Does gender influence leadership roles in academic surgery in the United States of America? A cross-sectional study

Representation of Women Authorship in the Top 5 Transplantation Journals in the United States

BACKGROUND

In the United States, only 13% of transplant surgeons are women. We evaluated gender distribution and trends of American authorship over the past 10 y in high-impact solid organ transplantation journals to gain insight into the current status of women authorship in transplantation.

METHODS

Original articles from 2012 to 2021 from the 5 highest-impact solid organ transplantation journals were extracted from Scopus. First and last author's gender was predicted using Genderize.io. Data of first and last authors, article type and topic, location, citation, and funding metrics were analyzed. Chi-square, logistic regression, and trend tests were performed where appropriate. Statistical significance was set at <0.05.

RESULTS

Women's first and last authorship increased over time among all journals. There was an increase in women first authors in the American Journal of Transplantation and in senior women authors in Liver Transplantation and Transplantation . Significant differences in gender authorship in lung, intestine, pancreas, general, and islet cell transplantation were found. Women's last authorship was associated with 1.69 higher odds of having a woman first author when adjusting for year and journal. There was an increase in the rate of women's first and last author collaborations over the years. Women last authors had 1.5 higher odds of being funded by the National Institutes of Health over the years.

CONCLUSIONS

Despite an increase in women transplant surgeons and physicians, the gap in women authorship in transplantation persists. Women's last authorship was associated with higher odds of having a woman first author, pointing to the importance of mentorship for women joining the transplant academia.

Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US

Importance

Surgical department chairs remain conspicuously nondiverse despite the recognized importance of diverse physician workforces. However, the extent of diversity among non-chair leadership remains underexplored.

Objective

To evaluate racial, ethnic, and gender diversity of surgical department chairs, vice chairs (VCs), and division chiefs (DCs) in the US.

Design, Setting, and Participants

For this cross-sectional study, publicly accessible medical school and affiliated hospital websites in the US and Puerto Rico were searched from January 15 to July 15, 2022, to collect demographic and leadership data about surgical faculty. Two independent reviewers abstracted demographic data, with up to 2 additional reviewers assisting with coding resolution as necessary. In all, 2165 faculty were included in the analyses.

Main Outcomes and Measures

Proportions of racial, ethnic, and gender diversity among chairs, VCs, and DCs in general surgery and 5 surgical specialties (neurosurgery, obstetrics and gynecology, ophthalmology, orthopedics, and otolaryngology).

Results

A total of 2165 faculty (1815 males [83.8%] and 350 females [16.2%]; 109 [5.0%] African American or Black individuals; 347 [16.0%] Asian individuals; 83 [3.8%] Hispanic, Latino, or individuals of Spanish origin; and 1624 [75.0%] White individuals as well as 2 individuals [0.1%] of other race or ethnicity) at 154 surgical departments affiliated with 146 medical schools in the US and Puerto Rico were included in the analysis. There were more males than females in leadership positions at all levels-chairs (85.9% vs 14.1%), VCs (68.4% vs 31.6%), and DCs (87.1% vs 12.9%)-and only 192 leaders (8.9%) were from racial or ethnic groups that are underrepresented in medicine (URiM). Females occupied more VC than chair or DC positions both overall (31.6% vs 14.1% and 12.9%, respectively) and within racial and ethnic groups (African American or Black females, 4.0% VC vs 1.5% chair and 0.6% DC positions; P < .001). URiM individuals were most commonly VCs of diversity, equity, and inclusion (DEI, 51.6%) or faculty development (17.9%). Vice chairs of faculty development were split equally between males and females, while 64.5% of VCs for DEI were female. All other VCs were predominantly male. Among DC roles, URiM representation was greatest in transplant surgery (13.8%) and lowest in oral and maxillofacial surgery (5.0%). Except for breast and endocrine surgery (63.6% female), females comprised less than 20% of DC roles. Nearly half of DCs (6 of 13 [46.2%]) and VCs (4 of 9 [44.4%]) had no female URiM leaders, and notably, no American Indian, Alaska Native, or Native Hawaiian or Other Pacific Islander individuals were identified in any surgical leadership positions.

Conclusions and Relevance

While it is unclear whether promotion from VC to chair or from DC to chair is more likely, these findings of similar gender distribution between chairs and DCs suggest the latter and may partially explain persistent nondiversity among surgical chairs. Female and URiM surgical leaders are disproportionately clustered in roles (eg, VCs of DEI or faculty development) that may not translate into future promotion to department chairs.

A Practical Guide to Implementing Holistic Review during Surgery Resident Selection

Provider workforce diversity is a key component of improving healthcare quality and addressing healthcare disparities. Furthermore, the traditional approach of "score-centered" application metrics do not consistently correlate with meeting milestones in surgery, nor do they adequately predict a surgical resident's clinical strength and operative abilities. We present here an adaptable process by which surgical residency programs can identify their values and incorporate holistic review into their resident selection process to improve resident selection and physician workforce diversity.

Gender and Racial Diversity Among Colon and Rectal Surgery Trainees and Leaders

BACKGROUND

Despite recent changes in women and underrepresented minorities in medicine, there still exists large gender and racial gaps in surgical training and leadership.

OBJECTIVE

We hypothesize that gender and racial representation have improved among general and colorectal surgical trainees and leadership over the past 20 years.

DESIGN

This cross-sectional study examines gender and racial representation of general and colorectal surgery residents, colorectal faculty members, and the American Society of Colon and Rectal Surgeons Executive Council.

SETTINGS

We extracted data from the Journal of the American Medical Association Graduate Medical Education yearly reports for information on surgical residents. We used the American Society of Colon and Rectal Surgeons website and publicly available practice websites to obtain information regarding colon and rectal surgery residents, faculty members, and the American Society of Colon and Rectal Surgeons Executive Council.

MAIN OUTCOME MEASURES

We primarily focused on the gender and underrepresented minority breakdowns of general surgery residents, colorectal surgery residents, and the American Society of Colon and Rectal Surgeons Executive Council.

RESULTS

We found that between 2001 and 2021, the number of women and people identifying as underrepresented minorities increased within general surgery programs. In addition, there has been a similar increase in underrepresented minorities and women entering colorectal surgery residency programs. Finally, there has been a steady, significant increase in women representation in the American Society of Colon and Rectal Surgeons Executive Council, with a slower increase in underrepresented minorities on the council.

LIMITATIONS

The study is limited by using previously collected data and relying on publicly available profiles for gender and race information.

CONCLUSIONS

General and colon and rectal surgery have significantly increased gender and racial diversity at the training and leadership levels.

DIVERSIDAD RACIAL Y DE GNERO ENTRE LOS APRENDICES Y LDERES DE CIRUGA DE COLON Y RECTO

ANTECEDENTES: A pesar de los cambios recientes en las mujeres y las minorías subrepresentadas en la medicina, todavía existen grandes brechas de género y raza en la capacitación y el liderazgo quirúrgico.OBJETIVO: Presumimos que la representación racial y de género ha mejorado entre los pasantes y el liderazgo en cirugía general y colorrectal en los últimos 20 años.DISEÑO: Este es un estudio transversal que examina la representación racial y de género de los residentes de cirugía general y colorrectal, miembros de la facultad colorrectal y el Consejo Ejecutivo de la Sociedad Estadounidense de Cirujanos de Colon y Recto.CONFIGURACIÓN: Extrajimos datos de los informes anuales de Educación Médica para Graduados del Journal of the American Medical Association para obtener información sobre los residentes quirúrgicos. Utilizamos el sitio web de la Sociedad Estadounidense de Cirujanos de Colon y Recto, así como los sitios web de práctica disponibles públicamente para obtener información sobre los residentes de cirugía de colon y recto, miembros de la facultad y el Consejo Ejecutivo de la Sociedad Estadounidense de Cirujanos de Colon y Recto.MEDIDAS PRINCIPALES DE RESULTADO: Nos enfocamos principalmente en los desgloses de género y minorías subrepresentadas de residentes de cirugía general, residentes de cirugía colorrectal y el Consejo Ejecutivo de la Sociedad Estadounidense de Cirujanos de Colon y Recto.RESULTADOS: Encontramos que entre 2001 y 2021, la cantidad de mujeres y personas que se identificaron como minorías subrepresentadas aumentó dentro de los programas de cirugía general. Además, ha habido un aumento similar en minorías subrepresentadas y mujeres que ingresan a programas de residencia en cirugía colorrectal. Finalmente, ha habido un aumento constante y significativo en la representación de mujeres en el Consejo Ejecutivo de la Sociedad Estadounidense de Cirujanos de Colon y Recto con un aumento más lento en las minorías subrepresentadas en el consejo.LIMITACIONES: El estudio está limitado por el uso de datos recopilados previamente y por confiar en perfiles disponibles públicamente para la información de género y raza.CONCLUSIONES: La cirugía general y de colon y recto han hecho algunos avances significativos en el aumento de la diversidad racial y de género en los niveles de formación y liderazgo. (Traducción-Yesenia.Rojas-Khalil ).

Understanding Gender Differences in Research Productivity of Canadian Otolaryngologists-A Comprehensive National Audit

Objective: To understand the factors contributing to gender disparities in the research productivity of Canadian academic otolaryngologist-head and neck surgeons. Methods: Publicly available sources including departmental websites, SCOPUS, and the Royal College of Physicians and Surgeons of Canada were accessed between February and April 2022 to analyze gender differences in the academic productivity of otolaryngologist-head and neck surgeons across Canada. Gender differences in research productivity metrics, including h-index, i10-index, publication number, and number of first and senior authorships were assessed. Demographic data, including gender, institution, years in practice, and leadership roles were assessed for correlation with increased research productivity. Subgroup analyses were used to evaluate gender differences in productivity metrics, and univariable and multivariable regression analyses were used to evaluate predictors of research productivity. Results: Data were collected for 316 academic otolaryngologists (252 men, 64 women, P < .001). Men had significantly more years of publishing [mean (standard deviation, SD), 15.64 (9.45) vs 12.44 (8.28), P = .014], higher h-indices [12.22 (11.47) vs 7.33 (5.36), P < .001], i10-indices [22.61 (37.88) vs 8.17 (9.14), P > .001], publication numbers [46.63 (65.18) vs 19.59 (23.40), P < .001], and first [8.18 (9.95) vs 4.89 (6.18), P = .001] and senior authorships [12.98 (22.72) vs 3.83 (6.89), P < .001]. Gender differences were most pronounced in head and neck oncology, pediatrics, and the late career stage. Gender disparities in productivity were absent in the early career stage. Multivariate analysis identified only the number publications and number of senior author publications as being significantly influenced by gender. Conclusion: Canadian female otolaryngologist-head and neck surgeons appear to have equivalent research productivity to their male counterparts in the early career stage. This mirrors the recent findings in the United States, and demonstrates progress compared to earlier studies that found women to have lower research productivity in the early career stage.

Female authorship trends in the field of colorectal surgery: A retrospective bibliometric study

Background

Gender disparity and hidden discrimination remained in the surgical subspecialties. This study aimed to explore the authorship gender composition in four high-impact colorectal surgery journals over the past two decades.

Method

This cross-sectional study queried the Web of Science Core Collection database and PubMed (MEDLINE) for articles published in four high-impact colorectal surgery specialty journals between 2000 and 2021 (Database accessed at July 2022). Extracted data included authors' full names, institutions, year of publication and total citation numbers. Authors' genders were assigned via gendrize.io, a third-party name predictor tool.

Results

100,325 authorship records were included in the final analysis. 21.8% of writers were identified as female, an increase from 11.4% (95% CI, 9.4%-13.3%) in 2000 to 26.5% (95% CI, 25.6%-27.4%) in 2021. Female authorship has risen in all authorship types, but women physicians were less likely to be the last authors than the first (OR, 0.63; 95%CI, 0.6-0.67) or middle authors (OR, 0.57; 95%CI, 0.55-0.60). Female authorship has also increased substantially in different document types, but female authorships were less likely in editorials than original articles (OR, 0.76; 95%CI, 0.7-0.83) and reviews (OR, 0.83; 95%CI, 0.74-0.94). Compared with male physicians, females were more likely to author in publications with reportable funding, either as first authors (OR, 1.46; 95%CI, 1.12-1.78) or last authors (OR, 1.51; 95%CI, 1.22-1.89). Authorship varied geographically, and countries with the highest female authorship percentage were mainly in Europe and North America.

Conclusion

Female authorship has grown substantially in colorectal surgery literature. However, female physicians were still underrepresented and less likely to assume senior or leading authorship roles.

Gender disparity among ophthalmologists awarded Canadian institute of health research grants

Despite efforts toward equity, diversity, and inclusion in academic ophthalmology faculties, gender disparity continues to exist. Current evidence indicates that female ophthalmologists consistently hold lower academic ranks and receive less funding from the National Institutes of Health compared to their male colleagues. The extent of this disparity is unknown in the Canadian context. We sought to characterize the gender gap in Canadian Institutes of Health Research funding among ophthalmologists. From inception, funding decision data were collected from the official Canadian Institutes of Health Research website database hosted by the Government of Canada. Measures including gender, number of grants held over the study period, number of simultaneous grants, and total funding were collected. Female ophthalmologists were consistently awarded fewer grants (21.43 percent) compared to male counterparts and were less likely to hold multiple grants since 2008. An over five-fold disparity was found in total funding for female compared to male ophthalmologists. As well, females were less likely than males to hold a grant in each particular year except in 2020. Female ophthalmologists continue to face barriers to attaining academic support from Canadian Institute of Health Research funds. Continued action to mitigate this gender gap may improve gender-based parity in federal research funding.

A descriptive analysis of general surgery residency program directors in the United States

BACKGROUND

Women remain underrepresented in surgery. We analyzed the demographics of general surgery program directors (PDs) and compared gender differences.

METHODS

A search of online resources was conducted, including 344 general surgery residencies.

RESULTS

340 residencies were included. 261 PDs (76.8%) were male and 79 (23.2%) were female. Females were appointed at a younger age (p < 0.0001), were appointed sooner after residency (p < 0.0001) and have served similar term lengths compared to males (p = 0.556). There was no difference in academic position, fellowship training, or scholarly output between genders. Residencies with a female PD had a greater percentage of female residents (p = 0.04).

CONCLUSION

General surgery PDs are predominately male with fellowship training; however the percentage of female PDs is similar to the percentage of practicing female general surgeons in the US. Gaining a better understanding of the characteristics of general surgery PDs can aid female surgeons in attaining academic leadership positions.

Gender Disparity in Surgical Device Patents: A 5-year Trend From Canada and the United States

INTRODUCTION

Despite an increasing number of women pursuing careers in science, engineering, and medicine, gender disparities in patents persist. This study sought to analyze trends in inventor's gender for surgical device patents filed and granted in Canada and the United States from 2015 to 2019.

METHODS

This study analyzed patents filed and granted by the Canadian Intellectual Property Office (CIPO) in the category of "Diagnosis; Surgery; Identification" and the United States Patent and Trademark Office (USPTO) in the category of "Surgery" from 2015 to 2019. The gender of the patent applicants was determined using a gender algorithm that predicts gender based on first names. Gender matches with names having a probability of less than 95% were excluded.

RESULTS

We identified 14,312 inventors on patents filed and 12,737 inventors on patents granted by the CIPO for "Diagnosis; Surgery; Identification". In the USPTO category of "Surgery," we identified 75,890 inventors on patents filed and 44,842 inventors on patents granted. Female inventors accounted for 7%-10% of inventors from 2015 to 2019 for both patents filed and granted. The proportion of female inventors on patents granted was significantly lower than for patents filed for four of the 5 y analyzed for both the USPTO and CIPO.

CONCLUSIONS

Female representation in surgical device patenting has stagnated, between 7 and 10%, from 2015 to 2019 in Canada and the United States. This underrepresentation of female inventors in surgical device patenting represents sizable gender disparity.

Gender Distribution & Rank of Authorship in Surgical Literature

BACKGROUND

Authorship of surgical literature is important for the career advancement of surgeons, and gender disparities in authorship may hinder the representation and leadership of women within academic surgery. The aim of this systematic review and meta-analysis was to evaluate the gender distribution of first, senior, and overall authorship in peer-reviewed surgical journal studies across all surgical specialties to determine if disparities exist.

METHODS

PubMed, EMBASE, and Google Scholar databases were searched for studies investigating the gender distribution of authorship of surgical literature published before December 10th, 2021. Meta-analysis was performed and Cohen's Q test for heterogenous effects was used to determine whether random or fixed-effects models were appropriate.

RESULTS

Fifteen studies investigating gender distribution of authorship met inclusion, which included a total of 136,627 pooled studies. The meta-analysis demonstrated the meta-proportion of first authorship for women to be 20.6% (95% CI: 13.9, 28.2), the meta-proportion of senior authorship for women to be 11.9% (95% CI: 6.6, 18.5), and the meta-proportion of overall authorship for women to be 23% (95% CI: 16.2, 30.7). In addition, the proportion of senior authorship for women was found to be significantly lower than the proportion of overall authorship for women (11.9% versus 23.0%, P = .0106).

CONCLUSION

There is a significantly smaller proportion of women who are first, senior, and overall authors in surgical literature compared to their colleagues who are men. Sustainable and effective solutions aimed at improving the representation of women surgeons in surgical research and research leadership are necessary.

Assessment of female authorship in Journal of NeuroInterventional Surgery (JNIS) publications in 2016-2020

BACKGROUND

Since female neurointerventionalists make up a minority of the work force, the contributions this group has made to academic scholarship should be highlighted.

OBJECTIVE

The main objective of this project was to identify all of the recent papers published in the Journal of NeuroInterventional Surgery (JNIS) by female first authors or last authors over 5 years.

METHODS

The online issues of JNIS from January 2016 through December 2020 were reviewed. Data were collected on the number and types of articles published monthly. For each article, the gender of the first author and the senior author was evaluated. Bivariate analyses were performed to compare female authorship trends between 2016 and 2020.

RESULTS

In 2016, 38 (14.8%) of the 257 articles published had female involvement compared with 60 (22.8%) of 263 articles in 2020 (p=0.019). In 2016, 9.7% of all articles had a female first author only, 3.9% had a female last author only, and 1.2% had both a female first and last author. In 2020, the percentages increased to 14.5%, 6.5%, and 1.9% respectively. Over 80% of the articles published in 2016 and 2020 by female authors were original research articles. One editorial commentary and two special topic articles were published by female authors in 2020 compared with none in 2016.

CONCLUSION

More papers were published by female authors in JNIS in 2020 relative to 2016. Most of these papers had a female first author, and were original research articles.

A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States

BACKGROUND

The role sex plays in surgical leadership positions is heavily discussed in the literature; however, there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs.

METHODS

A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on sex.

RESULTS

Eighty-two integrated plastic surgery residencies were analyzed. Fifteen PDs (18.3%) were female. Fifty-six (68%) PDs completed general surgery residencies, whereas 24 (29%) completed an integrated plastics residency. All female PDs were fellowship trained, whereas only 46 (68%) male PDs pursued additional training after residency (P = 0.02). Research output among male PDs was greater with 49.9 publications and a higher average H-index, at 13.3, compared with women with an average of 27.5 publications (P = 0.008) and an H-index of 8.7 (P = 0.02). When comparing male to female PDs, there was no difference between age at PD appointment (P = 0.15), or in the amount of time between completion of plastic surgery training to PD appointment (P = 0.29). Male PDs were older (52.2) compared with female PDs (46.5) (P = 0.02). Male PDs served longer terms (4.98 years) than female PDs (2.87 years) (P = 0.003).

CONCLUSIONS

The majority of integrated plastic surgery PDs are men with a Doctor of Medicine degree who completed a general surgery residency and a plastic surgery fellowship. Most PDs also completed fellowship in a plastic subspecialty. Male PDs had higher research output, which may be attributed to their older age on average. Although women make up only 18.3% of plastic surgery PDs, this percentage is similar to the 17.2% of active female plastic surgeons in the United States. As more women train in plastic surgery, it is possible that the percentage of women serving academic leadership roles will increase. By gaining a better understanding of the demographics and diversity in plastic surgery residency program leadership, efforts can be made to increase the representation of minority groups in academic leadership roles.

Discrimination Towards Women in Surgery: A Systematic Scoping Review

BACKGROUND

Over the past twenty years explicit gender bias towards women in surgery has been replaced by more subtle barriers, which represent indirect forms of discrimination and prevents equality.

OBJECTIVE

The aim of our scoping review is to summarize the different forms of discrimination towards women in surgery.

METHODS

The database search consisted of original studies regarding discrimination towards female surgeons.

RESULTS

Of 3,615 studies meeting research criteria, 63 were included. Of these articles, 11 (18%) were focused on gender-based discrimination, 14 (22%) on discrimination in authorship, research productivity and research funding, 21 (33%) on discrimination in academic surgery, 7 (11%) on discrimination in surgical leadership positions and 10 (16%) on discrimination during conferences and in surgical societies. The majority (n = 53, 84%) of the included studies were conducted in the U.S.A. According to our analysis, female surgeons experience discrimination from male colleagues, healthcare workers, but also from patients and trainees. Possible solutions may include acknowledgement of the problem, increased education of diversity and integration for the younger generations, mentorship, coaching and more active engagement by male and female partners to support women in the surgical field.

CONCLUSIONS

Gender-based discrimination toward women in the field of surgery has evolved over the past twenty years, from an explicit to a more subtle attitude. A work-environment where diversity and flexibility are valued would allow female surgeons to better realize their full potential.

Gender inequality among medical, pharmaceutical and dental practitioners in French hospitals: Where have we been and where are we now?

INTRODUCTION

Women are under-represented in senior academic and hospital positions in many countries. The authors aim to assess the place and the evolution of all appointed female and male health practitioners' working in French public Hospitals.

MATERIALS AND METHODS

Data of this observational study were collected from the National Management Centre (Centre National de Gestion) from 2015 up to January 1, 2020. First, the authors described demographic characteristics and specialties of all appointed medicine, pharmacy, and dentistry doctors' working as Hospital Practitioners, Associate Professors, and Full Professors in French General and University-affiliated Hospitals in 2020. Then, they retrospectively reported the annual incidence of new entrance according to gender and professional status from 1999 to 2019 thanks to the appointment date of all practitioners in activity between 2015 and 2020.

RESULTS

In 2020, 51 401 appointed practitioners (49.7% of female) were in activity in French public hospitals with a large majority being medical doctors (92.4%) compared to pharmacists (6%) and dentists (1.6%). Women represented 52.5% of the Hospital Practitioners, 48.6% of the Associate Professors, and 22.0% of the Full Professors (p < 0.001). There were disparities between the rates of female Full Professors in medicine (20.6%), pharmacy (36.1%), and dentistry (44.3%, p < 0.001). Women were appointed Hospital Practitioners and Associate Professors earlier than men (respectively 37.1 versus 38.8 years, p < 0.001 and 36.1 versus 36.5 years, p = 0.04), and at a later age among Full Professors (43.7 versus 41.9 years, p < 0.001). Compared to men, the annual proportion of appointed women varied significantly between 1999 and 2019 from 47.6% to 60.4% for Hospital Practitioners, from 50.0% to 44.6% for Associate Professors, and from 11.2% to 33.3% for Full Professors (p < 0.001 for trend).

CONCLUSIONS

Although more and more women occupy positions in French hospitals, there is still a gender gap regarding access to Full Professor status in medicine and pharmacy, but not in dentistry. The disparity in numbers makes comparison difficult. Despite a trend towards gender equality during the last twenty years, it has not yet been achieved regarding access to the highest positions.