Gender gap narrows in medical journals

Female scientists are authoring more original research papers, but publishing rates still don't match women's enrollment in medicine

By | July 20, 2006

Women are now heading a greater portion of original research papers in medical journals than they were in 1970, Harvard researchers report in the New England Journal of Medicine (NEJM). However, the current rate of first-authorship by women -- nearly 30% -- remains significantly lower than the current rate of enrollment by women in medical school. "I'm actually quite pleased with the findings," said Catherine DeAngelis, editor-in-chief of the Journal of the American Medical Association (JAMA). "I wish we were going faster but it's not bad, we're getting there." And according to the American Association of Medical Colleges (AAMC), women made up only 19% of associate and full clinical professors in 2004 (the last year included in this report), suggesting that women in those positions "are overachievers rather than underachievers," said Patricia Numann at SUNY Upstate Medical University, founder of the Association of Women Surgeons. First author Reshma Jagsi and colleagues at Harvard Medical School began the study after noticing an overwhelming majority of medical papers they read seemed to be authored by men. When they discovered that no-one had quantified the gender gap for leading American medical journals, they scoured six published in 1970, 1980, 1990, 2000, and 2004 to see how the numbers had changed over time. Overall, the proportion of female first authors rose from 5.9% in 1970 to 29.3% in 2004. The rate of senior-authorship by women jumped from 3.7% to 19.3% over the same span. Not surprisingly, journals for fields now dominated by women showed the greatest leaps (with 2004 percentages as high as 40.7% for female first authors in Obstetrics & Gynecology). Publishing rates in the Annals of Surgery, in contrast, remained low (women made up 6.7% of senior authors in 2004, compared to 0.7% in 1970). In 2004, only 11.4% of guest editorials in NEJM and 18.8% of those in JAMA were penned by women, they reported. The study also evaluated publishing rates in the Annals of Internal Medicine and the Journal of Pediatrics. SUNY's Numann suggested that unconscious bias on the part of reviewers may account for the under-representation of female authors, since their names are not always blinded during review. Indeed, Nancy Andreasen at the University of Iowa College of Medicine in Iowa City told The Scientist that when she began her career in psychiatry, she used first initials when submitting papers to NEJM and JAMA until she had developed a reputation in the field, out of concern that being a woman might lower her chances of getting published. It would be "interesting to have a couple of journals look at submission rate versus the acceptance rate" in light of the gender make-up of their editorial boards, said Numann. But the bigger issue, said Jagsi, is the rate of attrition among women on the road to senior faculty positions, largely due to barriers such as "biological clocks that collide with academic tenure clocks." Susan Ivey at University of California, Berkeley, who is president of the American Medical Women's Association, told The Scientist she started her academic medicine career after raising her kids, at the age of 40. "A man exactly my age has a ten-year lead on publications," she said. Jagsi said she has benefited from mentorship by successful female professors, including her coauthors, but the publication disparity still has a big impact. "If everything you see in NEJM is published by a guy, you're going to be discouraged." Betsy Tuttle Newhall at Duke University, who is also councilmember of the Association of Women Surgeons, had few women mentors as a trainee but this year, as Duke's associate residency director for general surgery, she welcomed a class of more than 50% women; she considers this a sign that the deficit in surgery, in particular, will shrink. "As you train [women] and you mentor them through the clinical and basic science research years, you'll see the differential narrow," she said. According to Jagsi, she and her colleagues are now evaluating the impact of intervention programs, such as Massachusetts General Hospital's two-year bridge funding grant for junior women faculty with children, and looking more closely at factors such as productivity of female authors and career choice. Ishani Ganguli Links within this article R. Jagsi et al., "The 'Gender Gap' in Authorship of Academic Medical Literature-A 35-Year Perspective," N. Engl. J. Med.355:281-7, 2006 Catherine DeAngelis American Association of Medical Colleges Patricia Numann Association of Women Surgeons Reshma Jagsi Nancy Andreasen L. Nonnemaker, "Women physicians in academic medicine: new insights from cohort studies," N. Engl. J. Med, 2005. PM_ID: 10666431 Susan Ivey American Medical Women's Association

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