Because society membership information generally was not publicly available and the Association of American Medical Colleges (AAMC) did not report workforce data in every specialty grouping or every year during the study period, the percentages of women physicians in active practice as reported by the AAMC are only available for 2010 (30.4%),2 2013 (32.6%),3 and 2015 (34.0%).1 Error bars indicate the 95% CIs for the percentage of women among presidential leaders.
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Silver JK, Ghalib R, Poorman JA, et al. Analysis of Gender Equity in Leadership of Physician-Focused Medical Specialty Societies, 2008-2017. JAMA Intern Med. 2019;179(3):433–435. doi:10.1001/jamainternmed.2018.5303
The long-standing underrepresentation of women among medical academic leaders (deans, chairs, and professors) is well documented. However, little is known about trends in medical society leadership. Because tenure in society leadership positions contributes to academic advancement and provides opportunities to influence both the organization and the medical specialty, it is crucial to begin examining the demographics of society leadership.
In this cross-sectional study, we identified 1 major physician-focused medical society for each of the 43 specialty groupings listed in the 2016 Physician Specialty Data Report (Table).1 We generally selected the largest and/or most influential society in the field. Groupings for internal medicine/pediatrics, neonatal-perinatal medicine, pediatric cardiology, and pediatric hematology/oncology (4 of 43 groupings) were then excluded because physicians in these specialties generally belong to the American Academy of Pediatrics (AAP). The primary outcome measures were years of presidential leadership attributed to men and women. To minimize some lack of independence across years, which is even greater for societies using 2-year presidential terms (4 of 39 societies; Table), data were collected for a 10-year period (2008-2017), allowing for a minimum of 5 election cycles. For 38 societies, presidents’ names were assigned to the year of election. For the AAP, which changed the start of its presidential term from fall to January in 2014, presidents elected before 2014 were assigned to the year following election. Gender was determined and verified via publicly available online profiles. One-sample tests of proportions comparing the percentage of women among association presidents with the percentage of women in active practice (Figure) were used to determine the significance (2-sided P values) of underrepresentation or overrepresentation.1-3 The Partners Human Research Committee/institutional review board determined that review of the study and participant written consent were not required.
Between 2008 and 2017, presidential leadership was held predominantly by men, with men serving as presidents in 82.6% of years (322 of 390 years) vs women serving as presidents in 17.4% of years (68 of 390 years). Women were underrepresented overall but were significantly underrepresented in 2015 in terms of the percentage of women among society presidents vs the percentage of women among active physicians (15.4% vs 34.0%; P = .01) (Figure). The Society of Critical Care Medicine, American Society of Neuroradiology, American Psychiatric Association, and American Geriatrics Society had the highest number of years with women presidential leaders (4-6 of 10 years; Table). In contrast, 10 societies had 0 of 10 years with women presidential leaders.
To gain perspective on the representation of women in top leadership roles, data on presidents from each society were compared with the representation of women among active physicians in the respective specialty grouping in 2015 (Table).1 We were limited to this single comparison because the Association of American Medical Colleges workforce data were not reported in consistent specialty groupings or at consistent intervals during the study period, and society membership information generally was not publicly available. Equitable or better representation (positive differences) was found in 10 societies. However, gaps (negative differences) were found in 29 societies, with the 5 largest gaps (>30%) found in the American Academy of Dermatology, American College of Obstetricians and Gynecologists, College of American Pathologists, American Association of Clinical Endocrinologists, and AAP.
Society leadership has a role in academic advancement, and leaders may exert considerable influence on their organizations and specialties. Our finding of sustained underrepresentation of women within the critical post of society president highlights a challenge to achievement of gender equity in medicine that persists today. We suspect that barriers to equitable representation of women within societies may have affected women’s ability to ascend to presidential leadership, though we have data only for selected societies and no data on internal processes used during selection of presidential leaders.4-6 Our results suggest that efforts to improve diversity and inclusion may have been more successful in some societies than in others. Therefore, societies must prioritize examination and mitigation of disparities in the inclusion and support of members and report both challenges and successful strategies.4,5
Accepted for Publication: August 8, 2018.
Corresponding Author: Julie K. Silver, MD, Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (firstname.lastname@example.org).
Published Online: January 7, 2019. doi:10.1001/jamainternmed.2018.5303
Author Contributions: Dr Silver had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Silver, Poorman, Parangi, Shillcutt.
Acquisition, analysis, or interpretation of data: Silver, Ghalib, Poorman, Al-Assi, Parangi, Bhargava.
Drafting of the manuscript: Silver, Poorman, Parangi, Shillcutt.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Silver, Bhargava.
Administrative, technical, or material support: Silver, Al-Assi, Bhargava, Shillcutt.
Study supervision: Silver, Parangi.
Conflict of Interest Disclosures: None reported.
Additional Contributions: The authors would like to recognize the efforts of additional contributors to this work: Linda M. Girgis, MD, Department of Family Medicine, Rutgers University, Robert Wood Johnson Medical School, participated in data collection and interpretation, writing, and editing content; Richard Goldstein, PhD, Department of Physical Medicine and Rehabilitation, Harvard Medical School, participated in statistical analysis and data interpretation; Robin Schoenthaler, MD, Department of Radiation Oncology, Massachusetts General Hospital, participated in data collection and interpretation, writing, and editing content; Ranna Parekh, MD, American Psychiatric Association, participated in data collection and interpretation, writing, and editing content; Sarah Diekman, MD, College of Law, Florida Mechanical and Agricultural University, participated in data collection and interpretation. They received no compensation for their contributions.
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