Representation of Women in Authorship and Dissemination of Analyses of Physician Compensation

Abstract

This cross-sectional study examines the representation of women in authorship and dissemination of analyses of physician compensation.

Introduction

Physician gender pay gaps persist in the US despite an impressive body of research spanning more than 25 years and adjusting for potentially confounding factors, including rank, years in practice, practice type, specialty, parental status, and hours worked.^1,2,3,4,5 We hypothesized that women physicians were disproportionately represented as producers and disseminators of pay equity research and were largely unfunded for this work. Men have great power to drive change, given their larger representation within academic medical leadership. If compensation studies are unfunded and if women are more engaged than men in the pay equity issue, these factors may contribute to slow progress in addressing compensation disparities.

Methods

This cross-sectional study was performed on US-based physician compensation studies published from January 1, 2013, to February 22, 2019, in refereed medical journals indexed by PubMed. Because this study did not involve human participants and data were publicly available, the Boston University institutional review board determined that review was not required. This study is reported following the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.

Search details included text word and Medical Subject Headings searches on salary, research support, pay, compensation, wage, payment, and funding; physicians and faculty; and sex factors, gender, male, female, men, and women. References were reviewed in included studies to identify additional related reports. Studies that did not include physician compensation or gender data or were secondary sources (eg, reviews, perspectives) were excluded.

Unique authors in each category were recorded, as were presence and sources of funding for each compensation study. Journal article citations for the studies were collected from the Scopus database (Elsevier) (eAppendix in the Supplement). We ascertained the gender of most authors from their online profiles using their stated pronouns and/or photographs. For authors for whom this was not possible (2.8% of compensation authors, 3.2% of citation authors, 6.8% of disseminators), data were included if algorithmic assessment (Gender API) of first-name gender probabilities resulted in 1 gender meeting or exceeding 80%.

On February 23, 2019, we captured online dissemination metrics. Every person who tweeted or retweeted a link containing the digital object identifier to each study was recorded. The gender of disseminators with active accounts on Twitter was obtained by the same mechanisms that were used for authors.

We performed χ² tests for statistical comparisons. P values were considered significant at less than .05. Analyses were performed using R statistical software version 3.4.0 (R Project for Statistical Computing). Data were analyzed from January 11 to February 15, 2020.

Results

We identified 39 physician compensation studies (Table 1). Among 37 unique first authors and last authors, women were listed as the first authors in 22 studies (59.5%), and last authors for 19 studies (51.4%). Among 148 unique middle authors, 82 (55.4%) were women. Among 311 identified articles citing these studies, 200 unique women (64.3%) were identified as first authors, and among 789 unique middle authors for these articles, 446 (56.5%) were women (Table 2). There was an approximately equal balance of last authors of citations, a role often denoting the senior author, including 124 unique women last authors (49.8%) and 125 unique men last authors (50.2%) with men last authors. Among 1435 disseminator tweets identified, 913 tweets (63.6%) were by women (Table 2). When our data were compared with Association of American Medical Colleges data on full-time academic women faculty of clinical departments in 2015,⁶ which suggest that 40% of full-time academic faculty are women, our data revealed significantly greater proportions of women in total authors (117 women of 209 authors [56.0%]; P < .001), citation authors (716 women of 1264 authors [56.6%]; P < .001), and Twitter disseminators (913 women of 1435 disseminators [63.6%]; P < .001) (Table 2).

Table 1. Included Physician Compensation Studies.

Source	Journal	Setting	Participants	Type of compensation
Dermody et al, 2019	Laryngoscope	Governmental	Otolaryngologists at Veterans Affairs medical centers	Salarya
Guss et al, 2019	International Journal of Radiation Oncology, Biology, Physics	Academic	Radiation oncology faculty at US public medical schools	Salarya
Weng et al, 2019	JAMA Network Open	Mixed	Radiation oncologists listed in CMS as receiving industry funding	Industry
Wingard et al, 2019	Journal of the National Medical Association	Academic	Faculty at one academic health center	Salarya
Apaydin et al, 2018	Journal of General Internal Medicine	Mixed	Mixed specialty physicians	Income
Holliday et al, 2018	Journal of Bone and Joint Surgery, American volume	Mixed	Orthopedic surgeons who submitted Medicare claims	Medicare reimbursement
Hoops et al, 2018	Annals of Surgery	Academic	Surgical faculty at 1 institution	Salarya
Morris et al, 2018	Annals of Surgery	Academic	Surgeons within 1 department	Salarya
Muffly et al, 2018	Obstetrics & Gynecology	Mixed	Obstetricians and gynecologists in the US listed in CMS as receiving industry funding	Industry
Rao et al, 2018	JAMA Network Open	Academic	Faculty at 1 medical school	Salarya
Read et al, 2018	Annals of Internal Medicine	Mixed	Internal medicine society physician members	Income
Tringale and Hattangadi-Gluth, 2018	JAMA Internal Medicine	Mixed	Mixed specialty physicians listed in CMS as receiving industry funding	Industry
Trotman et al, 2018	Open Forum Infectious Diseases	Mixed	Infectious disease society members	Income
Weiss et al, 2018	American Journal of Surgery	Mixed	Mixed specialty physicians	Industry
Eloy et al, 2017	JAMA Otolaryngology–Head & Neck Surgery	Academic	Academic otolaryngologists listed in CMS as receiving industry funding	Industry
Kapoor et al, 2017	American Journal of Roentgenology	Academic	Faculty at US public medical schools	Salarya
Madsen et al, 2017	Academic Emergency Medicine	Academic	US academic emergency departments	Salarya
Nguyen et al, 2017	Journal of the American Dental Association	Mixed	Mixed specialty physicians	Income
Reddy et al, 2017	JAMA Ophthalmology	Mixed	Ophthalmologists who submitted Medicare claims	Medicare reimbursement
Rosenthal and Sabuco, 2017	Psychosomatics	Mixed	Psychosomatic medicine society members	Salarya
Amoli et al, 2016	Clinical Orthopaedics and Related Research	Mixed	North American pediatric orthopedic society members	Salarya
Bandari et al, 2016	Urology Practice	Mixed	Urologists listed in CMS as receiving industry funding	Industry
Desai et al, 2016	Postgraduate Medical Journal	Mixed	Mixed specialty physicians who submitted Medicare claims	Medicare reimbursement
Freund et al, 2016	Academic Medicine	Academic	Mixed specialty physicians at US public medical schools	Salarya
Jagsi et al, 2016	Journal of the American College of Cardiology	Mixed	Cardiologists	Salarya
Jena et al, 2016	JAMA Internal Medicine	Academic	Mixed specialty physicians at US public medical schools	Salarya
Ly et al, 2016	The BMJ	Mixed	Mixed specialty physicians	Income
Raj et al, 2016	Academic Medicine	Academic	Faculty at US public medical schools	NIH grant funding
Reddy et al, 2016	JAMA Ophthalmology	Mixed	Ophthalmologists listed in CMS as receiving industry funding	Industry
Spencer et al, 2016	Journal of Urology	Mixed	Urological society US members	Salarya
Baird et al, 2015	Anesthesiology	Mixed	Anesthesia society members	Salarya
Manahan et al, 2015	Annals of Surgical Oncology	Mixed	Breast surgery society members	Salarya
Rose et al, 2015	PLoS One	Mixed	Mixed specialty physicians	Industry
Weaver et al, 2015	Journal of Hospital Medicine	Academic	US hospitalists	Income
Wilett et al, 2015	American Journal of Medicine	Academic	US internal medicine program director society members	Salarya
Svider et al, 2014	Journal of Surgical Education	Academic	Principal investigators within ophthalmology departments	NIH grant funding
Eloy et al, 2013	Otolaryngology–Head and Neck Surgery	Academic	Principal investigators within otolaryngology departments	NIH grant funding
Jagsi et al, 2013	Academic Medicine	Academic	Mixed specialty physician recipients of NIH K awards	Salarya
Seabury et al, 2013	JAMA Internal Medicine	Mixed	Current Population Survey data on physicians	Income

Abbreviations: CMS, Center for Medicare & Medicaid Services; NIH, National Institutes of Health.

^aMay include other contracted work–related compensation, such as bonuses and fee-for-service incentives.

Table 2. Representation of Women as Compensation Study Authors, Authors of Articles Citing Compensation Studies, and Disseminators.

Category	Total, No.	No. (%)		P valuea
		Women	Men
Unique physician compensation study authors
Totalb	209	117 (56.0)	92 (44.0)	<.001
First	37	22 (59.5)	15 (40.5)
Middle	148	82 (55.4)	66 (45.0)
Last	37	19 (51.4)	18 (48.6)
Unique citation authors
Totalb	1264	716 (56.6)	548 (43.4)	<.001
First	311	200 (64.3)	111 (35.7)
Middle	789	446 (56.5)	343 (43.5)
Last	249	124 (49.8)	125 (50.2)
Unique Twitter disseminators	1435	913 (63.6)	522 (36.4)	<.001

^aP values indicate comparisons made to numbers of full-time academic faculty members within clinical science departments based on 2015 Association of American Medical Colleges data.

^bTotal indicates number of authors after duplicate authors were removed.

Of 39 reports analyzed in this study, 23 (59.0%) reported no funding or no relevant funding. There were 2 instances (8.7%) of medical society support, 4 instances (17.4%) of institutional, and 1 instance (4.3%) each of regional, foundational, and organizational support; 1 instance (4.3%) was uncategorized, and 10 reports (43.5%) cited national grants, although it was not clear for some of these whether the grants supported this work or other work performed by the authors.

Discussion

These findings suggest that women are significantly overrepresented as producers and disseminators of compensation studies that include gender data. Furthermore, most of this area of research is unfunded. These findings are important because women may be more engaged and knowledgeable about pay disparities, while men are disproportionately represented in leadership roles and better positioned to fix disparities. If women are primarily producing this mostly unfunded research, a cycle can develop in which women lose additional income (eg, clinical revenue) and do not receive appropriate academic credit for promotions (eg, grant funding). This study is limited by the accuracy of online gender information and to those studies found in our search.

In conclusion, there is an opportunity for men to more actively participate as producers and disseminators of compensation research. Future grant funding organizations should make these studies a priority.

Supplement.

eAppendix. Included Studies