Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis

Giang L Ha; Eric J Lehrer; Ming Wang; Emma Holliday; Reshma Jagsi; Nicholas G Zaorsky

doi:10.1001/jamanetworkopen.2021.12404

. 2021 Jun 29;4(6):e2112404. doi: 10.1001/jamanetworkopen.2021.12404

Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine

A Systematic Review and Meta-analysis

Giang L Ha ¹, Eric J Lehrer ², Ming Wang ³, Emma Holliday ⁴, Reshma Jagsi ^5,⁶, Nicholas G Zaorsky ^1,^✉

¹Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania

²Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York

³Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State Cancer Institute, Hershey, Pennsylvania

⁴Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston

⁵Department of Radiation Oncology, University of Michigan, Ann Arbor

⁶Center for Bioethics and Social Sciences, University of Michigan, Ann Arbor

Accepted for Publication: April 7, 2021.

Published: June 29, 2021. doi:10.1001/jamanetworkopen.2021.12404

^✉

Corresponding Author: Nicholas G. Zaorsky, MD, MS, Department of Radiation Oncology, Penn State Cancer Institute, 500 University Dr, Hershey, PA 17033 (nicholaszaorsky@gmail.com).

Author Contributions: Dr Zaorsky and Mr Ha had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ha, Lehrer, Holliday, Zaorsky.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ha, Zaorsky.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Lehrer, Wang.

Administrative, technical, or material support: Ha, Zaorsky.

Supervision: Holliday, Zaorsky.

Conflict of Interest Disclosures: Dr Holliday reported receiving grants from Merck outside the submitted work. Dr Jagsi reported receiving grants from the National Institutes of Health, Komen Foundation, Greenwall Foundation, Doris Duke Foundation, and Blue Cross Blue Shield of Michigan; receiving personal fees from Genentech, Amgen, Sherinian and Hasso, and Dressman Benziger Lavelle; and receiving stock options for service as an adviser from Equity Quotient outside the submitted work and serving as an uncompensated founding member of TIME’S UP Healthcare and on the American Society of Clinical Oncology Board of Directors. Dr Zaorsky is supported by startup funding from Penn State Cancer Institute and Penn State College of Medicine, grant LRP 1 L30 CA231572-01 from the National Institutes of Health, and grant CSDG-20-013-01-CCE from the American Cancer Society–Tri State CEOs Against Cancer Clinician Scientist Development. Dr aorsky also received remuneration from Springer Nature for his textbook Absolute Clinical Radiation Oncology Review, and received payments from Weatherby Healthcare unrelated to the current work. No other disclosures were reported.

Funding/Support: This study was funded by the Penn State Cancer Institute.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

^✉

Corresponding author.

PMCID: PMC8243235 PMID: 34185071

Key Points

Question

What are the sex differences in citation-related publication productivity across academic ranks and specialties in academic medicine?

Findings

This systematic review and meta-analysis found that women had lower publication productivity than men. When productivity was evaluated separately by specialty, women had lower productivity than men in all analyzed specialties except for plastic surgery; when productivity was organized by rank, women had lower productivity than men at the ranks of assistant professor, associate professor, and professor.

Meaning

These findings suggest that future investigation should be conducted regarding the causes of women’s decreased citation-related publication productivity within the field and interventions should be developed to provide a more equitable environment for all physicians, regardless of sex.

Abstract

Importance

Despite equal numbers of men and women entering medical school, women are underrepresented in the upper echelons of academic medicine and receive less compensation and research funding. Citation-related publication productivity metrics, such as the h-index, are increasingly used for hiring, salary, grants, retention, promotion, and tenure decisions. Exploring sex differences in these metrics across academic medicine provides deeper insight into why differences are observed in career outcomes.

Objective

To systematically examine the available literature on sex differences in h-index of academic faculty physicians across all medical specialties and all levels of academic rank.

Data Sources

Medical literature with the term h-index found in PubMed and published between January 1, 2009, and December 31, 2018, was used.

Study Selection

A PICOS (Population, Intervention, Comparison, and Outcomes), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and MOOSE (Meta-analysis of Observational Studies in Epidemiology) selection protocol was used to find observational studies that published h-indexes for faculty physicians that were stratified by sex. Studies were excluded if they were review articles, retracted, or unavailable online. Ultimately, 14 of 786 studies (1.78%) met the inclusion criteria.

Data Extraction and Synthesis

Data from 9 studies across 16 specialties were examined using weighted random-effects meta-analyses. Five studies were excluded because of overlapping specialties with another study or because they were missing appropriate statistics for the meta-analysis. Four of these studies were included in qualitative synthesis to bring the total to 13 studies.

Main Outcomes and Measures

The primary study outcome was the h-index.

Results

The meta-analysis included 10 665 North American unique academic physicians across 9 different studies from the years 2009 to 2018. Of the 10 665 physicians, 2655 (24.89%) were women. Summary effect sizes for mean h-indexes of men and women and mean h-index difference between men and women were determined for all faculty physicians and at each academic rank. Overall, female faculty had lower h-indexes than male faculty (mean difference, −4.09; 95% CI, −5.44 to −2.73; P < .001). When adjusting for academic rank, female faculty still had lower h-indexes than male faculty at the ranks of assistant professor (mean difference, −1.3; 95% CI, −1.90 to −0.72; P < .001), associate professor (mean difference, −2.09; 95% CI, −3.40 to −0.78; P = .002), and professor (mean difference, −3.41; 95% CI, −6.24 to −0.58; P = .02).

Conclusions and Relevance

In this systematic review and meta-analysis, women had lower h-indexes than men across most specialties and at all academic ranks, but it is unclear why these differences exist. These findings suggest that future investigation should be conducted regarding the causes of lower h-indexes in women and that interventions should be developed to provide a more equitable environment for all physicians regardless of sex.

This systematic review and meta-analysis examines the available literature on sex differences in h-index, a measure of citation-related publication productivity, of academic faculty physicians across all medical specialties and all levels of academic rank.

Introduction

Sex inequality continues to be a major concern in academic medicine. In 2018, women made up 50.9% of applicants to US medical schools, 41.4% of full-time clinical faculty at US medical schools, and 35.8% of the US physician workforce.¹ Furthermore, specialties vary widely in female representation.^1,2 Women remain in the minority among those in leadership positions and positions of higher academic rank.^3,4,5,6,7,8 Women in medicine also have lower salaries,^9,10 number of publications,^4,11,12 and research funding^13,14 compared with their male counterparts.

Potential reasons for female underrepresentation in the upper echelons of academic medicine have generated much discussion.¹⁵ One major component of performance assessment is academic influence; in particular, academic influence impacts the selection of residents, hiring and promotion of faculty physicians, and receipt of research funding.^{16,17,18,19,20,21} The h-index was developed as a metric to quantify the amount and impact of one’s publications and is equivalent to the highest number (h), so that h of the individual’s total number of publications (N_p) have at least h citations, and the remaining number of papers (N_p – h) have h citations or fewer.²² The m-index (or m-quotient) is a common variation that divides the h-index by the number of years since an individual’s first publication. The m-index mitigates some of the inherent time bias of the h-index and allows for comparison of researchers in different stages of their career.²² Because it is easy to calculate, benchmark, and compare, the h-index has earned a prominent place in the performance evaluation of faculty physicians.²³ Despite its purpose as an objective metric, the h-index neglects to account for bias and disparity inherent in several determinants of publication authorship.^{6,13,14,19,24,25,26,27,28} Although studies^{24,29,30,31,32,33,34,35,36,37,38,39,40} have examined sex differences in academic influence within individual specialties, a gap remains in the study of sex differences in academic influence across medicine as a whole.

The purpose of this study was to systematically synthesize and examine the available literature on sex differences regarding h- and m-indexes of academic physician faculty across a wide range of specialties and all levels of academic rank. We hypothesized that women would have lower publication productivity citation-related metrics than men, particularly within specialties that are historically male dominated.

Methods

The primary metric used for this study was the h-index. The secondary metric was the m-index. This meta-analysis was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline⁴¹ and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline (Figure 1).⁴²

Data Sources and Searches

Medical literature, including observational studies, published in the English language from January 1, 2005, to December 31, 2018, was searched in multiple databases (Figure 1) using the term h-index. We aimed to identify all active clinical and nonclinical researchers. However, most studies were clinical and focused on academic medical subspecialties. We also used a long string search (Figure 1) to find relevant literature, but no additional results were produced.

Study Selection

The inclusion criteria for the literature search were defined using the Population, Intervention, Control, Outcome, and Study Design (PICOS) approach (eTable in the Supplement).⁴³ The population was composed of faculty in academic medicine with reported mean and/or median h-indexes. The studies must have not only reported h-indexes but also categorized these metrics by sex. On the basis of the inclusion criteria, 786 studies were screened by 1 of the investigators (G.L.H.). Of these, 440 humans-only studies were assessed for eligibility, and 426 were excluded if they were retracted, not available online, were review articles, did not include h-indexes and/or total sample sizes, and did not assess h-indexes by sex. Ultimately, 14 full-text articles met all the inclusion criteria, encompassing 16 different medical specialties. Some studies also stratified the h-index by academic rank: assistant professor, associate professor, professor, and chair.

Data Extraction and Quality Assessment

Data in these articles were extracted by 1 author (G.L.H.), who was not involved in any of the studies. Discrepancies in values were resolved by discussion with 2 other investigators (N.G.Z. and E.J.L.). When multiple studies existed for the same specialty, the studies that were included were chosen based on whether they provided both means and either SEMs or SDs. If the studies provided the same descriptive statistics, studies were chosen based on whether they also assessed h-indexes by position and/or provided h-indexes across multiple specialties. This process eliminated 2 studies.^31,32 However, 1 study³¹ reported m-indexes; m-indexes were included in this systematic review but not in the meta-analysis. Risk of bias was not assessed because the studies did not report any type of intervention.

Data Synthesis and Analysis

Of the remaining 12 studies, 9^{24,29,33,34,35,36,37,38,39} reported the mean h-index and provided the data needed to calculate the SDs, SEMs, and 95% CIs. These 9 studies were included in the meta-analysis. Three studies^4,30,40 did not directly provide numerical values for means, SDs, or SEMs but instead provided bar graphs that depicted these values. For those studies, we used Plot Digitizer, version 2.6.8 (Plot Digitizer) to approximate the values we needed to calculate SDs, SEMs, and 95% CIs. These 3 studies reported only median or mean h-indexes without SEMs or SDs. The authors of these studies were unsuccessfully contacted to supply missing data, and these studies^4,30,40 were not included in the meta-analysis; however, they were still included in the subsequent systematic review. (Figure 1).

Statistical Analysis

The data were analyzed using RStudio, version 1.1.383 (RStudio) and the Meta-Analysis Package for R (metafor), version 4.0.2 (Wolfgang Viechtbauer) to conduct the meta-analyses and heterogeneity tests. Meta-analyses were conducted on the difference in the h-index between men and women overall and by academic specialty. In particular, the random mixed-effects models with the restricted maximum likelihood approach were used for analysis.^44,45 Hypothesis tests were 2-tailed, and the a priori level of significance was α = .05. Forest plots for overall findings and findings by academic specialty were generated to show the heterogeneity and significance of differences in h-indexes between men and women.

Results

Study Characteristics

The meta-analysis included a total of 10 665 unique North American academic physicians across 9 different studies from the years 2009 to 2018. A total of 2655 (24.89%) were women. Publication metrics were analyzed for anesthesiology,³³ dermatology,³⁴ general surgery,^33,35 internal medicine,³³ neurosurgery,³⁶ obstetrics and gynecology,³³ ophthalmology,³⁷ orthopedic surgery,²⁹ otolaryngology,³⁶ pediatrics,³³ plastic surgery,^36,38 radiology,³³ surgical oncology,²⁴ and urology.^36,39 Additional data on craniofacial surgery⁴⁰ and radiation oncology^4,30 were found but were not included in the meta-analysis because of the h-indexes being reported as median values or the reference not reporting an SEM or SD (Table 1). An additional study³¹ for neurosurgery was included in the systematic review for its analysis of m-indexes. All studies^{4,24,29,30,33,34,35,36,37,39,40} included in the systematic review assessed the sex of physicians through searching online faculty listings except for 2 studies,^31,38 which did not state how sex was assessed. Furthermore, all studies attributed binary identity.

Table 1. Mean and Median h-Indexes by Specialty, Position, and Sex, 2009-2018.

Specialty and position	Mean h-index (SEM)^a		Publication	Discusses possible causes?	Discusses intervention?
Specialty and position	Women	Men	Publication	Discusses possible causes?	Discusses intervention?
Anesthesiology
Professor	4.72 (1.12) (n = 20)	9.49 (0.76) (n = 82)	Pashkova et al,³³ 2013	Yes; female anesthesiologists contribute more to clinical and educational domains	Yes; increase recruitment of research-avid female medical students
Overall	1.75 (0.24) (n = 198)	3.37 (0.24) (n = 447)		Women have only recently increased their numbers in this field	Increase mentorship for female trainees
Overall	1.75 (0.24) (n = 198)	3.37 (0.24) (n = 447)		Lifestyle factors (eg, family care) decrease time devoted to academic work	Encourage women to be more proactive at seeking career opportunities early in training
Craniofacial surgery overall	6 (5.5)^b^,^c (n = 14)	12 (14)^b^,^c (n = 88)	Ruan et al,⁴⁰ 2017	No	No
Dermatology
Assistant professor	4.51 (n = 267)	6.51 (n = 199)	John et al,³⁴ 2016	No	Yes; emphasize doing research early in residency training
Associate professor	10.70 (n = 98)	10.89 (n = 135)
Professor	19.01 (n = 86)	25.02 (n = 182)
Chair	16.68 (n = 23)	26.95 (n = 71)
Overall	8.74 (0.42) (n = 474)	15.15 (0.61) (n = 587)
General surgery
Assistant professor	6.39 (0.91) (n = 23)	8.63 (0.80) (n = 51)	Mueller et al,³⁵ 2017	No	No
Associate professor	11.3 (1.17) (n = 10)	14.93 (1.06) (n = 45)
Professor	21.94 (3.07) (n = 18)	25.20 (1.65) (n = 59)
Overall	6.31 (0.70) (n = 57)	11.73 (0.76) (n = 237)	Pashkova et al,³³ 2013	No	No
Internal medicine overall	2.01 (0.37) (n = 149)	5.26 (0.63) (n = 197)	Pashkova et al,³³ 2013	No	No
Neurosurgery overall	8.48 (1.63) (n = 19)	13.04 (0.95) (n = 171)	Eloy et al,³⁶ 2013	Yes; mentorship opportunities are not as robust for women; educational and community service responsibilities are more often assigned to women, taking away from their academic time; women have increased family responsibilities	No
Obstetrics and gynecology overall	3.78 (0.39) (n = 153)	8.14 (0.81) (n = 148)	Pashkova et al,³³ 2013	No	No
Ophthalmology
Assistant professor	2.85 (0.21) (n = 271)	3.99 (0.25) (n = 348)	Lopez et al,³⁷ 2014	Yes; familial obligations early in career for women lead to lower productivity early in career, higher productivity later in career when compared with men	No
Associate professor	8.00 (0.68) (n = 84)	8.36 (0.52) (n = 237)
Professor	16.77 (1.41) (n = 50)	16.44 (0.73) (n = 361)
Chair	18.31 (1.17) (n = 6)	15.64 (6.26) (n = 102)
Overall	6.00 (0.38) (n = 419)	10.40 (0.34) (n = 1011)
Orthopedic surgery
Assistant professor	2.80 (0.30) (n = 133)	3.80 (0.16) (n = 843)	Bastian et al,²⁹ 2017	No	No
Associate professor	6.50 (0.73) (n = 45)	8.60 (0.32) (n = 459)
Professor	14.60 (1.61) (n = 19)	15.10 (0.53) (n = 442)
Otolaryngology
Assistant professor	3.82 (0.42) (n = 108)	4.32 (0.28) (n = 348)	Eloy et al,³⁶ 2013	Yes; mentorship opportunities are not as robust for women; educational and community service responsibilities are more often assigned to women, taking away from their academic time; women have increased family responsibilities	No
Associate professor	7.78 (0.78) (n = 50)	8.99 (0.42) (n = 198)
Professor	16.84 (1.49) (n = 31)	14.65 (0.71) (n = 227)
Overall	7.34 (0.54) (n = 191)	9.27 (0.28) (n = 862)
Pediatrics overall	2.78 (0.42) (n = 84)	4.57 (0.65) (n = 118)	Pashkova et al,³³ 2013	No	No
Plastic surgery
Assistant or associate professor	5.1 (0.46) (n = 67)	6.40 (0.33) (n = 254)	Paik et al,³⁸ 2014	Yes; educational and community service responsibilities are more often assigned to women, taking away from their academic time	No
Professor	8.20 (1.72) (n = 6)	13.30 (0.89) (n = 101)
Chair	14.30 (4.55) (n = 6)	11.90 (0.92) (n = 71)
Overall	7.37 (1.33) (n = 15)	7.41 (0.65) (n = 93)	Eloy et al,³⁶ 2013	Yes; mentorship opportunities are not as robust for women; educational and community service responsibilities are more often assigned to women, taking away from their academic time; women have increased family responsibilities	No
Radiology overall	4.52 (0.60) (n = 132)	7.25 (0.51) (n = 319)	Pashkova et al,³³ 2013	No	No
Radiation oncology
Assistant professor	3^b (n = 137)	4^b (n = 274)	Holliday et al,⁴ 2014	No	No
Associate professor	10^b (n = 54)	12^b (n = 115)
Professor or chair	20.5^b (n = 293)	23^b (n = 738)
Overall	6.4 (n = 234)	9.4 (n = 592)	Choi et al,³⁰ 2009	Yes; there are much fewer women in academic radiation oncology, especially in higher ranks; there is a lack of female role models; familial obligations affect women more than men; subtle discrimination according to sex decreases the resources available for women	No
Surgical oncology
Assistant professor	6.7 (0.53) (n = 111)	9.7 (0.58) (n = 75)	Nguyen et al,²⁴ 2018	Yes; there are fewer available mentors and collaborators for women because the field is male dominated; female physicians may have authored papers under their maiden names, which may not be counted in the h-index; familial responsibilities affect female physicians more than male physicians; female physicians are more likely to focus on clinical excellence and teaching rather than research	No
Associate professor	15 (1.07) (n = 50)	20 (1.05) (n = 78)
Professor	24 (2.17) (n = 36)	34 (1.75) (n = 107)
Division chief	28 (3.05) (n = 13)	34 (2.43) (n = 55)
Chair	25 (15.59) (n = 3)	51 (6.31) (n = 17)
Overall	13 (0.75) (n = 213)	26 (1.04) (n = 331)
Urology
Assistant professor	5.63 (0.61) (n = 141)	7.49 (0.57) (n = 603)	Mayer et al,³⁹ 2017	Yes; longer career duration for men; women are more likely to pursue clinical-educator track; women are pigeonholed (relegated to less academically productive subspecialties); women have more familial responsibilities than men	Yes; more same-sex mentors and better opposite-sex mentors to provide better mentorship for female urologists
Associate professor	10.63 (3.40) (n = 46)	14.19 (1.60) (n = 315)
Professor	20.20 (1.64) (n = 25)	28.15 (0.81) (n = 441)
Chair	27.33 (6.43) (n = 3)	31.54 (2.28) (n = 126)
Overall	8.32 (1.60) (n = 27)	13.23 (0.80) (n = 239)	Eloy et al,³⁶ 2013	Yes; mentorship opportunities are not as robust for women; educational and community service responsibilities are more often assigned to women, taking away from their academic time; women have increased family responsibilities	No

Open in a new tab

^{^a}

SEM only shown if directly provided or can be calculated from provided SD.

^{^b}

Median instead of mean.

^{^c}

Interquartile range instead of SEM.

Publication Productivity and Sex

Table 1 lists the mean h-indexes of male and female academic physician faculty members by specialty and academic rank. There was consistently greater male representation across all specialties (except obstetrics and gynecology) and academic ranks. Table 1 also includes a summary of possible causes of observed sex differences and interventions proposed in the included studies.

eFigure 1 in the Supplement presents the mean h-indexes of female and male faculty, and Figure 2A presents the mean difference between female and male faculty. The summary effect sizes revealed the following: mean h-index for women of 6.07 (95% CI, 4.37-7.77; n = 2150), mean h-index for men of 10.32 (95% CI, 7.63-12.80; n = 5352), and mean h-index difference of −4.09 (95% CI, −5.44 to −2.73; P < .001). On the basis of the aforementioned mean difference and P value, female faculty overall have a significantly lower mean h-index than men. Mean h-indexes of female faculty were also lower than mean h-indexes of male faculty across all specialties except plastic surgery (7.38 [5.15] for female faculty vs 7.41 [6.27] for male faculty for overall plastic surgery) (Figure 2A).

eFigure 2A and B in the Supplement presents the mean h-indexes of female and male assistant professors, and Figure 2B presents the mean difference between female and male assistant professors. The summary effect sizes revealed the following: mean h-index for women of 4.58 (95% CI, 3.33-5.83; n = 787), mean h-index for men of 6.19 (95% CI, 4.73-7.66; n = 2268), and mean h-index difference of −1.31 (95% CI, −1.90 to −0.72; P < .001). On the basis of the aforementioned mean difference and P value, the mean h-indexes of female assistant professors were lower than the mean h-indexes of male assistant professors. The mean h-indexes of female faculty were also lower than the mean h-indexes of male faculty across all specialties except otolaryngology (3.82 [4.36] for female faculty vs 4.31 [5.22] for male faculty for overall otolaryngology) (Figure 2B). eFigure 2C and D in the Supplement presents the mean h-indexes of female and male associate professors, and Figure 2C presents the mean difference between female and male associate professors. The summary effect sizes revealed the following: mean h-index for women of 9.70 (95% CI, 7.20-12.20; n = 285), mean h-index for men of 12.31 (95% CI, 9.69-14.92; n = 1332), and mean h-index difference of −2.09 (95% CI, −3.40 to −0.78; P = .002). On the basis of the aforementioned mean difference and P value, the mean h-indexes of female associate professors were lower than the mean h-indexes of male professors. The mean h-indexes of female faculty were also lower than the mean h-indexes of male faculty across all specialties except ophthalmology (8.00 [6.19] for female faculty vs 8.36 [8.02] for male faculty for overall ophthalmology) and otolaryngology (7.78 [5.52] for female faculty vs 8.99 [5.91] for male faculty).

eFigure 3A and B in the Supplement presents the mean h-indexes of female and male professors, and Figure 2D presents the mean difference between female and male professors. The summary effect sizes revealed the following: mean h-index for women of 15.74 (95% CI, 10.88-20.60; n = 185), mean h-index for men of 19.40 (95% CI, 14.85-23.95; n = 1738), and mean h-index difference of −3.41 (95% CI, −6.24 to −0.58; P = .02). On the basis of the aforementioned mean difference and P value, the mean h-indexes of female professors were lower than the mean h-indexes of male professors. The mean h-indexes of female professors were also lower than the mean h-indexes of male professors across all specialties, but not always with significance (Figure 2D).

eFigure 3C and D in the Supplement presents the mean h-indexes of female and male chairs, and Figure 2E presents the mean difference between female and male chairs. The summary effect sizes revealed the following: mean h-index for women of 18.82 (95% CI, 12.68-24.96; n = 18), mean h-index for men of 25.32 (95% CI, 16.19-34.45; n = 316), and mean h-index difference of −0.21 (95% CI, −6.89 to 6.46; P = .95). Overall and by specialty, no significance is seen in the mean difference of the h-indexes of female and male chairs (Figure 2E). Figure 3 summarizes the overall mean h-indexes of female and male faculty physicians stratified by rank.

Table 2 presents mean and median m-indexes for various specialties, categorized by sex and academic rank. The mean m-indexes of men were generally higher than the m-indexes of women, which is consistent with the trend seen in h-indexes (0.58 vs 0.47 for radiation oncology overall, 0.6 vs 0.5 for urology overall, and 0.72 vs 0.64 for neurosurgery overall (Table 2). However, not enough data were given to be able to test for significance.

Table 2. Mean and Median m-Indexes by Specialty, Position, and Sex, 2009-2018.

Specialty and rank	Mean m-index		Publication	Discusses possible causes?	Discusses intervention?
Specialty and rank	Women	Men	Publication	Discusses possible causes?	Discusses intervention?
Radiation oncology
Assistant professor	0.43 (n = 137)^a	0.43 (n = 274)^a	Holliday et al,⁴ 2014	No	No
Associate professor	0.7 (n = 54)^a	0.54 (n = 115)^a
Professor or chair	0.74 (n = 34)^a	1 (n = 211) ^a
Other	0.29 (n = 68)^a	0.36 (n = 138) ^a
Overall	0.47 (n = 293)^a	0.58 (n = 738) ^a		Yes; fewer women in higher academic ranks
Urology
Instructor	0.14 (n = 21) ^a	0.19 (n = 201) ^a	Mayer et al,³⁹ 2017	No	No
Assistant professor	0.46 (n = 141) ^a	0.43 (n = 603) ^a
Associate professor	0.65 (n = 46) ^a	0.68 (n = 315) ^a
Chair or division chief	1.19 (n = 3) ^a	0.97 (n = 126) ^a
Professor	0.79 (n = 25) ^a	0.88 (n = 441) ^a
Overall	0.5 (n = 236) ^a	0.6 (n = 1686) ^a		Yes; larger proportion of men at senior-level positions than women; longer career duration for men; women are more likely to pursue clinical-educator track; women are pigeonholed (relegated to less academically productive subspecialties); women have more familial responsibilities than men	Yes; more same-sex mentors and better opposite-sex mentors to provide better mentorship for female urologists
Neurosurgery overall	0.64 (n = 81)	0.72 (n = 1144)	Khan et al,³¹ 2014	Yes; women produce fewer but more significant impact publications	No

Open in a new tab

^{^a}

Median instead of mean.

Discussion

This is the first published systematic review and meta-analysis, to our knowledge, that analyzed sex differences across multiple specialties while adjusting for academic rank, although many single-specialty studies^{4,20,24,29,30,31,32,33,34,35,36,37,38,39,40} have focused on sex differences in academic productivity. The results suggest that female faculty have lower h-indexes (−4.09; 95% CI, −5.44 to −2.73; P < .001) than male faculty (Figure 1, Figure 2, and Table 1). By academic rank, women have lower h-indexes in the ranks of assistant professor (−1.3; 95% CI, −1.90 to −0.72; P < .001), associate professor (−2.09; 95% CI, −3.40 to −0.78; P = .002), and professor (−3.41; 95% CI, −6.24 to −0.58; P = .02) (Figure 2, Figure 3, and Table 1). These results highlight the pervasive sex disparities that exist in citation-related publication productivity metrics within academic medicine. Although observed sex differences are not seen across all specialties,⁴⁶ these data illuminate the need for ongoing discussion of the potential contributing factors to the observed sex differences to ensure equitable engagement of the full pipeline of available contributors to the field because the causes for these differences are still unclear.

Several modifiable institutional and cultural factors may contribute to these observed sex differences.^{4,24,29,30,31,32,33,34,35,36,37,38,39,40} A lack of women in senior positions may limit visible role models, contributing to a culture that encourages bias.⁴⁷ This issue is particularly germane to women in specialties that are historically male dominated.⁴⁸ Leaders may unconsciously select protégés who look like them with regard to sex and race, and this homophily can propagate current disparities.⁴⁹ Therefore, women may not have equal access to high-quality mentors and sponsors, valuable networking and research collaboration, or leadership opportunities, as exemplified by the fewer women seen in higher leadership roles^7,8,50,51 and the tendency of women to be on practitioner-educator rather than tenure tracks.⁵² Studies^53,54 in STEM (science, technology, engineering, and math) fields have found that women have fewer research opportunities early in their careers, which may have negative effects on future academic impact. Women in academic medicine receive less initial start-up and subsequent research funding than men.^13,14 Even at senior levels, they are less likely to hold endowed professorships.⁵⁵ Therefore, women have fewer opportunities, resources, and protected time to be able to conduct high-quality research.^19,24,56

Implicit bias and the tendency of networks to exclude women also reduce their likelihood to be invited to speak in prominent venues, write author-invited editorials, or participate in other activities that increase the visibility and subsequent citation of the work they produce.^11,57 Journal peer review processes may be biased, given the typical reliance on single-blinded peer review, and studies^58,59 have even documented differences in the descriptive language used by men and women that may influence numbers of citations. Men are also more likely to engage in self-promotion, and self-promotion by men is less likely to violate societal norms.^{60,61,62,63,64,65,66} Both traditional news media and novel forms of calling attention to published work, such as Twitter, also amplify men’s voices more than women’s.^67,68

Sex differences in home and caretaking responsibilities may also play a role. Evidence suggests that sex differences in career trajectories in academic medicine are not simply a reflection of differences in women’s priorities.⁶⁹ Structural challenges persist, such as the collision between “the biological clock” and “the tenure clock” and continued expectations of society for a sex-based division of domestic labor. Although involvement by male parents has increased during recent decades, there are unavoidable differences in the impact of pregnancy, childbirth, and breastfeeding on female physicians during training and/or early in their careers,⁷⁰ and women in academic medicine are disproportionately responsible for caretaking and other domestic responsibilities.^28,71 Women with children receive less institutional support and publish less than men with children.²⁷ Such issues are likely amplified in the current environment of school closures and social distancing caused by the COVID-19 pandemic.^72,73

Sexual harassment and sex discrimination also demonstrably impact women’s career choices and academic success.^74,75 Women who seek advancement are more vulnerable to sexual harassment than men, and this risk may deter women from pursuing academic opportunities.⁷⁶ Because sexual harassment is more common in fields where women do not share equally in power and authority, a vicious cycle exists whereby its eradication depends on efforts to ensure that women are fully integrated at all levels.

Pointing out observed sex differences does little good unless the numbers are accompanied by productive discussion and suggestions for improvement. Several of the above-referenced studies^{4,24,30,31,33,36,37,38,39} mentioned contributing factors that are modifiable with intervention. The #MeToo movement prompted interest in establishing policies and programs that make the workplace safer for women physicians.^77,78,79 Some (but not all) studies^80,81 have found that implicit bias training is helpful in breaking ingrained sex bias habits to support career advancement for women in science, technology, engineering, and math fields. Formal mentorship programs also have the potential to improve the academic footprint of female physicians, particularly in their early careers.^82,83,84 Increased mentorship, however, is not enough, as seen by the dearth of women in upper faculty ranks to this day.⁷ With an established association between sponsorship and academic success, increased sponsorship is also needed to improve the academic influence of female physicians.^50,85 Nationally recognized career development programs can also retain women in the academic pipeline and help women prepare for leadership roles.^75,86,87,88 Interventions that serve to promote the academic work of women are also important to in turn increase the academic influence of women.^{60,61,62,63,64,65,66} Finally, institutional policies to promote work-life integration, such as programs and grants that target individuals with substantial extraprofessional caregiving responsibilities, have the potential to ensure all faculty have the opportunity to contribute their insights.^88,89,90

The reasons that the included studies^{24,30,33,36,37,39} cited to explain the sex gap, such as lack of effective mentorship for women and the disparate influence of familial responsibilities on women, aligned with the reasons that we discussed previously. Another proposed reason was the tendency for women to have more clinical and educational responsibilities than men, which takes away from their time to do academic work.^{24,33,36,38,39,52} Only 3 studies^33,34,39 listed proposed interventions. The interventions focused on increasing effective mentorship for women, emphasizing that women perform research early, and recruiting women who are research-minded early as residents or medical students to pursue an academic career. We believe that this synthesis of the broader literature helps to highlight a number of other interventions that should also be evaluated.

Limitations

This study has limitations. Many specialties were excluded because of the dearth of studies looking at sex differences. Furthermore, many included specialties are male dominated; therefore, the percentage of women in this meta-analysis is lower than the overall representation of women in academic medicine, limiting the generalizability of the findings. In addition, the need to approximate some data and the use of multiple databases slightly diminish the findings’ accuracy.^24,39 In addition, a meta-analysis was performed instead of an analysis of a random sample of faculty at academic medical institutions because data on individual faculty were lacking. The h-index and m-index have their own limitations as citation-related publication productivity metrics because they do not account for journal impact or author placement, are prone to inflation by coauthorship and self-citations, and do not fully account for time.

Conclusions

The results of this study suggest that the h-indexes of women are lower than those of men across medical specialties and academic ranks, corroborating the sex differences described in many previous single-specialty studies^{4,24,29,30,31,32,33,34,35,36,37,38,39,40} and suggesting that more pervasive sex differences exist across academic medicine. This study provides important benchmarking information and motivation for further investigation of potential causes of these observed sex differences and mitigation of modifiable factors that influence them.

Supplement.

eTable. PICOS Inclusion Criteria for Population, Intervention, Control, Outcome, and Study

eFigure 1. Mean h-Indexes and 95% Confidence Interval of Male and Female Medical Faculty, Organized by Academic Specialty

eFigure 2. Mean h-Indexes and 95% Confidence Interval of Assistant Professors and Associate Professors, Organized by Gender and Academic Specialty

eFigure 3. Comparison of Mean h-Indexes and 95% Confidence Interval of Professors and Chairs, Organized by Academic Specialty

Click here for additional data file.^{(469KB, pdf)}

References

1.Association of American Medical Colleges . Diversity in medicine: facts and figures 2019. Accessed October 3, 2019. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019
2.Association of American Medical Colleges . Historical specialty specific applicant data. 2020. Accessed March 9, 2020. https://www.aamc.org/services/eras/stats/359278/stats.html
3.Carnevale M, Phair J, Batarseh P, LaFontaine S, Koelling E, Koleilat I. Gender disparities in academic vascular surgeons. J Vasc Surg. 2020;72(4):1445-1450. doi: 10.1016/j.jvs.2019.12.042 [DOI] [PubMed] [Google Scholar]
4.Holliday EB, Jagsi R, Wilson LD, Choi M, Thomas CR Jr, Fuller CD. Gender differences in publication productivity, academic position, career duration, and funding among U.S. academic radiation oncology faculty. Acad Med. 2014;89(5):767-773. doi: 10.1097/ACM.0000000000000229 [DOI] [PMC free article] [PubMed] [Google Scholar]
5.Riaz IB, Siddiqi R, Zahid U, et al. Gender differences in faculty rank and leadership positions among hematologists and oncologists in the United States. JCO Oncol Pract. 2020;16(6):e507-e516. doi: 10.1200/OP.19.00255 [DOI] [PubMed] [Google Scholar]
6.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 [DOI] [PubMed] [Google Scholar]
7.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 [DOI] [PubMed] [Google Scholar]
8.Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in academic medicine: retention, rank, and leadership comparisons from the national faculty survey. Acad Med. 2018;93(11):1694-1699. doi: 10.1097/ACM.0000000000002146 [DOI] [PMC free article] [PubMed] [Google Scholar]
9.Carr P, Friedman RH, Moskowitz MA, Kazis LE, Weed HG. Research, academic rank, and compensation of women and men faculty in academic general internal medicine. J Gen Intern Med. 1992;7(4):418-423. doi: 10.1007/BF02599159 [DOI] [PubMed] [Google Scholar]
10.Jagsi R, Griffith KA, Stewart A, Sambuco D, DeCastro R, Ubel PA. Gender differences in the salaries of physician researchers. JAMA. 2012;307(22):2410-2417. doi: 10.1001/jama.2012.6183 [DOI] [PubMed] [Google Scholar]
11.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 [DOI] [PubMed] [Google Scholar]
12.Duma N. Gender differences in publication rates in oncology: looking at the past, present, and future. Cancer. 2020;126(12):2759-2761. doi: 10.1002/cncr.32819 [DOI] [PubMed] [Google Scholar]
13.Jagsi R, Motomura AR, Griffith KA, Rangarajan S, Ubel PA. Sex differences in attainment of independent funding by career development awardees. Ann Intern Med. 2009;151(11):804-811. doi: 10.7326/0003-4819-151-11-200912010-00009 [DOI] [PubMed] [Google Scholar]
14.Ley TJ, Hamilton BH. Sociology: the gender gap in NIH grant applications. Science. 2008;322(5907):1472-1474. doi: 10.1126/science.1165878 [DOI] [PubMed] [Google Scholar]
15.Carr PL, Gunn C, Raj A, Kaplan S, Freund KM. Recruitment, promotion, and retention of women in academic medicine: how institutions are addressing gender disparities. Womens Health Issues. 2017;27(3):374-381. doi: 10.1016/j.whi.2016.11.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
16.Gast KM, Kuzon WM Jr, Waljee JF. Bibliometric indices and academic promotion within plastic surgery. Plast Reconstr Surg. 2014;134(5):838e-844e. doi: 10.1097/PRS.0000000000000594 [DOI] [PubMed] [Google Scholar]
17.Oleck NC, Gala Z, Weisberger JS, et al. Relevance of academic productivity in the assessment of integrated plastic surgery applicants. J Surg Educ. 2020;77(6):1429-1439. doi: 10.1016/j.jsurg.2020.05.001 [DOI] [PubMed] [Google Scholar]
18.Pagel PS, Hudetz JA. An analysis of scholarly productivity in United States academic anaesthesiologists by citation bibliometrics. Anaesthesia. 2011;66(10):873-878. doi: 10.1111/j.1365-2044.2011.06860.x [DOI] [PubMed] [Google Scholar]
19.Venable GT, Khan NR, Taylor DR, Thompson CJ, Michael LM, Klimo P Jr. A correlation between National Institutes of Health funding and bibliometrics in neurosurgery. World Neurosurg. 2014;81(3-4):468-472. doi: 10.1016/j.wneu.2013.11.013 [DOI] [PubMed] [Google Scholar]
20.Zaorsky NG, O’Brien Em, Mardini J, Lehrer EJ, Holliday E, Weisman CS. Publication productivity and academic rank in medicine: a systematic review and meta-analysis. Acad Med. 2020;95(8):1274-1282. doi: 10.1097/ACM.0000000000003185 [DOI] [PubMed] [Google Scholar]
21.Zaorsky NG, Ahmed AA, Zhu J, et al. Industry funding is correlated with publication productivity of US academic radiation oncologists. J Am Coll Radiol. 2019;16(2):244-251. doi: 10.1016/j.jacr.2018.07.024 [DOI] [PMC free article] [PubMed] [Google Scholar]
22.Hirsch JE. An index to quantify an individual’s scientific research output. Proc Natl Acad Sci U S A. 2005;102(46):16569-16572. doi: 10.1073/pnas.0507655102 [DOI] [PMC free article] [PubMed] [Google Scholar]
23.Braithwaite J, Herkes J, Churruca K, et al. Comprehensive Researcher Achievement Model (CRAM): a framework for measuring researcher achievement, impact and influence derived from a systematic literature review of metrics and models. BMJ Open. 2019;9(3):e025320. doi: 10.1136/bmjopen-2018-025320 [DOI] [PMC free article] [PubMed] [Google Scholar]
24.Nguyen V, Marmor RA, Ramamoorthy SL, Blair SL, Clary BM, Sicklick JK. Academic surgical oncologists’ productivity correlates with gender, grant funding, and institutional NCI Comprehensive Cancer Center affiliation. Ann Surg Oncol. 2018;25(7):1852-1859. doi: 10.1245/s10434-018-6450-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Ash AS, Carr PL, Goldstein R, Friedman RH. Compensation and advancement of women in academic medicine: is there equity? Ann Intern Med. 2004;141(3):205-212. doi: 10.7326/0003-4819-141-3-200408030-00009 [DOI] [PubMed] [Google Scholar]
26.Yedidia MJ, Bickel J. Why aren’t there more women leaders in academic medicine? the views of clinical department chairs. Acad Med. 2001;76(5):453-465. doi: 10.1097/00001888-200105000-00017 [DOI] [PubMed] [Google Scholar]
27.Carr PL, Ash AS, Friedman RH, et al. Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty. Ann Intern Med. 1998;129(7):532-538. doi: 10.7326/0003-4819-129-7-199810010-00004 [DOI] [PubMed] [Google Scholar]
28.Mayer KL, Ho HS, Goodnight JE Jr. Childbearing and child care in surgery. Arch Surg. 2001;136(6):649-655. doi: 10.1001/archsurg.136.6.649 [DOI] [PubMed] [Google Scholar]
29.Bastian S, Ippolito JA, Lopez SA, Eloy JA, Beebe KS. The use of the h-index in academic orthopaedic surgery. J Bone Joint Surg Am. 2017;99(4):e14. doi: 10.2106/JBJS.15.01354 [DOI] [PubMed] [Google Scholar]
30.Choi M, Fuller CD, Thomas CR Jr. Estimation of citation-based scholarly activity among radiation oncology faculty at domestic residency-training institutions: 1996-2007. Int J Radiat Oncol Biol Phys. 2009;74(1):172-178. doi: 10.1016/j.ijrobp.2008.07.030 [DOI] [PubMed] [Google Scholar]
31.Khan NR, Thompson CJ, Taylor DR, et al. An analysis of publication productivity for 1225 academic neurosurgeons and 99 departments in the United States. J Neurosurg. 2014;120(3):746-755. doi: 10.3171/2013.11.JNS131708 [DOI] [PubMed] [Google Scholar]
32.Therattil PJ, Hoppe IC, Granick MS, Lee ES. Application of the h-index in academic plastic surgery. Ann Plast Surg. 2016;76(5):545-549. doi: 10.1097/SAP.0000000000000382 [DOI] [PubMed] [Google Scholar]
33.Pashkova AA, Svider PF, Chang CY, Diaz L, Eloy JA, Eloy JD. Gender disparity among US anaesthesiologists: are women underrepresented in academic ranks and scholarly productivity? Acta Anaesthesiol Scand. 2013;57(8):1058-1064. doi: 10.1111/aas.12141 [DOI] [PubMed] [Google Scholar]
34.John AM, Gupta AB, John ES, Lopez SA, Lambert WC. A gender-based comparison of promotion and research productivity in academic dermatology. Dermatol Online J. 2016;22(4):13030/qt1hx610pf. [PubMed] [Google Scholar]
35.Mueller C, Wright R, Girod S. The publication gender gap in US academic surgery. BMC Surg. 2017;17(1):16. doi: 10.1186/s12893-017-0211-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
36.Eloy JA, Svider P, Chandrasekhar SS, et al. Gender disparities in scholarly productivity within academic otolaryngology departments. Otolaryngol Head Neck Surg. 2013;148(2):215-222. doi: 10.1177/0194599812466055 [DOI] [PubMed] [Google Scholar]
37.Lopez SA, Svider PF, Misra P, Bhagat N, Langer PD, Eloy JA. Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists. J Surg Educ. 2014;71(6):851-859. doi: 10.1016/j.jsurg.2014.03.015 [DOI] [PubMed] [Google Scholar]
38.Paik AM, Mady LJ, Villanueva NL, et al. Research productivity and gender disparities: a look at academic plastic surgery. J Surg Educ. 2014;71(4):593-600. doi: 10.1016/j.jsurg.2014.01.010 [DOI] [PubMed] [Google Scholar]
39.Mayer EN, Lenherr SM, Hanson HA, Jessop TC, Lowrance WT. Gender differences in publication productivity among academic urologists in the United States. Urology. 2017;103:39-46. doi: 10.1016/j.urology.2016.12.064 [DOI] [PMC free article] [PubMed] [Google Scholar]
40.Ruan QZ, Ricci JA, Silvestre J, Ho OA, Ganor O, Lee BT. Academic productivity of faculty associated with craniofacial surgery fellowship programs. J Craniofac Surg. 2017;28(8):1988-1992. doi: 10.1097/SCS.0000000000003615 [DOI] [PubMed] [Google Scholar]
41.Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097 [DOI] [PMC free article] [PubMed] [Google Scholar]
42.Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-2012. doi: 10.1001/jama.283.15.2008 [DOI] [PubMed] [Google Scholar]
43.Eldawlatly A, Alshehri H, Alqahtani A, Ahmad A, Al-Dammas F, Marzouk A. Appearance of population, intervention, comparison, and outcome as research question in the title of articles of three different anesthesia journals: a pilot study. Saudi J Anaesth. 2018;12(2):283-286. doi: 10.4103/sja.SJA_767_17 [DOI] [PMC free article] [PubMed] [Google Scholar]
44.DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-188. doi: 10.1016/0197-2456(86)90046-2 [DOI] [PubMed] [Google Scholar]
45.Rücker G, Schwarzer G, Carpenter J, Olkin I. Why add anything to nothing? the arcsine difference as a measure of treatment effect in meta-analysis with zero cells. Stat Med. 2009;28(5):721-738. doi: 10.1002/sim.3511 [DOI] [PubMed] [Google Scholar]
46.Yang HY, Rhee G, Xuan L, Silver JK, Jalal S, Khosa F. Analysis of h-index in assessing gender differences in academic rank and leadership in physical medicine and rehabilitation in the United States and Canada. Am J Phys Med Rehabil. 2019;98(6):479-483. doi: 10.1097/PHM.0000000000001129 [DOI] [PubMed] [Google Scholar]
47.Beeler WH, Cortina LM, Jagsi R. Diving beneath the surface: addressing gender inequities among clinical investigators. J Clin Invest. 2019;129(9):3468-3471. doi: 10.1172/JCI130901 [DOI] [PMC free article] [PubMed] [Google Scholar]
48.Erzurum VZ, Obermeyer RJ, Fecher A, et al. What influences medical students’ choice of surgical careers. Surgery. 2000;128(2):e2112404. doi: 10.1067/msy.2000.108214 [DOI] [PubMed] [Google Scholar]
49.Ellis J, Otugo OA-O, Landry A, Landry A. Interviewed while Black. N Engl J Med. 2020;383(25):2401-2404. doi: 10.1056/NEJMp2023999 [DOI] [PubMed] [Google Scholar]
50.Patton EW, Griffith KA, Jones RD, Stewart A, Ubel PA, Jagsi R. Differences in mentor-mentee sponsorship in male vs female recipients of National Institutes of Health grants. JAMA Intern Med. 2017;177(4):580-582. doi: 10.1001/jamainternmed.2016.9391 [DOI] [PMC free article] [PubMed] [Google Scholar]
51.McGregor J. Nearly three-quarters of executive proteges pick protégés who look just like them. January 1, 2019. Accessed August 16, 2019. https://www.washingtonpost.com/business/2019/01/09/nearly-three-quarters-executives-pick-proteges-who-look-just-like-them/
52.Mayer AP, Blair JE, Ko MG, et al. Gender distribution of U.S. medical school faculty by academic track type. Acad Med. 2014;89(2):312-317. doi: 10.1097/ACM.0000000000000089 [DOI] [PubMed] [Google Scholar]
53.Milkman KL, Akinola M, Chugh D. What happens before? a field experiment exploring how pay and representation differentially shape bias on the pathway into organizations. J Appl Psychol. 2015;100(6):1678-1712. doi: 10.1037/apl0000022 [DOI] [PubMed] [Google Scholar]
54.Cheryan S, Plaut VC, Handron C, Hudson L. The stereotypical computer scientist: gendered media representations as a barrier to inclusion for women. Sex Roles. 2013;69:58-71. doi: 10.1007/s11199-013-0296-x [DOI] [Google Scholar]
55.Gold JA, Roubinov D, Jia LS, et al. Gender differences in endowed chairs in medicine at top schools. JAMA Intern Med. 2020;180(10):1391-1394. doi: 10.1001/jamainternmed.2020.2677 [DOI] [PMC free article] [PubMed] [Google Scholar]
56.Valian V. Why So Slow? The Advancement of Women. MIT Press; 1999. [Google Scholar]
57.Williams WA, 2nd, Garvey KL, Goodman DM, Lauderdale DS, Ross LF. The role of gender in publication in the Journal of Pediatrics 2015-2016: equal reviews, unequal opportunities. J Pediatr. 2018;200:254-260.e1. doi: 10.1016/j.jpeds.2018.06.059 [DOI] [PubMed] [Google Scholar]
58.Lerchenmueller MJ, Sorenson O, Jena AB. Gender differences in how scientists present the importance of their research: observational study. BMJ. 2019;367:l6573. doi: 10.1136/bmj.l6573 [DOI] [PMC free article] [PubMed] [Google Scholar]
59.Jagsi R, Silver JK. Gender differences in research reporting. BMJ. 2019;367:l6692. doi: 10.1136/bmj.l6692 [DOI] [PubMed] [Google Scholar]
60.Moss-Racusin CA, Phelan JE, Rudman LA. When men break the gender rules: status incongruity and backlash against modest men. Psychol Men Masc. 2010;11(2):140. doi: 10.1037/a0018093 [DOI] [Google Scholar]
61.Moss-Racusin CA, Rudman LA. Disruptions in women's self-promotion: The backlash avoidance model. Psychol Women Q. 2010;34(2):186-202. doi: 10.1111/j.1471-6402.2010.01561.x [DOI] [Google Scholar]
62.Rudman LA. Self-promotion as a risk factor for women: the costs and benefits of counterstereotypical impression management. J Pers Soc Psychol. 1998;74(3):629-645. doi: 10.1037/0022-3514.74.3.629 [DOI] [PubMed] [Google Scholar]
63.Scharff C. Blowing your own trumpet: exploring the gendered dynamics of self-promotion in the classical music profession. Sociol Rev. 2015;63:97-112. doi: 10.1111/1467-954X.12243 [DOI] [Google Scholar]
64.Cheryan S, Ziegler SA, Montoya AK, Jiang L. Why are some STEM fields more gender balanced than others? Psychol Bull. 2017;143(1):1-35. doi: 10.1037/bul0000052 [DOI] [PubMed] [Google Scholar]
65.Williams CL, Muller C, Kilanski K. Gendered organizations in the new economy. Gend Soc. 2012;26(4):549-573. doi: 10.1177/0891243212445466 [DOI] [PMC free article] [PubMed] [Google Scholar]
66.Shackelford S, Wood W, Worchel S.. Behavioral styles and the influence of women in mixed-sex groups. Soc Psychol Q. 1996;59(3):284-293. doi: 10.2307/2787024 [DOI] [Google Scholar]
67.Zhu JM, Pelullo AP, Hassan S, Siderowf L, Merchant RM, Werner RM. Gender differences in Twitter use and influence among health policy and health services researchers. JAMA Intern Med. 2019;179(12):1726-1729. doi: 10.1001/jamainternmed.2019.4027 [DOI] [PMC free article] [PubMed] [Google Scholar]
68.Tezel A, Griffith KA, Jones RD, Jagsi R. Diversity and representation of physicians during the COVID-19 news cycle. JAMA Intern Med. 2021;181(1):124-127. doi: 10.1001/jamainternmed.2020.6285 [DOI] [PMC free article] [PubMed] [Google Scholar]
69.Jones RD, Griffith KA, Ubel PA, Stewart A, Jagsi R. A mixed-methods investigation of the motivations, goals, and aspirations of male and female academic medical faculty. Acad Med. 2016;91(8):1089-1097. doi: 10.1097/ACM.0000000000001244 [DOI] [PMC free article] [PubMed] [Google Scholar]
70.Guille C, Frank E, Zhao Z, et al. Work-family conflict and the sex difference in depression among training physicians. JAMA Intern Med. 2017;177(12):1766-1772. doi: 10.1001/jamainternmed.2017.5138 [DOI] [PMC free article] [PubMed] [Google Scholar]
71.Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344-353. doi: 10.7326/M13-0974 [DOI] [PMC free article] [PubMed] [Google Scholar]
72.Andersen JP, Nielsen MW, Simone NL, Lewiss RE, Jagsi R. COVID-19 medical papers have fewer women first authors than expected. Elife. 2020;9:9. doi: 10.7554/eLife.58807 [DOI] [PMC free article] [PubMed] [Google Scholar]
73.Vincent-Lamarre P, Sugimoto CR, Larviere V. The decline of women’s research production during the coronavirus pandemic. May 19, 2020. Accessed May 10, 2021. https://www.natureindex.com/news-blog/decline-women-scientist-research-publishing-production-coronavirus-pandemic
74.Stratton TD, McLaughlin MA, Witte FM, Fosson SE, Nora LM. Does students’ exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection? Acad Med. 2005;80(4):400-408. doi: 10.1097/00001888-200504000-00020 [DOI] [PubMed] [Google Scholar]
75.Bates CK, Jagsi R, Gordon LK, et al. It is time for zero tolerance for sexual harassment in academic medicine. Acad Med. 2018;93(2):163-165. doi: 10.1097/ACM.0000000000002050 [DOI] [PubMed] [Google Scholar]
76.Raj A, Freund KM, McDonald JM, Carr PL. Effects of sexual harassment on advancement of women in academic medicine: a multi-institutional longitudinal study. EClinicalMedicine. 2020;20:100298. doi: 10.1016/j.eclinm.2020.100298 [DOI] [PMC free article] [PubMed] [Google Scholar]
77.Jagsi R. Sexual harassment in medicine: #MeToo. N Engl J Med. 2018;378(3):209-211. doi: 10.1056/NEJMp1715962 [DOI] [PubMed] [Google Scholar]
78.Choo EK, Byington CL, Johnson NL, Jagsi R. From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? Lancet. 2019;393(10171):499-502. doi: 10.1016/S0140-6736(19)30251-X [DOI] [PubMed] [Google Scholar]
79.Stone L, Phillips C, Douglas KA. Sexual assault and harassment of doctors, by doctors: a qualitative study. Med Educ. 2019;53(8):833-843. doi: 10.1111/medu.13912 [DOI] [PubMed] [Google Scholar]
80.Carnes M, Devine PG, Baier Manwell L, et al. The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial. Acad Med. 2015;90(2):221-230. doi: 10.1097/ACM.0000000000000552 [DOI] [PMC free article] [PubMed] [Google Scholar]
81.Devine PG, Forscher PS, Cox WTL, Kaatz A, Sheridan J, Carnes M. A gender bias habit-breaking intervention led to increased hiring of female faculty in STEMM departments. J Exp Soc Psychol. 2017;73:211-215. doi: 10.1016/j.jesp.2017.07.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
82.Prendergast HM, Heinert SW, Erickson TB, Thompson TM, Vanden Hoek TL. Evaluation of an enhanced peer mentoring program on scholarly productivity and promotion in academic emergency medicine: a five-year review. J Natl Med Assoc. 2019;111(6):600-605. doi: 10.1016/j.jnma.2019.07.001 [DOI] [PubMed] [Google Scholar]
83.Varkey P, Jatoi A, Williams A, et al. The positive impact of a facilitated peer mentoring program on academic skills of women faculty. BMC Med Educ. 2012;12:14. doi: 10.1186/1472-6920-12-14 [DOI] [PMC free article] [PubMed] [Google Scholar]
84.DeCastro R, Griffith KA, Ubel PA, Stewart A, Jagsi R. Mentoring and the career satisfaction of male and female academic medical faculty. Acad Med. 2014;89(2):301-311. doi: 10.1097/ACM.0000000000000109 [DOI] [PMC free article] [PubMed] [Google Scholar]
85.Gottlieb AS, Travis EL. Rationale and models for career advancement sponsorship in academic medicine: the time is here; the time is now. Acad Med. 2018;93(11):1620-1623. doi: 10.1097/ACM.0000000000002342 [DOI] [PubMed] [Google Scholar]
86.Chang S, Morahan PS, Magrane D, et al. Retaining faculty in academic medicine: the impact of career development programs for women. J Womens Health (Larchmt). 2016;25(7):687-696. doi: 10.1089/jwh.2015.5608 [DOI] [PMC free article] [PubMed] [Google Scholar]
87.Chaudron LH, Anson E, Bryson Tolbert JM, Inoue S, Cerulli C. Meeting the needs of mid-career women in academic medicine: one model career development program. J Womens Health (Larchmt). 2020. doi: 10.1089/jwh.2019.8062 [DOI] [PubMed] [Google Scholar]
88.Jagsi R, Butterton JR, Starr R, Tarbell NJ. A targeted intervention for the career development of women in academic medicine. Arch Intern Med. 2007;167(4):343-345. doi: 10.1001/archinte.167.4.343 [DOI] [PubMed] [Google Scholar]
89.Fassiotto M, Simard C, Sandborg C, Valantine H, Raymond J. An integrated career coaching and time-banking system promoting flexibility, wellness, and success: a pilot program at Stanford University School of Medicine. Acad Med. 2018;93(6):881-887. doi: 10.1097/ACM.0000000000002121 [DOI] [PMC free article] [PubMed] [Google Scholar]
90.Jones RD, Miller J, Vitous CA, et al. The most valuable resource is time: insights from a novel national program to improve retention of physician-scientists with caregiving responsibilities. Acad Med. 2019;94(11):1746-1756. doi: 10.1097/ACM.0000000000002903 [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement.

eTable. PICOS Inclusion Criteria for Population, Intervention, Control, Outcome, and Study

eFigure 1. Mean h-Indexes and 95% Confidence Interval of Male and Female Medical Faculty, Organized by Academic Specialty

eFigure 2. Mean h-Indexes and 95% Confidence Interval of Assistant Professors and Associate Professors, Organized by Gender and Academic Specialty

eFigure 3. Comparison of Mean h-Indexes and 95% Confidence Interval of Professors and Chairs, Organized by Academic Specialty

Click here for additional data file.^{(469KB, pdf)}

[zoi210367r1] 1.Association of American Medical Colleges . Diversity in medicine: facts and figures 2019. Accessed October 3, 2019. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019

[zoi210367r2] 2.Association of American Medical Colleges . Historical specialty specific applicant data. 2020. Accessed March 9, 2020. https://www.aamc.org/services/eras/stats/359278/stats.html

[zoi210367r3] 3.Carnevale M, Phair J, Batarseh P, LaFontaine S, Koelling E, Koleilat I. Gender disparities in academic vascular surgeons. J Vasc Surg. 2020;72(4):1445-1450. doi: 10.1016/j.jvs.2019.12.042 [DOI] [PubMed] [Google Scholar]

[zoi210367r4] 4.Holliday EB, Jagsi R, Wilson LD, Choi M, Thomas CR Jr, Fuller CD. Gender differences in publication productivity, academic position, career duration, and funding among U.S. academic radiation oncology faculty. Acad Med. 2014;89(5):767-773. doi: 10.1097/ACM.0000000000000229 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r5] 5.Riaz IB, Siddiqi R, Zahid U, et al. Gender differences in faculty rank and leadership positions among hematologists and oncologists in the United States. JCO Oncol Pract. 2020;16(6):e507-e516. doi: 10.1200/OP.19.00255 [DOI] [PubMed] [Google Scholar]

[zoi210367r6] 6.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 [DOI] [PubMed] [Google Scholar]

[zoi210367r7] 7.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 [DOI] [PubMed] [Google Scholar]

[zoi210367r8] 8.Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in academic medicine: retention, rank, and leadership comparisons from the national faculty survey. Acad Med. 2018;93(11):1694-1699. doi: 10.1097/ACM.0000000000002146 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r9] 9.Carr P, Friedman RH, Moskowitz MA, Kazis LE, Weed HG. Research, academic rank, and compensation of women and men faculty in academic general internal medicine. J Gen Intern Med. 1992;7(4):418-423. doi: 10.1007/BF02599159 [DOI] [PubMed] [Google Scholar]

[zoi210367r10] 10.Jagsi R, Griffith KA, Stewart A, Sambuco D, DeCastro R, Ubel PA. Gender differences in the salaries of physician researchers. JAMA. 2012;307(22):2410-2417. doi: 10.1001/jama.2012.6183 [DOI] [PubMed] [Google Scholar]

[zoi210367r11] 11.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 [DOI] [PubMed] [Google Scholar]

[zoi210367r12] 12.Duma N. Gender differences in publication rates in oncology: looking at the past, present, and future. Cancer. 2020;126(12):2759-2761. doi: 10.1002/cncr.32819 [DOI] [PubMed] [Google Scholar]

[zoi210367r13] 13.Jagsi R, Motomura AR, Griffith KA, Rangarajan S, Ubel PA. Sex differences in attainment of independent funding by career development awardees. Ann Intern Med. 2009;151(11):804-811. doi: 10.7326/0003-4819-151-11-200912010-00009 [DOI] [PubMed] [Google Scholar]

[zoi210367r14] 14.Ley TJ, Hamilton BH. Sociology: the gender gap in NIH grant applications. Science. 2008;322(5907):1472-1474. doi: 10.1126/science.1165878 [DOI] [PubMed] [Google Scholar]

[zoi210367r15] 15.Carr PL, Gunn C, Raj A, Kaplan S, Freund KM. Recruitment, promotion, and retention of women in academic medicine: how institutions are addressing gender disparities. Womens Health Issues. 2017;27(3):374-381. doi: 10.1016/j.whi.2016.11.003 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r16] 16.Gast KM, Kuzon WM Jr, Waljee JF. Bibliometric indices and academic promotion within plastic surgery. Plast Reconstr Surg. 2014;134(5):838e-844e. doi: 10.1097/PRS.0000000000000594 [DOI] [PubMed] [Google Scholar]

[zoi210367r17] 17.Oleck NC, Gala Z, Weisberger JS, et al. Relevance of academic productivity in the assessment of integrated plastic surgery applicants. J Surg Educ. 2020;77(6):1429-1439. doi: 10.1016/j.jsurg.2020.05.001 [DOI] [PubMed] [Google Scholar]

[zoi210367r18] 18.Pagel PS, Hudetz JA. An analysis of scholarly productivity in United States academic anaesthesiologists by citation bibliometrics. Anaesthesia. 2011;66(10):873-878. doi: 10.1111/j.1365-2044.2011.06860.x [DOI] [PubMed] [Google Scholar]

[zoi210367r19] 19.Venable GT, Khan NR, Taylor DR, Thompson CJ, Michael LM, Klimo P Jr. A correlation between National Institutes of Health funding and bibliometrics in neurosurgery. World Neurosurg. 2014;81(3-4):468-472. doi: 10.1016/j.wneu.2013.11.013 [DOI] [PubMed] [Google Scholar]

[zoi210367r20] 20.Zaorsky NG, O’Brien Em, Mardini J, Lehrer EJ, Holliday E, Weisman CS. Publication productivity and academic rank in medicine: a systematic review and meta-analysis. Acad Med. 2020;95(8):1274-1282. doi: 10.1097/ACM.0000000000003185 [DOI] [PubMed] [Google Scholar]

[zoi210367r21] 21.Zaorsky NG, Ahmed AA, Zhu J, et al. Industry funding is correlated with publication productivity of US academic radiation oncologists. J Am Coll Radiol. 2019;16(2):244-251. doi: 10.1016/j.jacr.2018.07.024 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r22] 22.Hirsch JE. An index to quantify an individual’s scientific research output. Proc Natl Acad Sci U S A. 2005;102(46):16569-16572. doi: 10.1073/pnas.0507655102 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r23] 23.Braithwaite J, Herkes J, Churruca K, et al. Comprehensive Researcher Achievement Model (CRAM): a framework for measuring researcher achievement, impact and influence derived from a systematic literature review of metrics and models. BMJ Open. 2019;9(3):e025320. doi: 10.1136/bmjopen-2018-025320 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r24] 24.Nguyen V, Marmor RA, Ramamoorthy SL, Blair SL, Clary BM, Sicklick JK. Academic surgical oncologists’ productivity correlates with gender, grant funding, and institutional NCI Comprehensive Cancer Center affiliation. Ann Surg Oncol. 2018;25(7):1852-1859. doi: 10.1245/s10434-018-6450-5 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r25] 25.Ash AS, Carr PL, Goldstein R, Friedman RH. Compensation and advancement of women in academic medicine: is there equity? Ann Intern Med. 2004;141(3):205-212. doi: 10.7326/0003-4819-141-3-200408030-00009 [DOI] [PubMed] [Google Scholar]

[zoi210367r26] 26.Yedidia MJ, Bickel J. Why aren’t there more women leaders in academic medicine? the views of clinical department chairs. Acad Med. 2001;76(5):453-465. doi: 10.1097/00001888-200105000-00017 [DOI] [PubMed] [Google Scholar]

[zoi210367r27] 27.Carr PL, Ash AS, Friedman RH, et al. Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty. Ann Intern Med. 1998;129(7):532-538. doi: 10.7326/0003-4819-129-7-199810010-00004 [DOI] [PubMed] [Google Scholar]

[zoi210367r28] 28.Mayer KL, Ho HS, Goodnight JE Jr. Childbearing and child care in surgery. Arch Surg. 2001;136(6):649-655. doi: 10.1001/archsurg.136.6.649 [DOI] [PubMed] [Google Scholar]

[zoi210367r29] 29.Bastian S, Ippolito JA, Lopez SA, Eloy JA, Beebe KS. The use of the h-index in academic orthopaedic surgery. J Bone Joint Surg Am. 2017;99(4):e14. doi: 10.2106/JBJS.15.01354 [DOI] [PubMed] [Google Scholar]

[zoi210367r30] 30.Choi M, Fuller CD, Thomas CR Jr. Estimation of citation-based scholarly activity among radiation oncology faculty at domestic residency-training institutions: 1996-2007. Int J Radiat Oncol Biol Phys. 2009;74(1):172-178. doi: 10.1016/j.ijrobp.2008.07.030 [DOI] [PubMed] [Google Scholar]

[zoi210367r31] 31.Khan NR, Thompson CJ, Taylor DR, et al. An analysis of publication productivity for 1225 academic neurosurgeons and 99 departments in the United States. J Neurosurg. 2014;120(3):746-755. doi: 10.3171/2013.11.JNS131708 [DOI] [PubMed] [Google Scholar]

[zoi210367r32] 32.Therattil PJ, Hoppe IC, Granick MS, Lee ES. Application of the h-index in academic plastic surgery. Ann Plast Surg. 2016;76(5):545-549. doi: 10.1097/SAP.0000000000000382 [DOI] [PubMed] [Google Scholar]

[zoi210367r33] 33.Pashkova AA, Svider PF, Chang CY, Diaz L, Eloy JA, Eloy JD. Gender disparity among US anaesthesiologists: are women underrepresented in academic ranks and scholarly productivity? Acta Anaesthesiol Scand. 2013;57(8):1058-1064. doi: 10.1111/aas.12141 [DOI] [PubMed] [Google Scholar]

[zoi210367r34] 34.John AM, Gupta AB, John ES, Lopez SA, Lambert WC. A gender-based comparison of promotion and research productivity in academic dermatology. Dermatol Online J. 2016;22(4):13030/qt1hx610pf. [PubMed] [Google Scholar]

[zoi210367r35] 35.Mueller C, Wright R, Girod S. The publication gender gap in US academic surgery. BMC Surg. 2017;17(1):16. doi: 10.1186/s12893-017-0211-4 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r36] 36.Eloy JA, Svider P, Chandrasekhar SS, et al. Gender disparities in scholarly productivity within academic otolaryngology departments. Otolaryngol Head Neck Surg. 2013;148(2):215-222. doi: 10.1177/0194599812466055 [DOI] [PubMed] [Google Scholar]

[zoi210367r37] 37.Lopez SA, Svider PF, Misra P, Bhagat N, Langer PD, Eloy JA. Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists. J Surg Educ. 2014;71(6):851-859. doi: 10.1016/j.jsurg.2014.03.015 [DOI] [PubMed] [Google Scholar]

[zoi210367r38] 38.Paik AM, Mady LJ, Villanueva NL, et al. Research productivity and gender disparities: a look at academic plastic surgery. J Surg Educ. 2014;71(4):593-600. doi: 10.1016/j.jsurg.2014.01.010 [DOI] [PubMed] [Google Scholar]

[zoi210367r39] 39.Mayer EN, Lenherr SM, Hanson HA, Jessop TC, Lowrance WT. Gender differences in publication productivity among academic urologists in the United States. Urology. 2017;103:39-46. doi: 10.1016/j.urology.2016.12.064 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r40] 40.Ruan QZ, Ricci JA, Silvestre J, Ho OA, Ganor O, Lee BT. Academic productivity of faculty associated with craniofacial surgery fellowship programs. J Craniofac Surg. 2017;28(8):1988-1992. doi: 10.1097/SCS.0000000000003615 [DOI] [PubMed] [Google Scholar]

[zoi210367r41] 41.Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r42] 42.Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-2012. doi: 10.1001/jama.283.15.2008 [DOI] [PubMed] [Google Scholar]

[zoi210367r43] 43.Eldawlatly A, Alshehri H, Alqahtani A, Ahmad A, Al-Dammas F, Marzouk A. Appearance of population, intervention, comparison, and outcome as research question in the title of articles of three different anesthesia journals: a pilot study. Saudi J Anaesth. 2018;12(2):283-286. doi: 10.4103/sja.SJA_767_17 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r44] 44.DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-188. doi: 10.1016/0197-2456(86)90046-2 [DOI] [PubMed] [Google Scholar]

[zoi210367r45] 45.Rücker G, Schwarzer G, Carpenter J, Olkin I. Why add anything to nothing? the arcsine difference as a measure of treatment effect in meta-analysis with zero cells. Stat Med. 2009;28(5):721-738. doi: 10.1002/sim.3511 [DOI] [PubMed] [Google Scholar]

[zoi210367r46] 46.Yang HY, Rhee G, Xuan L, Silver JK, Jalal S, Khosa F. Analysis of h-index in assessing gender differences in academic rank and leadership in physical medicine and rehabilitation in the United States and Canada. Am J Phys Med Rehabil. 2019;98(6):479-483. doi: 10.1097/PHM.0000000000001129 [DOI] [PubMed] [Google Scholar]

[zoi210367r47] 47.Beeler WH, Cortina LM, Jagsi R. Diving beneath the surface: addressing gender inequities among clinical investigators. J Clin Invest. 2019;129(9):3468-3471. doi: 10.1172/JCI130901 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r48] 48.Erzurum VZ, Obermeyer RJ, Fecher A, et al. What influences medical students’ choice of surgical careers. Surgery. 2000;128(2):e2112404. doi: 10.1067/msy.2000.108214 [DOI] [PubMed] [Google Scholar]

[zoi210367r49] 49.Ellis J, Otugo OA-O, Landry A, Landry A. Interviewed while Black. N Engl J Med. 2020;383(25):2401-2404. doi: 10.1056/NEJMp2023999 [DOI] [PubMed] [Google Scholar]

[zoi210367r50] 50.Patton EW, Griffith KA, Jones RD, Stewart A, Ubel PA, Jagsi R. Differences in mentor-mentee sponsorship in male vs female recipients of National Institutes of Health grants. JAMA Intern Med. 2017;177(4):580-582. doi: 10.1001/jamainternmed.2016.9391 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r51] 51.McGregor J. Nearly three-quarters of executive proteges pick protégés who look just like them. January 1, 2019. Accessed August 16, 2019. https://www.washingtonpost.com/business/2019/01/09/nearly-three-quarters-executives-pick-proteges-who-look-just-like-them/

[zoi210367r52] 52.Mayer AP, Blair JE, Ko MG, et al. Gender distribution of U.S. medical school faculty by academic track type. Acad Med. 2014;89(2):312-317. doi: 10.1097/ACM.0000000000000089 [DOI] [PubMed] [Google Scholar]

[zoi210367r53] 53.Milkman KL, Akinola M, Chugh D. What happens before? a field experiment exploring how pay and representation differentially shape bias on the pathway into organizations. J Appl Psychol. 2015;100(6):1678-1712. doi: 10.1037/apl0000022 [DOI] [PubMed] [Google Scholar]

[zoi210367r54] 54.Cheryan S, Plaut VC, Handron C, Hudson L. The stereotypical computer scientist: gendered media representations as a barrier to inclusion for women. Sex Roles. 2013;69:58-71. doi: 10.1007/s11199-013-0296-x [DOI] [Google Scholar]

[zoi210367r55] 55.Gold JA, Roubinov D, Jia LS, et al. Gender differences in endowed chairs in medicine at top schools. JAMA Intern Med. 2020;180(10):1391-1394. doi: 10.1001/jamainternmed.2020.2677 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r56] 56.Valian V. Why So Slow? The Advancement of Women. MIT Press; 1999. [Google Scholar]

[zoi210367r57] 57.Williams WA, 2nd, Garvey KL, Goodman DM, Lauderdale DS, Ross LF. The role of gender in publication in the Journal of Pediatrics 2015-2016: equal reviews, unequal opportunities. J Pediatr. 2018;200:254-260.e1. doi: 10.1016/j.jpeds.2018.06.059 [DOI] [PubMed] [Google Scholar]

[zoi210367r58] 58.Lerchenmueller MJ, Sorenson O, Jena AB. Gender differences in how scientists present the importance of their research: observational study. BMJ. 2019;367:l6573. doi: 10.1136/bmj.l6573 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r59] 59.Jagsi R, Silver JK. Gender differences in research reporting. BMJ. 2019;367:l6692. doi: 10.1136/bmj.l6692 [DOI] [PubMed] [Google Scholar]

[zoi210367r60] 60.Moss-Racusin CA, Phelan JE, Rudman LA. When men break the gender rules: status incongruity and backlash against modest men. Psychol Men Masc. 2010;11(2):140. doi: 10.1037/a0018093 [DOI] [Google Scholar]

[zoi210367r61] 61.Moss-Racusin CA, Rudman LA. Disruptions in women's self-promotion: The backlash avoidance model. Psychol Women Q. 2010;34(2):186-202. doi: 10.1111/j.1471-6402.2010.01561.x [DOI] [Google Scholar]

[zoi210367r62] 62.Rudman LA. Self-promotion as a risk factor for women: the costs and benefits of counterstereotypical impression management. J Pers Soc Psychol. 1998;74(3):629-645. doi: 10.1037/0022-3514.74.3.629 [DOI] [PubMed] [Google Scholar]

[zoi210367r63] 63.Scharff C. Blowing your own trumpet: exploring the gendered dynamics of self-promotion in the classical music profession. Sociol Rev. 2015;63:97-112. doi: 10.1111/1467-954X.12243 [DOI] [Google Scholar]

[zoi210367r64] 64.Cheryan S, Ziegler SA, Montoya AK, Jiang L. Why are some STEM fields more gender balanced than others? Psychol Bull. 2017;143(1):1-35. doi: 10.1037/bul0000052 [DOI] [PubMed] [Google Scholar]

[zoi210367r65] 65.Williams CL, Muller C, Kilanski K. Gendered organizations in the new economy. Gend Soc. 2012;26(4):549-573. doi: 10.1177/0891243212445466 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r66] 66.Shackelford S, Wood W, Worchel S.. Behavioral styles and the influence of women in mixed-sex groups. Soc Psychol Q. 1996;59(3):284-293. doi: 10.2307/2787024 [DOI] [Google Scholar]

[zoi210367r67] 67.Zhu JM, Pelullo AP, Hassan S, Siderowf L, Merchant RM, Werner RM. Gender differences in Twitter use and influence among health policy and health services researchers. JAMA Intern Med. 2019;179(12):1726-1729. doi: 10.1001/jamainternmed.2019.4027 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r68] 68.Tezel A, Griffith KA, Jones RD, Jagsi R. Diversity and representation of physicians during the COVID-19 news cycle. JAMA Intern Med. 2021;181(1):124-127. doi: 10.1001/jamainternmed.2020.6285 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r69] 69.Jones RD, Griffith KA, Ubel PA, Stewart A, Jagsi R. A mixed-methods investigation of the motivations, goals, and aspirations of male and female academic medical faculty. Acad Med. 2016;91(8):1089-1097. doi: 10.1097/ACM.0000000000001244 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r70] 70.Guille C, Frank E, Zhao Z, et al. Work-family conflict and the sex difference in depression among training physicians. JAMA Intern Med. 2017;177(12):1766-1772. doi: 10.1001/jamainternmed.2017.5138 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r71] 71.Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344-353. doi: 10.7326/M13-0974 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r72] 72.Andersen JP, Nielsen MW, Simone NL, Lewiss RE, Jagsi R. COVID-19 medical papers have fewer women first authors than expected. Elife. 2020;9:9. doi: 10.7554/eLife.58807 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r73] 73.Vincent-Lamarre P, Sugimoto CR, Larviere V. The decline of women’s research production during the coronavirus pandemic. May 19, 2020. Accessed May 10, 2021. https://www.natureindex.com/news-blog/decline-women-scientist-research-publishing-production-coronavirus-pandemic

[zoi210367r74] 74.Stratton TD, McLaughlin MA, Witte FM, Fosson SE, Nora LM. Does students’ exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection? Acad Med. 2005;80(4):400-408. doi: 10.1097/00001888-200504000-00020 [DOI] [PubMed] [Google Scholar]

[zoi210367r75] 75.Bates CK, Jagsi R, Gordon LK, et al. It is time for zero tolerance for sexual harassment in academic medicine. Acad Med. 2018;93(2):163-165. doi: 10.1097/ACM.0000000000002050 [DOI] [PubMed] [Google Scholar]

[zoi210367r76] 76.Raj A, Freund KM, McDonald JM, Carr PL. Effects of sexual harassment on advancement of women in academic medicine: a multi-institutional longitudinal study. EClinicalMedicine. 2020;20:100298. doi: 10.1016/j.eclinm.2020.100298 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r77] 77.Jagsi R. Sexual harassment in medicine: #MeToo. N Engl J Med. 2018;378(3):209-211. doi: 10.1056/NEJMp1715962 [DOI] [PubMed] [Google Scholar]

[zoi210367r78] 78.Choo EK, Byington CL, Johnson NL, Jagsi R. From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? Lancet. 2019;393(10171):499-502. doi: 10.1016/S0140-6736(19)30251-X [DOI] [PubMed] [Google Scholar]

[zoi210367r79] 79.Stone L, Phillips C, Douglas KA. Sexual assault and harassment of doctors, by doctors: a qualitative study. Med Educ. 2019;53(8):833-843. doi: 10.1111/medu.13912 [DOI] [PubMed] [Google Scholar]

[zoi210367r80] 80.Carnes M, Devine PG, Baier Manwell L, et al. The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial. Acad Med. 2015;90(2):221-230. doi: 10.1097/ACM.0000000000000552 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r81] 81.Devine PG, Forscher PS, Cox WTL, Kaatz A, Sheridan J, Carnes M. A gender bias habit-breaking intervention led to increased hiring of female faculty in STEMM departments. J Exp Soc Psychol. 2017;73:211-215. doi: 10.1016/j.jesp.2017.07.002 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r82] 82.Prendergast HM, Heinert SW, Erickson TB, Thompson TM, Vanden Hoek TL. Evaluation of an enhanced peer mentoring program on scholarly productivity and promotion in academic emergency medicine: a five-year review. J Natl Med Assoc. 2019;111(6):600-605. doi: 10.1016/j.jnma.2019.07.001 [DOI] [PubMed] [Google Scholar]

[zoi210367r83] 83.Varkey P, Jatoi A, Williams A, et al. The positive impact of a facilitated peer mentoring program on academic skills of women faculty. BMC Med Educ. 2012;12:14. doi: 10.1186/1472-6920-12-14 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r84] 84.DeCastro R, Griffith KA, Ubel PA, Stewart A, Jagsi R. Mentoring and the career satisfaction of male and female academic medical faculty. Acad Med. 2014;89(2):301-311. doi: 10.1097/ACM.0000000000000109 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r85] 85.Gottlieb AS, Travis EL. Rationale and models for career advancement sponsorship in academic medicine: the time is here; the time is now. Acad Med. 2018;93(11):1620-1623. doi: 10.1097/ACM.0000000000002342 [DOI] [PubMed] [Google Scholar]

[zoi210367r86] 86.Chang S, Morahan PS, Magrane D, et al. Retaining faculty in academic medicine: the impact of career development programs for women. J Womens Health (Larchmt). 2016;25(7):687-696. doi: 10.1089/jwh.2015.5608 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r87] 87.Chaudron LH, Anson E, Bryson Tolbert JM, Inoue S, Cerulli C. Meeting the needs of mid-career women in academic medicine: one model career development program. J Womens Health (Larchmt). 2020. doi: 10.1089/jwh.2019.8062 [DOI] [PubMed] [Google Scholar]

[zoi210367r88] 88.Jagsi R, Butterton JR, Starr R, Tarbell NJ. A targeted intervention for the career development of women in academic medicine. Arch Intern Med. 2007;167(4):343-345. doi: 10.1001/archinte.167.4.343 [DOI] [PubMed] [Google Scholar]

[zoi210367r89] 89.Fassiotto M, Simard C, Sandborg C, Valantine H, Raymond J. An integrated career coaching and time-banking system promoting flexibility, wellness, and success: a pilot program at Stanford University School of Medicine. Acad Med. 2018;93(6):881-887. doi: 10.1097/ACM.0000000000002121 [DOI] [PMC free article] [PubMed] [Google Scholar]

[zoi210367r90] 90.Jones RD, Miller J, Vitous CA, et al. The most valuable resource is time: insights from a novel national program to improve retention of physician-scientists with caregiving responsibilities. Acad Med. 2019;94(11):1746-1756. doi: 10.1097/ACM.0000000000002903 [DOI] [PubMed] [Google Scholar]

PERMALINK

Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine

Giang L Ha, MTM

Eric J Lehrer, MD, MS

Ming Wang, PhD, MS

Emma Holliday, MD

Reshma Jagsi, MD, DPhil

Nicholas G Zaorsky, MD, MS

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Data Sources

Study Selection

Data Extraction and Synthesis

Main Outcomes and Measures

Results

Conclusions and Relevance

Introduction

Methods

Figure 1. PRISMA Flow Diagram of Included Studies.

Data Sources and Searches

Study Selection

Data Extraction and Quality Assessment

Data Synthesis and Analysis

Statistical Analysis

Results

Study Characteristics

Table 1. Mean and Median h-Indexes by Specialty, Position, and Sex, 2009-2018.

Publication Productivity and Sex

Figure 2. Mean Difference Between h-Indexes of Female and Male Faculty With 95% CIs, Organized by Academic Rank and Specialty.

Figure 3. Overall Mean h-Index of Female and Male Faculty Physicians, Stratified by Rank.

Table 2. Mean and Median m-Indexes by Specialty, Position, and Sex, 2009-2018.

Discussion

Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases