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Invited Commentary
Medical Education
November 24, 2020

The Impacts of Gender Disparity in Residency Matching

Author Affiliations
  • 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston
JAMA Netw Open. 2020;3(11):e2028161. doi:10.1001/jamanetworkopen.2020.28161

A critical turning point for the female physician is highlighted in the study by Lorello et al1 as another one of the numerous inequities throughout the female physician’s career life cycle. Their study’s extensive assessment of residency applicants’ matching highlights disproportionate increases in numbers between Canadian female residency applicants and representation across specialties, with women having a greater likelihood of success in matching into family medicine and psychiatry and less likelihood in surgery.

Factors that are associated with equitable participation and success in academic medicine are multifactorial: individual and cultural. Vassie et al2 have done a quality job of mapping out a thematic synthesis of factors that are associated with equitable participation and success in academic careers, and individual factors are far outnumbered by cultural factors; a notable and substantial one being medical students’ exposure to sex discrimination, influencing women’s pursuits more than men’s pursuits.2

Although Canadian female applicants are more often successful in matching to their first-choice specialty than male applicants, this is not the case across surgical subspecialties.1 This same phenomenon is echoed in the US where “…the proportion of women and UIM [underrepresented in medicine] physicians in surgery consistently lags behind other represented groups.”3 The Annals of Surgery acknowledged the existence of the glass ceiling, attributing it to 3 major factors: traditional gender roles, manifestations of sexism in the medical environment, and lack of effective mentors.4

This phenomenon exists in other specialties as well, notably anesthesiology. It is widely published that leadership positions in anesthesiology (full professor, chair positions, journal editors) are usually held by men, whereas women generally hold assistant and associate professor positions. An international survey conducted throughout 148 countries with more than 11 000 participants (51.3% women, 48.7% men) revealed that despite “women making up an increasing proportion of the physician workforce in anaesthesia, they are consistently underrepresented in leadership and governance.”5

Throughout US medical schools, gender disparities are reflected across academic ranks, with women substantially less likely to be full professors (after accounting for other variables: age, experience, specialty, research productivity).6 Furthermore, across all specialties, female trainee representation is associated with a higher percentage of female faculty, suggesting that a paucity of female faculty underscores gender disparity in women entering the specialty, further amplifying the inequity.7

The imbalance in sex representation is important because it fosters a culture where female physicians are less likely to pursue and excel in academic medicine. This translates into less cognitive diversity, and a potential adverse effect on the Accreditation Council for Graduate Medicine Education core program requirement of recruitment and inclusiveness of a diverse group of physicians. Moreover, it erodes any competitive advantage, wastes human capital, and prevents improvement of health care for all.4 The Charter on Professionalism for Healthcare Organizations maintains that a healing environment is optimized when equal value and respect are afforded to all across the institution. Perhaps Woolley and Malone captured this concept best when they identified that a group’s collective intelligence rises when the group includes more women.8

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Article Information

Published: November 24, 2020. doi:10.1001/jamanetworkopen.2020.28161

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Kowalski A. JAMA Network Open.

Corresponding Author: Alicia Kowalski, MD, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Box 409, Houston, TX 77030 (amkowalsk@mdanderson.org).

Conflict of Interest Disclosures: None reported.

Lorello  GR, Silver  JK, Moineau  G, McCarthy  K, Flexman  AM.  Trends in representation of female applicants and matriculants in Canadian residency programs across specialties, 1995 to 2019.   JAMA Netw Open. 2020;3(11):e2027938. doi:10.1001/jamanetworkopen.2020.27938Google Scholar
Vassie  C, Smith  S, Leedham-Green  K.  Factors impacting on retention, success and equitable participation in clinical academic careers: a scoping review and meta-thematic synthesis.   BMJ Open. 2020;10(3):e033480. doi:10.1136/bmjopen-2019-033480PubMedGoogle Scholar
Nehemiah  A, Roberts  SE, Song  Y,  et al.  Looking beyond the numbers: increasing diversity and inclusion through holistic review in general surgery recruitment.   J Surg Educ. Published online September 16, 2020;S1931-7204(20)30348-2. doi:10.1016/j.jsurg.2020.08.048PubMedGoogle Scholar
Zhuge  Y, Kaufman  J, Simeone  DM, Chen  H, Velazquez  OC.  Is there still a glass ceiling for women in academic surgery?   Ann Surg. 2011;253(4):637-643. doi:10.1097/SLA.0b013e3182111120PubMedGoogle ScholarCrossref
Zdravkovic  M, Osinova  D, Brull  SJ, Prielipp  RC, Simões  CM, Berger-Estilita  J; Collaborators.  Perceptions of gender equity in departmental leadership, research opportunities, and clinical work attitudes: an international survey of 11 781 anaesthesiologists.   Br J Anaesth. 2020;124(3):e160-e170. doi:10.1016/j.bja.2019.12.022PubMedGoogle ScholarCrossref
Jena  AB, Khullar  D, Ho  O, Olenski  AR, Blumenthal  DM.  Sex differences in academic rank in US medical schools in 2014.   JAMA. 2015;314(11):1149-1158. doi:10.1001/jama.2015.10680PubMedGoogle ScholarCrossref
Chapman  CH, Hwang  W-T, Wang  X, Deville  C.  Factors that predict for representation of women in physician graduate medical education.   Med Educ Online. 2019;24(1):1624132. doi:10.1080/10872981.2019.1624132PubMedGoogle Scholar
Woolley  A, Malone  TW. Defend your research: what makes a team smarter? more women. Harvard Business Review. Published June 2011. Accessed November 4, 2020. https://hbr.org/2011/06/defend-your-research-what-makes-a-team-smarter-more-women