As lead author of the paper (Lipscomb MF, Joste NE, Markwood M et al.: Gender differences in appointments to pathology department interim chair positions and subsequent advancement to permanent chair positions. https://doi.org/10.1016/j.acpath.2023.100082) referenced in the letter above and on behalf of my co-authors, I thank Jacobs et al (https://doi.org/10.1016/j.acpath.2023.100104) for sharing their concerns about our paper. The authors rightfully emphasize the importance of distinguishing gender and sex in research studies related to gender disparities and ensuring the use of current standard terminology in reporting such studies. I also thank them for recognizing the importance of studying gender equity in academic medicine leadership. However, we disagree with their perspective that our use of “male” and “female” to designate gender in our publication undermined the validity of the research. We believe that the methods used to identify gender in our study were appropriate and that our publication's conclusions are valid. We showed that significantly more men than women are appointed as interim chairs and yet, when women do become interim chairs, they are more likely than men to become permanent chairs. Use of “male” and “female” as gender-specific terms, although not currently recommended, has historically been applied interchangeably with the terms men and women. The understanding of and terminology for gender and sex is a rapidly advancing field, and there continues to be some controversy about the best terminology to be used in addressing these topics. We describe below in more detail how the gender designation was done.
Table 1 and the accompanying result section commentary were derived from the Association of Pathology Chairs (APC) membership data. The membership data have not been in the past nor do they now ask for gender or sex identification. Accordingly, we identified the gender of most of the interim chairs based on their first names being recognized as masculine or feminine and other attributes such as culturally gender-consistent hair, clothing, demeanor, and gender-specific pronouns. For a few interim chairs, gender could not be determined using these criteria. The gender of these few chairs was identified (as indicated in Methods) by visiting their institutional website. Picture presentation and accompanying information observing pronouns were used to assign gender.
Tables 2 through 7 and accompanying text in the results section were derived from a survey of all 50 interim pathology chairs. The responding chairs were asked to identify their Gender as follows: 1) Male, 2) Female, 3) Other gender designation, or 4) Not specified. In asking interim chairs to respond to the survey, all were asked to respond directly to me or one of my co-authors if they had any questions or concerns about the survey. Respondents were also told that they could skip any question they felt uncomfortable answering. No respondent skipped this question nor asked for clarification. All those who responded that they were male (12/24) had previously been designated as male by appearances, masculine name, etc. and all of those who responded as female (12/24), similarly had been previously identified as female. Thus, survey data and commentary derived from these data could reliably be attributed to the appropriate gender.
In summary, the conclusions of our study are valid in relation to gender differences. Looking forward, any future studies related to gender issues, including those done by academic pathologists, will benefit from having read the comments and literature provided by the letter's authors.