Women in academic rheumatology less likely to be full, associate professors
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Among academic rheumatologists, women have fewer total publications compared with men, and are less likely than men to be full or associate professors, according to findings published in Arthritis & Rheumatology.
“It is well-documented that a gender gap exists between men and women when comparing academic rank, leadership roles and remuneration across United States academic medical centers,” April Jorge, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.
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“Differences in academic promotion and leadership positions among women and men in rheumatology have not been previously evaluated,” they added. “Defining these benchmarks are important to facilitate actions that will improve parity in the rheumatology workforce, help maintain women in academic rheumatology, and ensure that the distribution of men and women in academic rheumatology reflects the demographics of the specialty.”
To examine the potential link between gender and academic advancement among U.S. rheumatologists, Jorge and colleagues conducted a nationwide, cross-sectional study of all practicing rheumatologists in the country as of 2014. The researchers used data provided by Doximity, a free online networking service for physicians. According to Jorge and colleagues, physicians do not need to register for an account to be included in this database, as it includes all physicians with a registered National Provider Identifier (NPI) number, as well as those without NPI numbers who have registered for an account.
Data included in Doximity includes age, gender, year of medical school graduation, year of residency graduation, appointment at medical school, faculty rank and American Board of Internal Medicine specialty certification. The database also includes total number of publications for each physician, as well as numbers of those designated as first author and last author publications, the number of NIH grants with the role as the principal investigator and the number of clinical trials as the principal investigator or sub-investigator.
Jorge and colleagues used this data, along with a multivariate logistic regression model, to estimate gender differences in faculty rank, adjusting for differences in physician age, years since residency graduation, publications, NIH grants, registered clinical trials and appointment at a top 20 medical school. They also estimated gender differences in leadership positions, including titles such as division director and fellowship program director.
In all, the researchers analyzed data from 941 practicing rheumatologists with academic faculty appointments in 2014. Among these, 41.6% were women.
According to the researchers, women in academic rheumatology were younger and completed their residency more recently compared with men. In addition, women had fewer total publications, including first- and last-author bylines, as well as fewer NIH grants. In their fully adjusted analysis, Jorge and colleagues found that women were less likely to be full or associate professors, compared with men (aOR = 0.78; 95% CI, 0.62-0.99). Meanwhile, women were just as likely as men to be a fellowship program director (aOR = 0.9; 95% CI, 0.69-1.43) or a division director (aOR = 0.96; 95% CI, 0.66-1.41).
“We found that women in rheumatology are less likely than men to achieve senior faculty positions in U.S. medical schools but have similar opportunities for attaining leadership opportunities within rheumatology divisions,” Jorge and colleagues wrote. “These discrepancies might indicate differences in the value placed on different roles women and men may have in the academic setting and highlight barriers to the promotion of women faculty.
“Further work is needed to characterize and address these barriers,” they added. “As the workforce gender balance continues to shift, equity in the academic advancement of women in rheumatology must be ensured.”
Perspective
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Allan Gibofsky, MD, JD
The most recent data from ACR reported that while women made up only 41% of the workforce, they accounted for 66% of trainees. Thus, although there have been significant increases in the number of women practicing rheumatology, significant disparities in numbers and academic advancement continue to exist.
The study by Jorge and colleagues is a systematic attempt to describe and highlight the differences. In an analysis of 6,125 rheumatologists, they observed that female rheumatologists, including those in academic positions, are younger than their male counterparts and have fewer publications and NIH grants. The authors note a number of factors could explain this difference, including time spent on parental leave and mentorship; however, even after adjusting for these factors the differences remained, leading to a suggestion of an implicit gender bias in academic institutions.
Jorge and colleagues acknowledged the income differences between male and female rheumatologists, but were unable to define the contribution of parental leave and work effort in their study. In this regard, data from a recent paper published in The New England Journal of Medicine by Ganguli and colleagues report that although female primary care physicians had a lower volume of visits — and thus generated less visit revenue than male colleagues in the same practices — they spent more time in direct patient care per visit, per day and per year. These differences, if substantiated, should be evaluated in our specialty as well.
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