Representation of Women Among Physician Authors of Perspective-Type Articles in High-Impact Dermatology Journals

Abstract

This cross-sectional, descriptive study analyzes the number of women among physician first authors of articles published in the Journal of the American Academy of Dermatology and JAMA Dermatology across a 5-year period.

In 2015, women comprised 47.1% of active dermatologists in the United States,¹ including 47.9% of residency program directors and 55.3%, 42.4%, and 31.2% of assistant, associate, and full professors, respectively, but just 23.5% of department chairs or chiefs.² In a recent study,³ women accounted for 43.0% of research article authors in dermatology journals, including 50.2% of first authors. However, Silver and colleagues⁴ recently found that women were underrepresented among physician authors of perspective-type articles published in high-impact pediatric journals despite comprising 61.9% of active pediatricians and 53.0% of full-time physician pediatric faculty. Perspective-type articles are critical and provide platforms for physicians to influence their field and contribute to their career development as authors. In the present study, we hypothesized that despite parity in first authorship of research articles, women in dermatology may be underrepresented among physician authors of perspective-type articles.

Methods

The primary outcome measured in this cross-sectional, descriptive study was the number of women among physician first authors of articles published in perspective-type categories in 2 of the highest-impact general dermatology journals (Journal of the American Academy of Dermatology and JAMA Dermatology) over a 5-year period (2013-2017). Article categories were identified as perspective if the journal’s instructions to authors indicated that articles were independent opinions. By focusing on perspective-type categories, we hoped to (1) include articles that could be written by physicians at any stage of their careers and without expertise in any particular subfield of study, and (2) minimize bias stemming from inclusion of editorial or expert commentary–type article categories owing to previous reports of underrepresentation of women among editorial boards and senior academic faculty. Once categories were identified, individual articles were excluded only if gender of the first author could not be determined (n = 1). Coauthors were excluded if gender could not be determined (n = 2). The gender of each author was determined via Internet search of public profiles. Because this study did not involve interaction with human subjects and data were publicly available, the Partners Healthcare institutional review board determined the study did not require review.

Results

Two article categories, 1 from each journal, met the inclusion criteria: Journal of the American Academy of Dermatology’s Commentary category and JAMA Dermatology’s Viewpoint category (Table). The percentage of women among physician first authors (n = 25 of 78 [32%]) was lower than the percentage of women among active dermatologists in 2015 (47.1%).¹ Women were more equitably represented among physician first of multiple authors (n = 23 of 63 [37%]) than among physician first and only authors (n = 2 of 15 [13%]). Women physician first of multiple authors were more likely than men to be associated with women coauthors (22 of 44 [50%] vs 29 of 74 [39%]). Similarly, women physician first authors were more likely than men to be associated with women last authors (9 of 23 [39%] vs 12 of 40 [30%]). Overall, there were lower percentages of women among authors than among women in active dermatology practice in 2015 in 90.5% (n = 19 of 21) of the groupings.

Table. Representation of Women Among Physician First Authors, Coauthors, and Last Authors of Perspective-Type Dermatology Articles, 2013-2017^a.

Characteristic	Total Articles, No./Total No. (%)	Articles, No./Total No. (%)
		Journal of the American Academy of Dermatology Commentary Category	JAMA Dermatology Viewpoint Category
First author analysis
Articles written by physician first author	79	33	46
First author of unknown gender excluded	1	0	1
Woman as physician first author	25/78 (32)b	13/33 (39)b	12/45 (27)b
Articles written by physician first and only author	15/78 (19)	9/33 (27)	6/45 (13)
Woman as physician first author	2/15 (13)b	2/9 (22)b	0/6 (0)b
Articles written by physician first of multiple authors	63/78 (81)	24/33 (73)	39/45 (87)
Woman as physician first author	23/63 (37)b	11/24 (46)b	12/39 (31)b
Coauthor analysis
Articles written by men physician first of multiple authors
Coauthors of unknown gender excluded	2	1	1
Women as coauthors	29/74 (39)b	9/30 (30)b	20/44 (46)b
Articles written by women physician first of multiple authors
Coauthors of unknown gender excluded	1	0	1
Women as coauthors	22/44 (50)	15/27 (56)	7/17 (41)b
Last author analysis
Articles written by men physician first of multiple authors
Last authors of unknown gender excluded	0	0	0
Women as last authors	12/40 (30)b	2/13 (15)b	10/27 (37)b
Articles written by women physician first of multiple authors
Last authors of unknown gender excluded	0	0	0
Women as last authors	9/23 (39)b	4/11 (36)b	5/12 (42)b
Journal demographics during the study period
Editor-in-chief, online masthead		2013-2017: Man	January to June 2013: Not listed; July 2013 to December 2017: Woman
Editor-in-chief, supplied by journal staff			2013-2017: Woman
Category editor, online masthead		2013-2017: Not listed	2013-2017: Not listed
Category editor, supplied by journal staff		2013-2017: None designated	2013 to September 2017: None designated; September to December 2017: Woman
Category submission process, online masthead		2013-2017: Not listed	2013-2017: Not listed
Category submission process, supplied by journal staff		2013-2017: Mix of open and invited submissions	2013-2017: Open

^aIn cases in which information was not listed in the online masthead for the 2 highest-impact US dermatology journals included in this study, information was supplied by journal staff through personal communication.

^bLess than equitable levels of representation of women within the respective group when compared with the representation of women among physicians in active dermatology practice (47.1%) in 2015, the last year for which physician workforce sex data was available from the Association of American Medical Colleges.¹

When examining trends, we found lower percentages of women among physician first authors than were in active dermatology practice in Journal of the American Academy of Dermatology’s Commentary category in 2015 and in JAMA Dermatology’s Viewpoint category in 2013 and 2015 (Figure).^1,5 Between 2013 and 2017, the greatest representation of women among physician first authors of perspective-type articles published in 2 of the highest-impact dermatology journals occurred in 2013. Since then, women have been represented at levels as low as 14.3% (range, 14.3%-42.9%).

Figure. Representation of Women Among Physician First Authors of Perspective-Type Dermatology Articles, 2013-2017.

To gain perspective on the inclusion of women among physician first authors of perspective-type articles, authorship was examined both together and separately in data gleaned from the 2 highest-impact US dermatology journals. A, Data from articles published in Journal of the American Academy of Dermatology and JAMA Dermatology examined together. B, Data from articles published in the Journal of the American Academy of Dermatology Commentary category. C, Data from articles published in the JAMA Dermatology Viewpoint category. Comparators (orange circles), the percentages of women among physicians in active dermatology practice as reported by the Association of American Medical Colleges (AAMC), were not available for every year during the study period.

Discussion

Examinations of specific metrics (eg, submission practices and rates, acceptance rates, reviewer assignments) similar to a 6-step process suggested for medical specialty societies⁶ should be performed by journal leaders to identify potential areas for improvement toward achieving gender parity.