eAppendix. Included Studies
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Larson AR, Cawcutt KA, Englander MJ, et al. Representation of Women in Authorship and Dissemination of Analyses of Physician Compensation. JAMA Netw Open. 2020;3(3):e201330. doi:10.1001/jamanetworkopen.2020.1330
Physician gender pay gaps persist in the US despite an impressive body of research spanning more than 25 years and adjusting for potentially confounding factors, including rank, years in practice, practice type, specialty, parental status, and hours worked.1-5 We hypothesized that women physicians were disproportionately represented as producers and disseminators of pay equity research and were largely unfunded for this work. Men have great power to drive change, given their larger representation within academic medical leadership. If compensation studies are unfunded and if women are more engaged than men in the pay equity issue, these factors may contribute to slow progress in addressing compensation disparities.
This cross-sectional study was performed on US-based physician compensation studies published from January 1, 2013, to February 22, 2019, in refereed medical journals indexed by PubMed. Because this study did not involve human participants and data were publicly available, the Boston University institutional review board determined that review was not required. This study is reported following the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.
Search details included text word and Medical Subject Headings searches on salary, research support, pay, compensation, wage, payment, and funding; physicians and faculty; and sex factors, gender, male, female, men, and women. References were reviewed in included studies to identify additional related reports. Studies that did not include physician compensation or gender data or were secondary sources (eg, reviews, perspectives) were excluded.
Unique authors in each category were recorded, as were presence and sources of funding for each compensation study. Journal article citations for the studies were collected from the Scopus database (Elsevier) (eAppendix in the Supplement). We ascertained the gender of most authors from their online profiles using their stated pronouns and/or photographs. For authors for whom this was not possible (2.8% of compensation authors, 3.2% of citation authors, 6.8% of disseminators), data were included if algorithmic assessment (Gender API) of first-name gender probabilities resulted in 1 gender meeting or exceeding 80%.
On February 23, 2019, we captured online dissemination metrics. Every person who tweeted or retweeted a link containing the digital object identifier to each study was recorded. The gender of disseminators with active accounts on Twitter was obtained by the same mechanisms that were used for authors.
We performed χ2 tests for statistical comparisons. P values were considered significant at less than .05. Analyses were performed using R statistical software version 3.4.0 (R Project for Statistical Computing). Data were analyzed from January 11 to February 15, 2020.
We identified 39 physician compensation studies (Table 1). Among 37 unique first authors and last authors, women were listed as the first authors in 22 studies (59.5%), and last authors for 19 studies (51.4%). Among 148 unique middle authors, 82 (55.4%) were women. Among 311 identified articles citing these studies, 200 unique women (64.3%) were identified as first authors, and among 789 unique middle authors for these articles, 446 (56.5%) were women (Table 2). There was an approximately equal balance of last authors of citations, a role often denoting the senior author, including 124 unique women last authors (49.8%) and 125 unique men last authors (50.2%) with men last authors. Among 1435 disseminator tweets identified, 913 tweets (63.6%) were by women (Table 2). When our data were compared with Association of American Medical Colleges data on full-time academic women faculty of clinical departments in 2015,6 which suggest that 40% of full-time academic faculty are women, our data revealed significantly greater proportions of women in total authors (117 women of 209 authors [56.0%]; P < .001), citation authors (716 women of 1264 authors [56.6%]; P < .001), and Twitter disseminators (913 women of 1435 disseminators [63.6%]; P < .001) (Table 2).
Of 39 reports analyzed in this study, 23 (59.0%) reported no funding or no relevant funding. There were 2 instances (8.7%) of medical society support, 4 instances (17.4%) of institutional, and 1 instance (4.3%) each of regional, foundational, and organizational support; 1 instance (4.3%) was uncategorized, and 10 reports (43.5%) cited national grants, although it was not clear for some of these whether the grants supported this work or other work performed by the authors.
These findings suggest that women are significantly overrepresented as producers and disseminators of compensation studies that include gender data. Furthermore, most of this area of research is unfunded. These findings are important because women may be more engaged and knowledgeable about pay disparities, while men are disproportionately represented in leadership roles and better positioned to fix disparities. If women are primarily producing this mostly unfunded research, a cycle can develop in which women lose additional income (eg, clinical revenue) and do not receive appropriate academic credit for promotions (eg, grant funding). This study is limited by the accuracy of online gender information and to those studies found in our search.
In conclusion, there is an opportunity for men to more actively participate as producers and disseminators of compensation research. Future grant funding organizations should make these studies a priority.
Accepted for Publication: January 24, 2020.
Published: March 20, 2020. doi:10.1001/jamanetworkopen.2020.1330
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Larson AR et al. JAMA Network Open.
Corresponding Author: Allison R. Larson, MD, MS, Department of Dermatology, Boston University School of Medicine, Boston University, 609 Albany St, J-207, Boston, MA (firstname.lastname@example.org).
Author Contributions: Drs Larson and Silver had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Larson, Englander, Liu, Silver.
Acquisition, analysis, or interpretation of data: Larson, Cawcutt, Englander, Pitt, Ansari, Silver.
Drafting of the manuscript: Larson, Englander.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Larson.
Administrative, technical, or material support: Englander, Pitt, Ansari, Liu.
Conflict of Interest Disclosures: Dr Larson reported receiving personal fees from Sanofi Genzyme outside the submitted work. Dr Cawcutt reported receiving personal fees from the Infectious Diseases Society of America and CloroxPro outside the submitted work. Dr Silver reported serving as a founding member of TIME’S UP Healthcare and receiving funding from the Arnold P. Gold Foundation for physician and patient care disparities research. No other disclosures were reported.