Author response: Women physicians underrepresented in American Academy of Neurology recognition awards

Small female citation advantages for US journal articles in medicine

Female under-representation continues in senior roles within academic medicine, potentially influenced by a perception that female research has less citation impact. This article provides systematic evidence of (a) female participation rates from the perspective of published journal articles in 46 Scopus medical subject categories 1996–2018 and (b) gender differences in citation rates 1996–2014. The results show female proportion increases 1996–2018 in all fields and a female majority of first-authored articles in two-fifths of categories, but substantial differences between fields. A paper is 7.3 times more likely to have a female first author in Obstetrics and Gynaecology than in Orthopaedics and Sports Medicine. Only three fields had a female last author majority by 2018, a probable side effect of ongoing problems with appointing female leaders. Female first-authored research tended to be more cited than male first-authored research in most fields (59%), although with a maximum difference of only 5.1% (log-transformed normalised citations). In contrast, male last-authored research tends to be more cited than female last-authored research, perhaps due to cases where a senior male has attracted substantial funding for a project. These differences increase if team sizes are not accounted for in the calculations. Since female first-authored research is cited slightly more than male first-authored research, properly analysed bibliometric data considering career gaps should not disadvantage female candidates for senior roles.

Understanding and addressing gender equity for women in neurology

Despite the fact that the percentages of women among physicians and neurologists have been rising, gender-related disparities in numerous metrics persist, notably in compensation, promotion, funding, recognition, leadership, publishing, and speaking. Simultaneously, women working in academia, including medicine, face high rates of sexual harassment. Leaders of all health care-related organizations must accept the moral and ethical imperative to expeditiously address both gender-related discrimination and harassment (inclusive of but not limited to sexual harassment) of women in medicine. At this unique time in history, there is an opportunity for leaders in neurology to strategically accelerate efforts to address workforce gender disparities and ensure harassment-free training and work environments. Leaders will have to plan an intentional path forward, using a systematic process, metrics, and strategies unique to their own organizations, to overcome barriers to an equitable and safe work environment for women. Moreover, leaders in 4 gatekeeper organizations—medical schools/academic medical centers, funding agencies, journals, and medical societies—must hold each other accountable for gender equity as their own success and financial return on investment is dependent on the efforts of those in the other categories. In short, the path forward is to focus on ethical principles and behavior when it comes to addressing workforce gender disparities for women in medicine.