Implications of Sex Disparities in the h-Index for Academic Medicine | Health Disparities | JAMA Network Open | JAMA Network
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Invited Commentary
Medical Journals and Publishing
June 29, 2021

Implications of Sex Disparities in the h-Index for Academic Medicine

Author Affiliations
  • 1Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
JAMA Netw Open. 2021;4(6):e2112877. doi:10.1001/jamanetworkopen.2021.12877

Women in medicine have significantly lower h-indexes than men at the assistant, associate, and full professor ranks across numerous academic medical specialties as described in this study by Ha et al.1 The absolute difference in h-index widened with ascending academic rank within these categories. The h-index is calculated using the number of times one’s publications are cited in the literature and is 1 measure of their impact. An individual’s number of citations and, therefore, h-index increase with the number of publications and time since publication.

One potential factor that contributes to the sex disparities Ha and colleagues1 document is a slower rate of increase of the h-index for women compared with men during a career. Sex-based disparities among authors of scientific publications2 are well documented and are particularly prevalent at earlier career stages,3 impacting the opportunity for women to start accruing citations. In addition, citation numbers for individual manuscripts are influenced by factors such as the scope of journal readership, number of coauthors, author’s reputation, and funding, among others.4 These other factors include author-related factors, such as rank, reputation, national and international collaborations, and networks.4 Disparities exist for women in medicine in research funding, as well as high-visibility opportunities such as medical society awards, plenary speaking roles, invited authorships on perspective pieces, and leadership roles.3,5 These honors position individuals as experts in their field and influence the reach of their scholarly work, including citation rates.

Ha et al1 did not find a significant difference in the h-indexes of female chairs compared with male chairs. This finding is surprising given the widening gap in h-index with increasing academic rank. Past literature has found that the disparity in the number of women promoted to chair positions is larger than the promotion gaps between men and women at the associate and full professor levels.6 Of note, only 18 of the chairs in this study were women compared with 316 men, and the CIs around the h-indexes for female chairs in each department were understandably wide.1 Additional data will be needed to fully assess differences in h-indexes between male and female chairs.

In the promotion process, it is critical to consider holistic measures of success beyond publications and their impact, such as breadth and depth of mentorship, educational initiatives, and leadership roles. Women are more highly represented on practitioner-educator tracks than men,1,5 a path with historically lower research productivity, where greater contributions are made in other domains. The question that leaders and institutions need to ask is why women are represented to a lesser degree on research tracks and what institutional and departmental initiatives can be undertaken to correct this disparity. Programs and policies that support women in research careers overlap significantly with initiatives those that seek to correct h-index disparities.

h-Indexes can impact not only timing of promotion but also tenure, salary, research funding, and appointment to leadership positions and can contribute to sex disparities in each of these dimensions in academic medicine. Ha et al1 outline several systematic interventions that can positively impact the h-index disparity, specifically education on implicit bias, formal mentorship programs, career development programs, and institutional policies supporting work-life integration. In addition, individuals and departments should sponsor women for scholarly opportunities, especially roles that lead to manuscript authorship, and their publications should be highlighted and promoted by their institutions. Women should be included in research endeavors early in their careers. Intersectional disparities must also be considered based on race, ethnicity, LGBTQ+, and disabilities, among other factors. Institutions and individual faculty should educate all students, residents, postdoctoral fellows, and junior faculty on the meaning and importance of the h-index in academia. Recognizing the barriers that exist for women in medicine to build a national and international reputation,3,5 alternative metrics, including certain social media platforms, can be leveraged by researchers to showcase their work.7 These measures will serve to narrow not only the disparities in h-indexes but also broader disparities in the pursuit of research endeavors.

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Article Information

Published: June 29, 2021. doi:10.1001/jamanetworkopen.2021.12877

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Larson AR. JAMA Network Open.

Corresponding Author: Allison R. Larson, MD, MS, Department of Dermatology, Boston University, 609 Albany St, J-207, Boston, MA 02118 (arlarson@bu.edu).

Conflict of Interest Disclosures: Dr Larson reported receiving personal fees from Sanofi Genzyme as a onetime advisory board member in 2019 on resident education outside the submitted work.

References
1.
Ha GL, Lehrer EJ, Wang M, Holliday E, Jagsi R, Zaorsky NG. Sex differences in academic productivity across academic ranks and specialties in academic medicine: a systematic review and meta-analysis. JAMA Netw Open. 2021;4(6):e2112404. doi:10.1001/jamanetworkopen.2021.12404
2.
Jagsi  R, Guancial  EA, Worobey  CC,  et al.  The “gender gap” in authorship of academic medical literature: a 35-year perspective.   N Engl J Med. 2006;355(3):281-287. doi:10.1056/NEJMsa053910 PubMedGoogle ScholarCrossref
3.
Reed  DA, Enders  F, Lindor  R, McClees  M, Lindor  KD.  Gender differences in academic productivity and leadership appointments of physicians throughout academic careers.   Acad Med. 2011;86(1):43-47. doi:10.1097/ACM.0b013e3181ff9ff2 PubMedGoogle ScholarCrossref
4.
Tahamtan  I, Afshar  AS, Ahamdzadeh  K.  Factors affecting number of citations: a comprehensive review of the literature.   Scientometrics. 2016;107:1195–1225. doi:10.1007/s11192-016-1889-2 Google ScholarCrossref
5.
Nocco  SE, Larson  AR.  Promotion of women physicians in academic medicine.   J Womens Health (Larchmt). Published online May 14, 2020. doi:10.1089/jwh.2019.7992 PubMedGoogle Scholar
6.
Richter  KP, Clark  L, Wick  JA,  et al.  Women physicians and promotion in academic medicine.   N Engl J Med. 2020;383(22):2148-2157. doi:10.1056/NEJMsa1916935 PubMedGoogle ScholarCrossref
7.
Knowlton  SE, Paganoni  S, Niehaus  W,  et al.  Measuring the impact of research using conventional and alternative metrics.   Am J Phys Med Rehabil. 2019;98(4):331-338. doi:10.1097/PHM.0000000000001066 PubMedGoogle ScholarCrossref
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