New Study Examines the Underrepresentation of Women Physicians as Opinion Article Authors in High Impact Pediatric Journals

Boston, MA – Researchers from Harvard Medical School and Drexel University College of Medicine published a new study in the Journal of the American Medical Association (JAMA) Open titled, “Assessment of Women Physicians Among Authors of Perspective-Type Articles Published in High-Impact Pediatric Journals” examining the role gender may play in opinion articles published in high impact journals, which in turn, likely have an important role in creating opportunities for professional advancement. The study built upon previous work on gender disparities in medicine and barriers to professional advancement. Among the documented issues women physicians face are disparities in opportunities for publications, professional presentations, awards and recognitions. This study looked specifically at the pediatric specialty and four high impact journals related to it.

Even though most pediatricians are women (approximately 62%), the study found that all four journals underrepresented women physicians among first authors of perspective-type articles where they would have an opportunity to express their opinions and provide insights that may influence the field and their own careers. Notably, all four journals are led by editors-in-chiefs who are men and all have formal affiliations with medical societies that physicians belong to in order to support their careers. Importantly, for more than two decades there has been a steady stream of reports in the medical literature suggesting there is gender bias with the selection of journal editors that may affect women physicians’ ability to publish and advance in their careers. For example, a report published in JAMA in 1998 was titled “Is There a Sex Bias in Choosing Editors?” for which the authors made a compelling case and stated, “A selection process favoring men would have profound ramifications for the professional advancement and influence of women”. Julie K. Silver, MD, Harvard Medical School, Department of Physical Medicine and Rehabilitation was the lead author of the study. Dr. Silver says, “Clearly, women physicians are not being given the same opportunities to voice their knowledge and insights, and this is particularly troubling in a specialty such as pediatrics where they are the majority of doctors. Medical journals and societies have the power to change the status quo, and I hope that this study will drive immediate action not only for perspective-type articles in one specialty but for all gender parity issues that have been documented in the literature but not sufficiently addressed by journal and society leaders.” Dr. Silver, is an Associate Professor and Associate Chair in the Department of Physical Medicine and Rehabilitation at Harvard Medical School and the Associate Chair for Strategic Initiatives for Spaulding Rehabilitation.

The group used a cross-sectional survey of perspective-type articles published between 2013 and 2017 in the 4 highest-impact general pediatric journals: Academic Pediatrics, JAMA Pediatrics, The Journal of Pediatrics, and Pediatrics. Among the critical findings were women were underrepresented among physician first authors at only 41.7% of articles review while accounting for almost 62% of the pediatric medicine profession. Women physicians were particularly underrepresented among physician first authors of article categories described as scholarly (15.4%-44.1%) versus categories described as narrative (52.9%-65.6%) in nature. Women were also underrepresented among last authors (senior authors are often listed last) and coauthors of articles attributed to both male and female physician first authors, although the underrepresentation of women among last authors and coauthors was more pronounced if a man was the first author.

Nancy Spector, MD, a professor of pediatrics and Associate Dean of Faculty Development at Drexel University and the Executive Director of Executive Leadership in Academic Medicine (ELAM), is one of the study’s authors. Dr. Spector notes, “Intentional inclusion and solicitation of women authors by medical journals is a concrete and immediate action that can be taken to rectify some of the imbalance that we found in this study. Inclusion needs to be a standard that is upheld by journal editors and society leaders.”

The inability to gain equitable representation in high impact journals has wide ranging consequences. Within medicine these publication opportunities may contribute to disparities in promotion, compensation and other markers of career advancement. The importance of women physicians being able to express their opinions and share their scholarly knowledge cannot be understated. Furthermore, one opportunity to do so leads to enhanced professional visibility and may result in speaking invitations where women physicians have documented gaps such as Grand Rounds, panels, lectureships and plenaries.

The study group concluded the results demonstrate a problem in the editorial process and should serve to urge all journal editors to use a 6-step process and metrics described in a previous report by Silver et al titled “Where are the Women?” and published in the journal PM&R. The recommended 6-step process includes: (1) examining gender diversity and inclusion data; (2) transparently reporting the results to stakeholders, including medical schools and academic medical centers; (3) investigating less than proportionate inclusion of women; (4) implementing strategies to improve inclusion; (5) tracking outcomes; and, (6) publishing the results. This study concludes, “Transparency to all stakeholders regarding reporting disparities, interventions, and outcomes is a hallmark of best practices for diversity and inclusion efforts.”

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A member of Partners HealthCare, Spaulding Rehabilitation includes Spaulding Rehabilitation Hospital, its main campus in Charlestown as well as Spaulding Rehabilitation Hospital Cape Cod, Spaulding Hospital Cambridge and the Spaulding Brighton Skilled Nursing Facility, as well as twenty-five outpatient sites throughout Eastern Massachusetts. Spaulding has been awarded a Model Systems designation in three specialty areas- Brain Injury, Burn Injury Rehabilitation, and Spinal Cord Injury - by the National Institute on Disability, Independent Living and Rehabilitation Research. Spaulding is a teaching hospital of Harvard Medical School as well as the official rehabilitation hospital of the New England Revolution. Spaulding is the only rehabilitation hospital in New England continually ranked since 1995 by U.S. News and World Report in its Best Hospitals survey, ranking #4 ranking in 2017/18. For more information, please visit www.spauldingrehab.org.