New Report Finds Women and Racial/Ethnic Minority Experts Are Underrepresented as Clinical Practice Guideline Authors
A new report — the first of its kind — focused on authorship of rehabilitation-related clinical practice guidelines (CPGs). This report, titled “Author Diversity on Clinical Practice Guideline Committees,” was published in the American Journal of Physical Medicine and Rehabilitation and had three important findings. First, that women experts were underrepresented as authors of CPGs. Underrepresentation was particularly notable among women physicians. Second, experts from race and ethnicity minority groups were underrepresented. And third, there were gaps in diversity-related content such as pregnancy, menopause, and social determinants of health.
The senior author of this report, Julie Silver, MD, Associate Chair of the Department of Physical Medicine and Rehabilitation (PM&R) at Harvard Medical School and Spaulding Rehabilitation, believes that the equitable representation of experts on CPG committees is among the most important workforce disparity issues to solve. Dr. Silver states, “Clinical practice guidelines published in the United States are distributed worldwide — influencing the rehabilitation care of hundreds of millions of people and affecting how billions of dollars in healthcare dollars are allocated.”
The new report was co-authored by several physiatrists and physiatrists-in-training, including Drs. Monica Verduzco-Gutierrez, Talya Fleming, Miguel Escalon, Nicole Katz, and Tracey Hunter, as well as co-authors from other specialties. This team of diverse experts offer specific suggestions to address disparities on CPG author teams. For example, the Institute of Medicine (IOM) published a report more than a decade ago titled “Clinical Practice Guidelines We Can Trust” which could be updated to include issues related to author representation (e.g., gender, race, ethnicity, sexual orientation, ability status). A similar update could be conducted by the Veterans Administration and Department of Defense in their “Guideline for Guidelines” publication.
The authors of this new report also suggested that medical societies such as the American Academy of PM&R, which was listed as a “contributing” society on one of the CPGs that had marked underrepresentation of women and racial/ethnic minority authors, avoid supporting another society if it does not convene an equitable panel of authors.
Dr. Silver, who is the director of the highly acclaimed Harvard Medical School Women’s Leadership 3-day CME course, states, “Every physician at the table is a leader in healthcare, and they all have a voice and the opportunity to speak up if women and racial or ethnic minority individuals are not equitably represented. Silence perpetuates structural discrimination, and a powerful antidote is for people at the table to speak up.” Indeed, as the specialty of PM&R advances in research and clinical care, we need the talents of all physiatrists.