds, and with parenting noted as the primary responsibility. Thirty-seven percent of applicants were currently lactating or expressing milk. The average amount requested was $650 US dollars, and >60% of respondents indicated plans to use funds to bring a family member/friend to the conference. Seventy-seven percent of respondents indicated that receiving the grant would influence their attendance. The post-conference survey (n = 25) indicated that recipients felt that receiving the grant was helpful in attending the conference (92%), specifically attending scientific sessions (96%) and poster sessions (80%). Recipients indicated the grant helped them network with attendees (88%), visit the exhibitor hall (72%), and participate in career development activities (64%). The ASN family support grant aided attendance and supported recipients' participation in conference activities, particularly early-career women who are parents, with the goal of supporting diversity and inclusivity in scientific/academic fields. This trial was registered at www.clinicaltrials.gov as NCT03432585.

Factors Associated With Endowed Chair Allocation in Medical Oncology in the United States

To explore persisting gender disparities across leadership roles in medicine, we examined factors associated with holding endowed chairs in US oncology divisions. In 2019, we identified 95 academic oncology divisions, using the Oncology Division Chiefs and Department Chairs listing in the American Society of Clinical Oncology myConnection forum. We collected public information on gender, degree, total National Institutes of Health funding as principal investigator, H-indices, publication and citation numbers, and graduation year and constructed a multivariable logistic regression model. All statistical tests were 2-sided. We identified 1087 oncology full professors. Of these, 287 (26.4%) held endowed chairs: 60 of 269 women (22.3%) vs 227 of 818 men (27.8%) (P = .08). On multivariable analysis, greater research productivity and National Institutes of Health funding were associated with having an endowed chair (P < .001), whereas gender was not (P = .45). Though sample size was limited, if gender differences are in fact smaller in certain subspecialties than other fields of internal medicine, insights might emerge to guide efforts to promote equity.

Moving beyond ‘think leadership, think white male’: the contents and contexts of equity, diversity and inclusion in physician leadership programmes

The lack of both women and physicians from groups under-represented in medicine (UIM) in leadership has become a growing concern in healthcare. Despite increasing recognition that diversity in physician leadership can lead to reduced health disparities, improved population health and increased innovation and creativity in organisations, progress toward this goal is slow. One strategy for increasing the number of women and UIM physician leaders has been to create professional development opportunities that include leadership training on equity, diversity and inclusivity (EDI). However, the extent to which these concepts are explored in physician leadership programming is not known. It is also not clear whether this EDI content challenges structural barriers that perpetuate the status quo of white male leadership. To explore these issues, we conducted an environmental scan by adapting Arksey and O’Malley’s scoping review methodology to centre on three questions: How is EDI currently presented in physician leadership programming? How have these programmes been evaluated in the peer-reviewed literature? How is EDI presented and discussed by the wider medical community? We scanned institutional websites for physician leadership programmes, analysed peer-reviewed literature and examined material from medical education conferences. Our findings indicate that despite an apparent increase in the discussion of EDI concepts in the medical community, current physician leadership programming is built on theories that fail to move beyond race and gender as explanatory factors for a lack of diversity in physician leadership. To address inequity, physician leadership curricula should aim to equip physicians to identify and address the structural factors that perpetuate disparities.

The State of Racial and Gender Diversity In Cardiothoracic Surgery Training

BACKGROUND

The field of cardiothoracic surgery has been striving to increase its gender and racial diversity. We sought to examine changes in gender and racial diversity in cardiothoracic fellowships and integrated residencies in the past decade.

METHODS

Accreditation Council for Graduate Medical Education data was obtained from 2011 to 2019. Presence of linear trends was assessed for year-by-year data. Average percentages of women and under-represented minorities were then calculated in three-year intervals. Intervals were compared with t-test and chi-square tests.

RESULTS

There was no statistically significant increase in percent female trainees in cardiothoracic fellowships (18.5% to 22.1% [p=0.10]) or integrated residencies (22.8% to 27.8% [p=0.17]), despite a significant increase in percent female applicants to fellowship (18.2% to 35.3% [p<0.01]) and integrated residency (8.9% to 33.0% [p<0.01]). Cardiothoracic fellowships had no increase in under-represented minority trainees (8.3% to 9.4% [p=0.48]). Under-represented minority trainees in integrated residencies increased from 2.7% to 6.9% [p=0.03]. Although there was no significant increase in under-represented minority applicants to fellowships (10.2% to 11.3% [p=0.66]), the percent of under-represented minority applicants to integrated residencies increased from 13.1% to 19.3% [p<0.01].

CONCLUSION

Cardiothoracic surgery training programs are attracting more female applicants, but this has not resulted in more female trainees. While percentages of under-represented minorities increased among integrated residency applicants and trainees, they remain low compared to other specialties. This data reflects positive changes but highlights that much remains to be done to increase diversity in cardiothoracic surgery training.

Women in Medicine: The Limits of Individualism in Academic Medicine

In the 21st century, more than ever before, issues facing women in medicine, such as pay equity and workplace harassment, are being explored and attended to by physicians and health care institutions. Discussions about women in medicine almost exclusively center around women physicians, even though most women in medicine are, in fact, not physicians. In addition, these discussions typically focus on gender, often failing to consider how race, class, and other dimensions of identity influence the experiences of women in medicine. In this article, the authors argue that neoliberal feminism is the dominant strand of feminism in the discourse of women in medicine. With its focus on the individual and a conception of success defined in largely economic terms, neoliberal feminism fails to consider the broader conditions in which women are situated and, therefore, limits structural criticism and the possibility for all women to engage in social justice. The authors suggest that the pandemic is an opportunity to pursue a more expansive vision of feminism in medicine. They propose intersectional feminism as a theoretical framework that can widen the understanding of what is possible: moving from individual actions resulting in incremental change to collective action that can transform systems. Intersectional feminism enables a push for structures, institutions, and practices that support all workers, including basic income, labor protections, public childcare, accessible health care, transportation justice, and migrant rights. In so doing, intersectional feminism calls for solidarity with and among women both within and outside of medicine.

Development and Implementation of an International Virtual Didactic Series for Physical Medicine and Rehabilitation Graduate Medical Education During COVID-19

ABSTRACT

Coronavirus disease of 2019 presented significant challenges to residency and fellowship programs. Didactic lectures were particularly affected as redeployment of faculty and trainees, limitations on in-person gathering, and other barriers limited opportunities for educational engagement. We sought to develop an online didactic series to address this gap in graduate medical education.Lecturers were recruited via convenience sample and from previous Association of Academic Physiatrists presenters from across the United States and Canada; these presented via Zoom during April and May 2020. Lecturers and content reflected the diverse nature of the specialty. Learning objectives were adapted from the list of board examination topics provided by the American Board of Physical Medicine and Rehabilitation.Fifty-nine lectures were presented. Maximum concurrent live viewership totaled 4272 and recorded lecture viewership accounted for an additional 6849 views, for a total of at least 11,208 views between the date of the first lecture (April 9, 2020) and May 1, 2021. Live viewers of one of the lectures reported participating from several states and 16 countries.The Association of Academic Physiatrists-led virtual didactics augmented graduate medical education during the coronavirus disease of 2019 pandemic, and data confirm that the lectures have continued to enjoy a high level of viewership after the cessation of live lectures.

Gender and Leadership Positions in Spanish Dentistry

Dentists in Spain reached equal gender representation in 2012 and the number of female dentists has continued to grow (until 57.3% in 2020). This study aims to increase evidence about the gender distribution on the high responsibility positions and opinion leaders of the dental profession and academia. Composition of the executive comities of the main dental institutions of Spain (regional professional associations, national dental association, and scientific societies), members of the Faculty of Dentistry of the University of Granada in 2020 and speakers of the main dental congresses of 2019 (due to the lack of congress in 2020) were recorded and analyzed by genders using chi-squared test (P < .05). Mean representation of female dentists in executive committees of professional associations was 35.6%. More than 70% of presidents and vice-presidents of professional colleges and more than 60% of these positions in scientific societies were occupied by male dentists. None of dental congresses of 2019 reached equal gender participation, being 81.3% of lecturers presenting on main auditoriums male dentists. Although dental workforce in Spain is slightly overrepresented by females, leadership positions and figures among Spanish dentists doesn’t seem to reflect the gender distribution of the collective. There is a lack of women occupying high-level positions in dentistry that proves the existence of the so-called “glass ceiling effect” on the profession. Further studies about sociodemographic aspects of dental workforce are needed to develop evidence-based policies for the collective.

Analysis of Social Policy and the Effect of Career Advancement Support Programs for Female Doctors

Background: In Japan, the number of female doctors has gradually increased; however, they form less than half of the average percentage (46.3% in 2016) among the Organisation for Economic Cooperation and Development member countries. In addition, some female doctors reduce their working hours for childbirth, housework, and childcare. Thus, women find it challenging to continue medical practice in Japan. The Ministry of Education, Culture, Sports, Science, and Technology (MEXT) established a time-bound grants program from 2007 to 2009 to support female doctors and improve their working environment. This study examines the program contents and the increase in female doctors in university hospitals. Materials and Methods: Using individual data from the Survey of Physicians, Dentists, and Pharmacists from 1996 to 2016, we compared two categories of female doctors, faculty and nonfaculty members, at university hospitals that received grants compared to those that did not. In addition, we reviewed the support program for female doctors and nurses developed by nine university hospitals using content from the MEXT and information from previous studies. Results: Most programs included in-hospital childcare and shorter working hours. There were fewer women in the nine hospitals receiving grants compared to other university hospitals. There were significant differences in the percentages of male and female nonfaculty members in 2000, 2004, and 2008. Conclusions: While we could not find any evidence that programs supported by the grants could increase female doctor numbers, these programs may have improved the status of female doctors with children. More intensive measures are needed to increase the number of women doctors in leadership positions.

Speaker Introductions at Grand Rounds: Differences in Formality of Address by Gender and Specialty

Background: Despite increasing representation of women in medicine, gender bias remains pervasive. The authors sought to evaluate speaker introductions by gender in the grand rounds of multiple specialties at a large academic institution to understand the cultural context of this behavior and identify predictors of formality. Materials and Methods: The authors reviewed grand rounds recordings of speakers with doctorates presenting to the departments of family medicine, general surgery, internal medicine, obstetrics and gynecology, and pediatrics at one institution from 2014 to 2019. The primary outcome was whether a speaker's professional title was used as the first form of address. The authors assessed factors correlated with professional introduction using multivariable logistic regression. Results: Speakers were introduced professionally in 346/615 recordings (56.3%). Female introducers were more likely to introduce speakers professionally (odds ratio [OR]: 2.52). A significant interaction existed between speaker gender and home institution: female speakers visiting from an external institution were less likely than male external speakers to be introduced professionally (OR: 0.49), whereas female speakers internal to the institution were more likely to be introduced professionally than male internal speakers (OR: 1.75). Use of professional titles varied by specialty and was higher than average for family medicine (83.2%), surgery (75.8%), and pediatrics (64.0%) and lower for internal medicine (37.5%) and obstetrics and gynecology (50.7%). Conclusions: These findings suggest a complex relationship between gender and formality of introduction that merits further investigation. Understanding differences in culture across specialties is important to inform efforts to promote equity.

Association of Academic Physiatrists Women's Task Force Follow-up Report

ABSTRACT

The Association of Academic Physiatrists convened a Women's Task Force in 2016, under the leadership of then Association of Academic Physiatrists President Gerard Francisco, MD, to evaluate data and metrics pertaining to the representation and inclusion of female physiatrists in the society. An initial published report focused on a retrospective analysis of data in categories such as leadership, conference presentations, and recognition awards. The findings, which highlighted areas in which the Association of Academic Physiatrists had been successful in supporting gender equity as well as areas in which female physiatrists were underrepresented, provided a base from which to strategically focus on closing gaps in representation. The task force developed an action plan that was approved by the Board of Trustees and included strategies aimed at closing gaps and collecting data to determine corresponding effectiveness. Because most of the categories fell under the supervision of various Association of Academic Physiatrists committees, an appointee from each committee ("diversity steward") liaised with the Women's Task Force. The diversity stewards reviewed the plan with their respective committees and collected data within their committee's purview. This task force follow-up report documents recent progress, consistent with the Association of Academic Physiatrists Board of Trustees commitment to transparency and gender equity.

Leadership Development in Ophthalmology: Current Impact and Future Needs

Importance There is a lack of peer-reviewed literature on leadership development programs (LDP) in ophthalmology. Research into LDP demographics, outcomes, and methodology is needed.

Objective The aim of the study is to evaluate the extent to which LDPs targeting ophthalmologists meet the needs of emerging leaders.

Design The design type of the study is cross-sectional analysis.

Setting This study involves international setting.

Participants The participants involved were ophthalmologists at any career level.

Methods Routine internet search was used to identify LDPs targeting ophthalmologists. LDPs identified were categorized by the outcome data available into four levels based on prior literature. Participants were assessed using previously validated software for gender (Gender-API, 2020) and race or ethnicity (NamSor, 2020)

Results Nine programs were identified which were classified into LDP generations. The first LDP in ophthalmology was the American Academy of Ophthalmology (AAO) LDP, which served as the nidus for the formation of four multinational LDPs, together forming the Global LDP. These LDPs were similar in size and scope; program size ranging from nine to 30 participants; a length of 1 to 2 years; with similar curricular offerings; with funding primarily derived from cost-sharing with a nominating society. The second generation of ophthalmology LDPs in the United States has targeted female scientists or faculty (Women's LDP by ARVO) and academic ophthalmology leaders (Academic LDP by Association of University Professors of Ophthalmology).

The AAO's LDP appears increasingly diverse with approximately 13% women at inception, gradually increasing from 40 to 65% women in the last 5 years (n = 389). There has also been a notable increase in ethnic diversity.

Conclusion and Relevance AAO LDP is the preeminent leadership training program for ophthalmologists, and it has influenced the creation of a new generation of LDP offerings. There remains a paucity of LDP evaluation metrics and reported outcomes. Newer iterations are successfully targeting academic leadership and attempting to address known disparities in gender and race or ethnicity. Further expansion of LDPs and related research can ensure equity and diversity in the pipeline.

Representation of Women on Journal Editorial Boards Affiliated with the Association of American Medical College's Council of Faculty and Academic Societies

Background: The Council of Faculty and Academic Societies (CFAS) comprises representatives from medical schools and professional societies who guide the Association of American Medical Colleges (AAMC). Given the AAMC's stated mission to improve diversity and inclusion, we used gender-related representation on journal editorial boards as a proxy for evaluating CFAS member societies' commitments to equity. Methods: From screenshots of journal mastheads (n = 44) collected June 3-6, 2019, individuals were categorized by editorial position. Outcome measures included numbers of men and women among faculty, deans, department chairs, physicians, and nonphysicians on editorial boards. Outcomes were compared with 2018 AAMC and US Bureau of Labor Statistics workforce data. Results: Overall, the proportion of women among journal editors was 29.0% (364 of 1,255), range 0%-53.3%. This proportion was significantly less than the proportion of women among US medical school faculty and medical scientists. The lowest percentages of women were found among journals' section or topic editors (19.2%) and editors-in-chief (20.4%). Men were significantly more likely to be a professor or department chair and women were significantly more likely to be an associate professor or assistant professor, suggesting a bidirectional process between rank and editorial position that may inhibit the advancement of academic women, particularly women physicians. Conclusions: This study revealed disparities in the equitable representation of women among CFAS member-affiliated journal editors. Because CFAS member societies participate in a mutually beneficial relationship with the AAMC, they should strive to attain the equity goals set forth by the AAMC.

Has a critical mass of women resulted in gender equity in gynecologic surgery?

Gender equity in medicine and surgery has recently received widespread attention. Unlike surgical specialties that remain predominantly male, the majority of obstetrician-gynecologists have been women for nearly a decade, and women have composed the majority of trainees since the 1990s. Despite a critical mass of women, biases related to gender persist in the field. Professional and behavioral expectations of men and women gynecologists remain different for patients and workplace colleagues. Gender discrimination and sexual harassment are still experienced at high rates by both trainees and obstetrician-gynecologists in practice. In addition, in other surgical fields, women gynecologic surgeons face a gender wage gap that is unexplained by differences in experience, hours worked, or subspecialty training. Academic advancement and the attainment of leadership positions remain a challenge for many women. Policies related to pregnancy and parenting may disproportionately affect the careers of women gynecologists. This article presents peer-reviewed evidence relevant to gender equity in the workplace and suggests proactive interventions to ensure diversity and inclusion for gynecologic surgeons.

A Longitudinal Study of Gender Parity Trends of General Membership and Leadership in the Neurocritical Care Society between 2002 and 2019

BACKGROUND

Several studies in critical care and neurology demonstrate women under-representation in professional societies; representation trends within the Neurocritical Care Society (NCS) are unknown. We examined longitudinal gender parity trends in membership and leadership within NCS.

METHODS

A retrospective study of NCS membership and leadership rosters was conducted. To determine gender, self-reported binary gender was extracted. For individuals without recorded gender, a systematic Web-based search to identify usage of gender-specific pronouns in publicly available biographies was performed. According to previously published methods, available photographs were utilized to record presumed gender identification in the absence of available pronoun descriptors. We analyzed available data longitudinally from 2002 to 2019 and performed descriptive statistical and linear regression analyses.

RESULTS

In overall membership, the proportion of women members demonstrated an average 11% increase between 2005 and 2018 (95% confidence interval (CI) - 8.1 to 30.1, p = 0.08). The proportion of women Board of Directors (BOD) members increased significantly over time to 50% in 2019. There was an increase in women Officers from 0% in the first 3 years (2002-2004) to 40% in 2019, with two women Presidents out of 17 from 2002 to 2019. For available Executive Committee rosters, there was a statistically significant nearly 3% increase per year (95% CI 1.5-4; p = 0.0007) in the proportion of women members. Rosters for Committee members and chairpersons were also incomplete, but in an analysis of the available data, there was a statistically significant increase of 5% per year analyzed (95% CI 0.5-9.7; p = 0.04) in the proportion of women Committee members. We also found a statistically significant 4.3% increase per year analyzed (95% CI 2.4-6.1; p = 0.003) in the proportion of women Committee chairpersons.

CONCLUSIONS

This is the first study of longitudinal gender parity trends within neurocritical care. We report that from 2002 to 2019, the NCS has undergone a significant increase in women representation in general membership, committee membership, and leadership positions.

Representation of women plenary speakers at the American Academy of Neurology Annual Meeting

OBJECTIVE

To determine whether women have been equitably represented among plenary speakers at the American Academy of Neurology (AAN) Annual Meeting by counting and categorizing speakers and comparing outcomes to AAN membership and US neurology workforce data.

METHODS

Lists of plenary speakers between 1958 and 2019 (62 years) were obtained from the AAN. The primary outcome measures were numbers and proportions of men and women in aggregate and among physicians.

RESULTS

We identified 635 plenary speakers, including 148 (23.3%) women. Specifically, women made up 14.6% (19 of 130) of presidential and 25.5% (129 of 505) of nonpresidential plenary session speakers. The inclusion of women plenary speakers was meaningfully higher (h = 0.33; difference 14.9%; 95% confidence interval 4.2%-26.7%) for nonphysicians (27 of 74 [36.5%]) than physicians (121 of 561 [21.6%]). Although at zero levels for Annual Meetings held between 1958 and 1990 and at mostly low but varying levels thereafter, the representation of women and women physicians has been at or above their proportions in the AAN membership and US neurology workforce since 2017. Comparison of representation by plenary session name revealed an unequal distribution of women, with women physicians concentrated in the Sidney Carter Award in Child Neurology presidential session.

CONCLUSION

Historically and recently, women and women physicians were underrepresented among AAN plenary speakers. As the AAN has taken active steps to address equity, women have been included in more representative proportions overall. However, notable gaps remain, especially in specific prestigious plenary sessions, and further research is needed to determine causality.

Leading by Design: Lessons for the Future From 25 Years of the Executive Leadership in Academic Medicine (ELAM) Program for Women

The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is designed to promote the careers of senior female leaders in academic health care in a way that ultimately seeks to transform culture and promote gender equity far beyond the careers of its participants. In an era of increased awareness of gender inequity within academic medicine, the longevity of the ELAM program raises several important questions. First, why is such a program still needed? Second, what exactly does it do, and what has been its influence on its participants and beyond? And third, what lessons can ELAM's example provide to help guide the medical profession as it strives to promote gender equity in the field? In this Invited Commentary, the authors seek to answer these questions from the perspective of a recent program participant and the current program director. The authors review the evidence that identifies how women, even today, face accumulating disadvantage over the course of their academic careers, stemming from repeated encounters with powerful unconscious biases and stereotypes, societal expectations for a gendered division of domestic labor, and still-present overt discrimination and sexual harassment. They describe ELAM's approach, which builds the knowledge and skills of the women who participate in the program, while also intentionally raising their visibility within their home institutions so that they have opportunities to share with institutional leaders what they have learned in ways that not only promote their own careers but also support gender equity in the broader environment. The authors conclude by offering thoughts on how ELAM's model may be leveraged in the future, ideally in partnership with the numerous professional societies, funding agencies, and other organizations that are committed to accelerating the rate of progress toward gender equity at all levels of academic medicine.

Gender Differences in Endowed Chairs in Medicine at Top Schools

This cross-sectional study examines the gender distribution of endowed chairs in departments of medicine and the association of gender with holding an endowed chair.

Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations

Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.