Underrepresentation of Women Among Authors of Invited Commentaries in Medical Journals—Where Are the Female Editorialists?

To the growing list of gender-based disparities faced by women in academic medicine, we can add 1 more: on average, across thousands of medical journals, women with comparable credentials and experience are less likely than men to author invited commentary articles (ie, editorials).¹ Smaller studies, limited to specific disciplines, suggested this was the case but did not account for factors that are likely to be associated with invitations to write editorials, such as publication history.^2,3 Thomas and colleagues¹ reported on their examination of 72 038 medical journal commentary articles published from 2013 to 2017. The researchers used validated methods to infer author gender and matched commentary authors to controls on characteristics likely to be associated with invitations, including field of expertise, seniority, number of publications, and citation record. Adjustment for these confounders attenuated but did not eliminate the substantial differences in favor of men.¹ Surprisingly, the magnitude of the disadvantage was larger for senior women. Overall, the odds of authoring an editorial were 21% lower for women compared with men.¹ However, for the most senior women, the odds of authoring an editorial were 31% lower than for men with comparable credentials.¹

The researchers were able to generate journal-specific odds ratios for most publications in the sample. In most journals, the odds of authoring an editorial consistently favored men. There were some exceptions, notably among anatomy, rehabilitation, and health informatics journals. However, on average and at the level of individual journals, the numbers tell a mostly discouraging tale. “Female talent was underused,”¹ conclude Thomas et al.

Anecdotes regarding the barriers faced by women in academic medicine and publishing abound, but anecdotes are not high-level evidence. It is easy to generate plausible explanations for why an individual woman physician is infrequently or never invited to write editorials. It takes research like that of Thomas and colleagues,¹ looking at large samples across a range of disciplines, to demonstrate that this a systemic and not an individual problem.

Everyone loses when women experts are systematically excluded from academic medical discourse and debate. Their absence reinforces stereotypes and implies that there are no qualified women whose opinions are worth hearing. Editorialists are thought leaders whose words influence practicing clinicians, researchers, the industry, politicians, patients, and the media. To the extent that women are missing from high-level discussion, all of these constituents are deprived of fresh ideas and diverse opinions. The marginalization and neglect of the expertise and opinion of women is demoralizing for other women and may discourage them from pursuing or continuing medical careers. It also harms those excluded. Authoring a high-profile editorial confers expertise and authority, can lead to speaking opportunities and media exposure, and facilitates the accumulation of many other credentials needed for academic promotion. The compounded disadvantage of many professional snubs can have a serious and negative cumulative effect on a woman’s career.⁴

Clearly, a few journals and specialties do better than others in ensuring balance. This should be a challenge for other journals. Thomas and colleagues¹ showed conclusively that author-level factors did not explain disparities in commentary authorship. In fact, consistent with other evidence, the disadvantage appears to be greatest for women who, based on objective measures, such as academic stature and publication metrics, are the most accomplished in their fields.⁵

Because the problem is not the women, it must be the process. How are experts identified? Who decides whom to invite? How often do those invited accept an invitation? Of those, how many successfully complete the task? The answers to these questions vary depending on journal and specialty. Some large journals have paid editors whose only responsibility is to solicit editorial commentary. At small subspecialty journals with fewer resources, overworked volunteer editors with limited time or the editor in chief may be responsible for soliciting editorials.

Thomas and colleagues¹ suggest several ways journal editors might redress inequities, but the practicality and effects of these proposed solutions will vary among specialties and settings because of differing levels of resources and ingrained sexism. Notably, they suggest that natural language processing methods, like those used in their study, could be used to develop lists of qualified women experts.¹ Such an approach would address the problem of journal editors seeking commentary from experts who are highly visible, which depends on social networks, connections, and previous success. This system has not been advantageous for women, who are less visible because they hold fewer leadership positions in professional societies, are underrepresented on journal editorial boards, and are less likely to have been authors on previous important papers in the field.⁶

Journals can also pay more attention to balance when selecting peer reviewers because reviewers are often asked to write an editorial when a paper is accepted for publication. Some journals routinely ask every reviewer if they would be willing to write an editorial. This approach will not help women if there is gender bias in reviewer invitations extended by the journal or if women are less likely to accept review invitations. We work as editors for journals that do not ask reviewers whether they are willing to provide an editorial. However, reviewers will frequently email separately or mention in their review comments that they would be willing to provide an editorial. Sometimes they even attach an already written editorial. Those who self-nominate are predominantly men, so editors must be cautious accepting such offers.

It is important not to locate blame inaccurately and thereby foreclose opportunities for improvement. It is likely that the gender imbalance in editorial authorship is multifactorial, explained in part by factors that lie beyond the control of medical journal editors. These include challenges to women’s involvement that are related to competing demands on their time, their perceptions of themselves as experts, and their willingness to accept invitations. It is our impression as medical journal editors for a large general journal (The BMJ) and a subspecialty journal (Headache) that women are less likely than men to accept invitations to provide reviews or invited commentary. We are not aware of formal studies of this phenomenon in medicine, but it occurs in other fields. A science reporter who documented his efforts to increase the number of female experts quoted in his articles found that he had to invite 1.6 women but only 1.3 men to get a yes when he asked for expert comment.⁷ Thomas and colleagues¹ acknowledge that we do not know the extent to which women physicians decline invitations, and they suggest that journal editors should collect this information.

Medical science thrives when there is vigorous dissent, discussion, and debate. It is vital that women experts are able to play a full and active role in this process. Women physicians should insist on being heard, and medical journal editors and other gatekeepers must work to identify and dismantle the systems that stand in the way of their full participation.

Published: October 23, 2019. doi:10.1001/jamanetworkopen.2019.13665

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Loder E et al. JAMA Network Open.

Corresponding Author: Elizabeth Loder, MD, MPH, Division of Headache, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, 1153 Centre St, Boston, MA 02130 (eloder@bwh.harvard.edu).

Conflict of Interest Disclosures: Dr Loder reported receiving payment from the BMJ Publishing Group for work as the head of research for The BMJ, paid to her employer (the Brigham and Women’s Physician Organization) and that, in her role at The BMJ, she occasionally participates in decisions about invitations to author editorials or other invited commentary articles. Drs Loder and Burch reported working as volunteer associate editors for the journal Headache and being occasionally involved in decisions about editorial commentary.