Representation of women very low in academic internal medicine

Women remain significantly underrepresented in academic internal medicine leadership positions in the United States, according to findings published in the Journal of General Internal Medicine.

Underrepresentation persisted despite a record-high percentage — 50.7% — of female medical students matriculating in 2017.

“Improving the pipeline of women in internal medicine and its subspecialties is an important goal,” Stefanie Purdon, MD, an internist in the division of pulmonary and critical care medicine at Beaumont Hospital in Troy, Michigan, and colleagues wrote. “Improving diversity enables institutions to better mirror the populations they serve and create balance in the workplace. Yet, as our work and the work of others highlight, changing only one element in a system will not likely achieve meaningful improvement.”

In a cross-sectional cohort study, Purdon and colleagues evaluated gender representation at 940 academic internal medicine departments and internal medicine subspecialty divisions in the U.S. They assessed these departments for representation in leadership positions in 2018 and in traineeships from 2012 to 2016.

Overall, only 13.4% of internal medicine chairs were women, despite women accounting for 41.2% of internal medicine physicians in 2018. Purdon and colleagues also reported that female representation among chiefs of every fellowship specialty was less than 25%. Specifically, women accounted for 2.6% of cardiology chiefs, 6.6% of gastroenterology chiefs, 10.7% of pulmonary and critical care chiefs, 14.4% of nephrology chiefs, 20.6% of endocrinology chiefs, 23.2% of hematology/oncology chiefs and 24.3% of infectious disease chiefs. The researchers also reported that 43.1% of internal medicine residents were women, with much variability among fellows for subspecialties, from 22% for cardiology to 71.8% for endocrinology.

Representation was higher for the position of program director (PD), with 39.7% of internal medicine PD positions filled by women. Meanwhile, female representation in this position varied greatly for subspecialties, from almost 25% in cardiology and gastroenterology to nearly 50% in endocrinology and infectious disease.

Departments and programs in Arizona, Colorado, Idaho, Montana, New Mexico, Utah and Wyoming had the highest representation of women in leadership positions (24.2% for chairs/chiefs; 51.4% for PDs), according to Purdon and colleagues. Meanwhile, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota had the lowest representation of women (9.2% for chairs/chiefs; 29.1% for PDs).

In addition, the highest proportions of female trainees were in departments and programs in Alaska, California, Hawaii, Nevada, Oregon, Washington (46.3%) as well as Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont (44.9%) and New Jersey, New York and Pennsylvania (43.7%).

Overall, having more female fellows, but not chairs or PDs, was associated with having more female residents (per 1% fellow increase: OR = 0.3; 95% CI, 0.2-0.5), the researchers reported. In unadjusted analyses only, every 7.7% increase in female PDs (95% CI, 4.7-10.6) or 8.9% increase in female chiefs (95% CI, 4.6-13.1) was associated with an increase in female fellows.

“Until we can determine the pivotal aspects of culture to address, all available tools must be applied to foster leadership aspirations among women in academia,” Purdon and colleagues wrote.