The status of women in academic ophthalmology: Authorship of papers, presentations, and academic promotions

Gender Differences in Case Volume Among Ophthalmology Resident Graduates, 2014-2023

Importance

A previous multisite study found gender differences in cataract and total surgical volume among US residency programs. Whether that was representative of all ophthalmology residents in the US is unclear.

Objective

To determine whether reported surgical volume among US ophthalmology resident graduates varied by self-reported gender or by underrepresented in medicine (URiM) status.

Design, Setting, and Participants

Retrospective observational longitudinal cohort study of deidentified Accreditation Council for Graduate Medical Education (ACGME) surgical log data for all graduates of US ophthalmology residency programs from the years 2014-2023 compared by self-reported gender or URiM status. Surgical experience was obtained from the ACGME Accreditation Data System resident case log. Data were analyzed from November 2023 to April 2024.

Main Outcomes and Measures

The main outcome was a difference in mean reported surgical volume between comparison groups by gender or URiM status for cataract or total surgical procedures. The secondary outcomes were differences for other surgical categories by gender or URiM status.

Results

Of 4811 resident graduates, 41.6% (1999) were female and 58.4% were male (2812); 7.1% (343) self-identified as URiM. Cataract cases had a mean difference of -4.4% (-8.3 of 189.2) (95% CI, -6.4% to -2.4%; P < .001) fewer surgeries for female residents than male residents over the 10-year study, and total procedures had a mean difference of -7.4% (-43.4 of 587.3) (95% CI, -9.7% to -5.1%; P < .001) fewer surgeries for female than male residents over the 10-year study. URiM status over the same time period was not associated with a difference in cataract surgeries but was associated with a mean difference of -5.3% (-31.5 of 587.3) (95% CI, -9.8% to -0.9%; P = .02) fewer total procedures.

Conclusions and Relevance

In this study, female residents reported fewer cataract procedures than male residents from 2014-2023. Female and URiM residents reported fewer total procedures than their nonfemale or non-URiM colleagues. Future studies to assess the causes of these disparities are warranted.

[The glass ceiling in ophthalmology]

Currently, two thirds of medical students are female. However, women continue to be clearly underrepresented in leading medical positions, which is also true for ophthalmology. The scientific output of female ophthalmologists is increasing, more pronounced as first authors than last, but remains below that of male colleagues. However, a significant gender bias has been shown in the grant application processes. There are significantly more male surgeons in vitreoretinal, refractive, and corneal surgery. Concerning surgical training, it has been shown that female ophthalmologists operate less during their residency, especially in cataract surgery. Also among surgeons do women continue to shoulder the main responsibility for family and household, despite the negative consequences for their career. This publication presents an overview of the present career situation for women in ophthalmology and discusses possible measures to achieve gender equality, such as the establishment of mentoring programs and networks.