Abstract
This cross-sectional study examines gender equity in the presidential leadership of medical specialty societies over a 10-year period.
The long-standing underrepresentation of women among medical academic leaders (deans, chairs, and professors) is well documented. However, little is known about trends in medical society leadership. Because tenure in society leadership positions contributes to academic advancement and provides opportunities to influence both the organization and the medical specialty, it is crucial to begin examining the demographics of society leadership.
Methods
In this cross-sectional study, we identified 1 major physician-focused medical society for each of the 43 specialty groupings listed in the 2016 Physician Specialty Data Report (Table).1 We generally selected the largest and/or most influential society in the field. Groupings for internal medicine/pediatrics, neonatal-perinatal medicine, pediatric cardiology, and pediatric hematology/oncology (4 of 43 groupings) were then excluded because physicians in these specialties generally belong to the American Academy of Pediatrics (AAP). The primary outcome measures were years of presidential leadership attributed to men and women. To minimize some lack of independence across years, which is even greater for societies using 2-year presidential terms (4 of 39 societies; Table), data were collected for a 10-year period (2008-2017), allowing for a minimum of 5 election cycles. For 38 societies, presidents’ names were assigned to the year of election. For the AAP, which changed the start of its presidential term from fall to January in 2014, presidents elected before 2014 were assigned to the year following election. Gender was determined and verified via publicly available online profiles. One-sample tests of proportions comparing the percentage of women among association presidents with the percentage of women in active practice (Figure) were used to determine the significance (2-sided P values) of underrepresentation or overrepresentation.1,2,3 The Partners Human Research Committee/institutional review board determined that review of the study and participant written consent were not required.
Table. Profiles of Included Medical Specialty Societies.
| AAMC Specialty Grouping | No. of Active Physicians in 2015a | Active Women Physicians in 2015, No. (%)a | Medical Specialty Society Assessed (Abbreviation) | Presidential Term, y | Years With Woman President, %b | Difference, %c |
|---|---|---|---|---|---|---|
| Allergy and immunology | 4628 | 1675 (36.2) | American Academy of Allergy, Asthma, & Immunology (AAAAI) | 1 | 10 | −26.2 |
| Anatomic/clinical pathology | 13 277 | 4869 (36.7) | College of American Pathologists (CAP) | 2 | 0 | −36.7 |
| Anesthesiology | 41 306 | 10 276 (24.9) | American Society of Anesthesiologists (ASA) | 1 | 10 | −14.9 |
| Cardiovascular disease | 22 038 | 2908 (13.2) | American College of Cardiology (ACC) | 1 | 10 | −3.2 |
| Child and adolescent psychiatry | 8731 | 4519 (51.8) | American Academy of Child & Adolescent Psychiatry (AACAP) | 2 | 30 | −21.8 |
| Critical care medicine | 10 143 | 2588 (25.5) | Society of Critical Care Medicine (SCCM) | 1 | 40 | 14.5 |
| Dermatology | 11 696 | 5514 (47.1) | American Academy of Dermatology (AAD) | 1 | 0 | −47.1 |
| Emergency medicine | 39 547 | 10 509 (26.6) | American College of Emergency Physicians (ACEP) | 1 | 30 | 3.4 |
| Endocrinology, diabetes, and metabolism | 6957 | 3231 (46.4) | American Association of Clinical Endocrinologists (AACE) | 1 | 10 | −36.4 |
| Family medicine/general practice | 111 127 | 42 685 (38.4) | American Academy of Family Physicians (AAFP) | 1 | 20 | −18.4 |
| Gastroenterology | 14 107 | 2307 (16.4) | American College of Gastroenterology (ACG) | 1 | 10 | −6.4 |
| General surgery | 25 233 | 4835 (19.2) | American College of Surgeons (ACS) | 1 | 20 | 0.8 |
| Geriatric medicine | 5221 | 2673 (51.2) | American Geriatrics Society (AGS) | 1 | 60 | 8.8 |
| Hematology and oncology | 14 457 | 4611 (31.9) | American Society of Hematology (ASH) | 1 | 30 | −1.9 |
| Infectious disease | 8501 | 3371 (39.7) | Infectious Diseases Society of America (IDSA) | 1 | 20 | −19.7 |
| Internal medicine | 113 871 | 41 951 (36.8) | American College of Physicians (ACP) | 1 | 20 | −16.8 |
| Interventional cardiology | 3248 | 240 (7.4) | Society for Cardiovascular Angiography and Interventions (SCAI) | 1 | 0 | −7.4 |
| Nephrology | 10 070 | 2751 (27.3) | American Society of Nephrology (ASN) | 1 | 30 | 2.7 |
| Neurological surgery | 5343 | 419 (7.8) | American Association of Neurologic Surgeons (AANS) | 1 | 0 | −7.8 |
| Neurology | 13 378 | 3760 (28.1) | American Academy of Neurology (AAN) | 2 | 0 | −28.1 |
| Neuroradiology | 3289 | 642 (19.5) | American Society of Neuroradiology (ASNR) | 1 | 40 | 20.5 |
| Obstetrics and gynecology | 41 446 | 22 585 (54.5) | American College of Obstetricians and Gynecologists (ACOG) | 1 | 10 | −44.5 |
| Ophthalmology | 18 584 | 4436 (23.9) | American Academy of Ophthalmology (AAO) | 1 | 20 | −3.9 |
| Orthopedic surgery | 19 142 | 951 (5.0) | American Academy of Orthopaedic Surgeons (AAOS) | 1 | 0 | −5.0 |
| Otolaryngology | 9405 | 1485 (15.8) | American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) | 1 | 20 | 4.2 |
| Pain medicine and pain management | 4595 | 840 (18.3) | American Academy of Pain Medicine (AAPM) | 1 | 0 | −18.3 |
| Pediatrics | 57 491 | 35 573 (61.9) | American Academy of Pediatrics (AAP) | 1 | 30 | −31.9 |
| Physical medicine and rehabilitation | 9137 | 3204 (35.1) | American Academy of Physical Medicine and Rehabilitation (AAPM&R) | 1 | 20 | −15.1 |
| Plastic surgery | 7017 | 1050 (15.0) | American Society of Plastic Surgeons (ASPS) | 1 | 10 | −5.0 |
| Preventive medicine | 6588 | 2160 (32.8) | American College of Preventive Medicine (ACPM) | 2 | 20 | −12.8 |
| Psychiatry | 37 717 | 14 335 (38.0) | American Psychiatric Association (APA) | 1 | 50 | 12.0 |
| Pulmonary disease | 5480 | 615 (11.2) | American Thoracic Society (ATS) | 1 | 30 | 18.8 |
| Radiation oncology | 4845 | 1312 (27.1) | American Society for Radiation Oncology (ASTRO) | 1 | 10 | −17.1 |
| Radiology and diagnostic radiology | 27 505 | 6799 (24.7) | Radiologic Society of North America (RSNA) | 1 | 30 | 5.3 |
| Rheumatology | 5599 | 2378 (42.5) | American College of Rheumatology (ACR) | 1 | 30 | −12.5 |
| Thoracic surgery | 4484 | 271 (6.0) | American Association for Thoracic Surgery (AATS) | 1 | 0 | −6.0 |
| Urology | 9804 | 780 (8.0) | American Urologic Association (AUA) | 1 | 0 | −8.0 |
| Vascular and interventional radiology | 2966 | 273 (9.2) | Society of Interventional Radiologists (SIR) | 1 | 0 | −9.2 |
| Vascular surgery | 3356 | 379 (11.3) | Society for Vascular Surgery (SVS) | 1 | 10 | −1.3 |
Abbreviation: AAMC, Association of American Medical Colleges.
Data from Association of American Medical Colleges. 2016 Physician specialty data report: active physicians by sex and specialty, 2015. table 1.3. https://www.aamc.org/data/workforce/reports/458712/1-3-chart.html. Published 2015. Accessed January 30, 2017.
From 2008 to 2017; n = 10
The percentage of years with a woman president vs the percentage of women among active physicians in 2015. Positive values indicate equitable or better representation of women among years of presidential leadership. Negative values indicate lower than equitable levels of representation of women among years of presidential leadership.
Figure. Representation of Women Among Presidential Leaders of 39 Major Medical Specialty Societies by Year From 2008 to 2017.
Because society membership information generally was not publicly available and the Association of American Medical Colleges (AAMC) did not report workforce data in every specialty grouping or every year during the study period, the percentages of women physicians in active practice as reported by the AAMC are only available for 2010 (30.4%),2 2013 (32.6%),3 and 2015 (34.0%).1 Error bars indicate the 95% CIs for the percentage of women among presidential leaders.
Results
Between 2008 and 2017, presidential leadership was held predominantly by men, with men serving as presidents in 82.6% of years (322 of 390 years) vs women serving as presidents in 17.4% of years (68 of 390 years). Women were underrepresented overall but were significantly underrepresented in 2015 in terms of the percentage of women among society presidents vs the percentage of women among active physicians (15.4% vs 34.0%; P = .01) (Figure). The Society of Critical Care Medicine, American Society of Neuroradiology, American Psychiatric Association, and American Geriatrics Society had the highest number of years with women presidential leaders (4-6 of 10 years; Table). In contrast, 10 societies had 0 of 10 years with women presidential leaders.
To gain perspective on the representation of women in top leadership roles, data on presidents from each society were compared with the representation of women among active physicians in the respective specialty grouping in 2015 (Table).1 We were limited to this single comparison because the Association of American Medical Colleges workforce data were not reported in consistent specialty groupings or at consistent intervals during the study period, and society membership information generally was not publicly available. Equitable or better representation (positive differences) was found in 10 societies. However, gaps (negative differences) were found in 29 societies, with the 5 largest gaps (>30%) found in the American Academy of Dermatology, American College of Obstetricians and Gynecologists, College of American Pathologists, American Association of Clinical Endocrinologists, and AAP.
Discussion
Society leadership has a role in academic advancement, and leaders may exert considerable influence on their organizations and specialties. Our finding of sustained underrepresentation of women within the critical post of society president highlights a challenge to achievement of gender equity in medicine that persists today. We suspect that barriers to equitable representation of women within societies may have affected women’s ability to ascend to presidential leadership, though we have data only for selected societies and no data on internal processes used during selection of presidential leaders.4,5,6 Our results suggest that efforts to improve diversity and inclusion may have been more successful in some societies than in others. Therefore, societies must prioritize examination and mitigation of disparities in the inclusion and support of members and report both challenges and successful strategies.4,5
References
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