Representation by Gender of Recognition Award Recipients from Gastroenterology and Hepatology Professional Societies

Abstract

Background: Recognition awards from professional medical societies play an important role in physicians' career advancement. Our aim was to evaluate the gender representation of award recipients from gastroenterology and hepatology societies.

Methods: We analyzed the lists of award recipients from the American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy and determined the gender of these award recipients. The primary outcome was the overall representation of women physician award recipients as compared with the representation of women in the specialty.

Results: Between 1941 and 2019, there were 921 awards, of which 77 (8.4%) were given to women and 844 (91.6%) to men. There was a significant increase in the proportion of women recipients over time, from 0% in 1970–1984 to 22.0% in 2015–2019 (p for trend <0.0001). Compared with the concurrent representation of women in the specialty, women physician recipients were underrepresented from 1970 to 1981 and 1984 to 2015, equitably represented from 1981 to 1984, and overrepresented from 2015 to 2019. Of the total number of awards in each category, women received 13.8% of teaching/mentorship awards and 3.8% of the highest achievement awards (p = 0.002). The proportion of women recipients varied among the societies, from 6.8% to 14.5%.

Conclusions: The representation of women physician recipients of gastroenterology and hepatology society recognition awards has generally been low until most recently, when it has surpassed the proportion of women in the specialty. Because award recognition is important to career development, professional societies should have transparent processes that aim to identify and reduce various forms of bias, including gender-related bias, in all phases of award recognition.

Introduction

Involvement in professional medical societies plays a crucial role in facilitating career development through networking, committee work, and leadership roles, such as chairing a committee or task force.^1,2 Additionally, professional societies help recognize contributions of individuals through the allocation of recognition awards, usually presented and highlighted at the society's annual scientific meeting.

Recognition through awards is unique for several reasons. Trainee and early career awards help to encourage and advance the next generation of physicians and scientists. Mid- or late-career awards acknowledge cumulative achievements over a span of time, from a few years to even the course of one's entire career, often representing decades of work within a field. Awards may recognize specific achievements, such as mentorship, education, or community service. Awards also support individuals in building professional reputation, which can have a positive impact on advancement and financial compensation. Furthermore, recipients of professional society awards serve as the face of a profession. There has been underrecognition of women among profession awards in numerous medical specialties,³ including anesthesia,⁴ surgery,⁵ neurology,⁶ physical medicine and rehabilitation,^7,8 dermatology,³ plastic surgery,³ otolaryngology,³ and orthopedic surgery.³

Within gastroenterology and hepatology, there has been a dramatic upward trend in women entering fellowship training programs over the past three decades, increasing from 11% in 1992 to 33% in 2012.^9,10 Prior gender equity research in gastroenterology has shown differences in publications¹¹ and academic productivity by gender among U.S. gastroenterologists,¹² an upward trend in women faculty in one society's sponsored programming,¹³ and a higher rate of acceptance per request for committee membership among women compared with men within one society.¹⁴

To our knowledge, the distribution of award recipients by gender from gastroenterology and hepatology professional societies has not yet been studied. Therefore, our aim was to determine the representation by gender of award recipients from the American Association for the Study of Liver Disease (AASLD), American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE) over time.

Methods

Data sources

We analyzed the publicly available lists of award recipients for four major U.S. gastroenterology and hepatology societies, AASLD, ACG, AGA, and ASGE through the corresponding society websites and their online and printed meeting syllabi (Appendix Table A1). Each society was also contacted directly to ensure the accuracy of online award data and to obtain missing data, where relevant. At the time of this study, none of the societies had readily available data on the gender of award recipients. Types of awards included clinical, mentorship, educator, basic science, research, community service, international service, endoscopy, and highest achievement awards.

These categories were determined through the online description of each award. In addition to awards, because of their prestige and national visibility, named lectureships at society annual meetings were also included. Lectureship awardees were obtained online for ACG and directly from AASLD, AGA, and ASGE staff by email. We also collected data on the nomination requirements and award selection process for each society from their website, and if unavailable, then through direct contact with staff liaison at the society. We did not include research grant funding awards or awards specifically for trainees since the requirements and selection processes are generally different than for the included awards of interest. One-time awards were not included (e.g., AASLD's Sheila Sherlock Memorial Lecture and Kamal G. Ishak Memorial Lecture).

This report focuses on award recipients in gastroenterology and hepatology, and we recognize that gender is not binary but rather exists on a spectrum. However, much of gender equity research has been reported in binary terms due to the available data.

For this study, we use gender-related terms according to evolving best practices. “Women” is meant to be inclusion of all people who identify as women. To maintain consistency with original sources, we use terms that denote biological sex (“female” and “male”) when cited literature used those terms. The gender of each award recipient was determined by first name and online searches with photographs and/or he/she pronoun use. Importantly, women with intersectional identities—for example, women who identify with racial or ethnic groups that are underrepresented in medicine, identify as disabled, or transwomen—tend to experience both gender-related as well as other forms of bias. Demographic data regarding intersectional characteristics was not available, so only gender was studied.

We also determined the educational degree held by the award recipient (e.g., MD, PhD, MD/PhD, other including MA, MBA, MPH, JD) through information available on each society's website and, if not listed, through online search. If gender or advanced degree was not able to be discerned with confidence, then this data point was excluded from analysis. Because of the prestige of the highest achievement awards, we also collected data on whether recipients of this award type had served as a president of the associated society in the past.

Publicly available data on physician workforce were used to determine the percentage of women gastroenterologists and hepatologists nationally over the time period of this study. We used data from the American Medical Association (AMA) until the year in which it were last published, 2013, and then the Association of American Medical Colleges (AAMC) from 2013 to 2018. Data for 2019 were not yet available. For 2013, in which data were available from both the AMA and AAMC, we used an average of the two reported percentages.

Data classification

After review of online descriptions of each award and through discussion and consensus among all authors, awards were categorized into five different types: highest achievement, service, clinical/research, education/mentoring, and named lectureship. The categories of clinical and research as well as mentor and teaching were combined due to small numbers of awardees in each category. Data were evaluated cumulatively from 1941 to 1969 because of the small numbers of overall recipients in this time period, and then in 5-year intervals from 1970 to 2019.

Outcomes

The primary outcome was the overall percentage of physician award recipients by gender across all societies for each 5-year time period as compared with their percentage in the specialty over the same time period. Secondary outcomes included the percentage of award recipients by gender overall and by award type and society.

Analysis

We conducted descriptive statistics and reported the mean and 95% confidence intervals (CIs). We quantified the percentage of physician award recipients (defined as having an MD or equivalent degree) among the four societies reported by calculating proportions and compared this with the percentage of women in the specialty of gastroenterology and hepatology over the same time period.

Because we counted the number of recipients, we report frequencies rather than the mean, and calculated 95% CI. We compared the percentage of recipients for each 5-year-interval across time using the Cochran–Armitage test to test for trend over time and reported p-values to reflect the significance of the trends. We also evaluated the percentage of recipients and compared men and women recipients across each society and award type, using Chi-square and analysis of variance testing. To compare award recipients across societies, we limited analysis to 1981 to present because before this year, not all societies were consistently distributing awards. For the highest achievement award, we compared the number of recipients who had served as a president of the respective society by gender using chi square testing. Because of the small number of women award recipients, this analysis was performed for all four societies combined.

We evaluated for an association between award recipients and graduate degrees held by using the chi square test. Additionally, we conducted a univariable logistic regression analysis to identify factors associated with award recipients and report odds ratios (ORs) with 95% CI. For this analysis, the primary outcome of interest was overall award recipients by gender. Factors evaluated in the regression model included graduate degrees, 10-year time period, type of award, and awarding society. Factors with p < 0.2 in the unadjusted analysis were retained in a multivariable model and adjusted ORs (aORs) with 95% CI were calculated.

We performed sensitivity analysis limiting data to 1980–2019, since AASLD's award program started in 1981, and excluding named lectureships, to understand the gender representation compared with the other awards. Results for both the unadjusted and adjusted analyses were almost identical when data were limited to 1980–2019 and when named lectureships were excluded, and therefore we present results reflecting the full-time span of 1941–2019 and include named lectureships in our final results.

This study was considered a nonhuman subject research by the Dartmouth–Hitchcock Medical Center Institutional Review Board and was therefore exempt from review.

Results

Overall

We identified 22 different recognition awards and 15 named lectureships among the four gastroenterology and hepatology societies (Table 1). All societies offered awards for “highest achievement” and service, as well as named lectureships. AASLD, AGA, and ASGE offered teaching and mentoring awards, but ACG did not. Only the AGA and ASGE offered recognition for clinical or research achievements. Current award nomination requirements were similar among the four societies (more detail in Appendix Table A1 links). There was some variation in the current award selection process, particularly with regard to whether an awards committee composed of the current and past presidents of the society, the Board of Trustees, the Governing Board, or the President ultimately selected the recipient (Appendix Table A2).

Table 1.

Classification of Specific Awards by Gastroenterology and Hepatology Professional Society and Award Category

Award category	Gastroenterology and hepatology professional society
	AASLD	ACG	AGA	ASGE
Highest achievement	Distinguished achievement	Berk/Fisk Clinical Achievement	Julius Friedenwald Medal	Rudolf V. Schindler
Service	Distinguished service	Community Service International Leadership Minority Digestive Health Care Samuel Weiss	Research Service	Distinguished Service International Service
Clinical or research	None	None	Distinguished Achievement Basic Science William Beaumont Prize Distinguished Clinician	Master Endoscopist
Education or mentoring	Clinician educator/mentor	None	Distinguished Educator Distinguished Mentor	Distinguished Endoscopic Research Mentoring Distinguished Educator
Named lectureship	Thomas E. Starzl Transplant Surgery Hyman J. Zimmerman Hepatotoxicity Leon Schiff Hans Popper Basic Science	Baker Presidential J. Edward Berk Distinguished Emily Couric David Y. Graham David Sun Postgraduate Education	Morton Grossman Distinguished	Basil I. Hirschowitz J. Edward Berk Jack Vennes and Stephen Silvis Gene Overholt

AASLD, American Association for the Study of Liver Disease; ACG, American College of Gastroenterology; AGA, American Gastroenterological Association; ASGE, American Society for Gastrointestinal Endoscopy.

In total, there were 921 awards presented by the four different societies between 1941 and 2019. These awards were given to a total of 643 individual recipients, of which 585 were men (91.6%, 95% CI [88.9%–93.2%]) and 58 were women (9.0%, 95% CI [6.8%–11.2%]). The vast majority of recipients held an MD degree (86.5%) (Table 2). One hundred sixty-seven people received multiple awards. The mean number of awards per person was 1.4 (95% CI 1.4–1.5). There was no significant difference in the number of awards by gender (mean for women 1.3 [95% CI 1.1–1.5] vs. men 1.4 [95% CI 1.4–1.5]; p = 0.3). Women recipients were more likely to have a PhD or combined MD/PhD degree compared with men recipients (34.3% vs. 9.7%) and less likely to have an MD degree alone (62.1% vs. 88.9%) (p < 0.0001).

Table 2.

Description of the Recognition Awards Distributed by Four Gastrointestinal Societies between 1951 and 2019 and the Recipients Who Were Recognized

Award information	Total, n (%)	Women	Men	p
	N = 921	N = 77 (8.4)	N = 844 (91.6)
Award category				0.008
Highest achievement	212 (23.0)	8 (10.4)	204 (24.2)
Research/clinical	176 (19.1)	10 (12.9)	166 (19.7)
Service	145 (15.7)	14 (18.2)	131 (15.5)
Teaching/mentoring	87 (9.5)	12 (15.6)	75 (8.9)
Named lectureship	301 (32.7)	33 (42.9)	268 (31.7)
Society				0.02
AASLD	159 (17.3)	23 (29.9)	136 (16.1)
ACG	248 (26.9)	15 (19.5)	233 (27.6)
AGA	320 (34.7)	24 (31.2)	296 (35.1)
ASGE	194 (21.1)	15 (19.5)	179 (21.2)
Recipient information a	N = 643	N = 58 (9.0)	N = 585 (90.9)
Educational degree				<0.0001
MD	556 (86.5)	36 (62.1)	520 (88.9)
PhD	34 (5.3)	12 (20.7)	22 (3.8)
MD/PhD	43 (6.7)	8 (13.8)	35 (5.9)
Otherb	10 (1.6)	3 (3.4)	8 (1.4)
Number of awards				0.4
1	476 (74.0)	47 (81.0)	429 (73.3)
2	103 (16.0)	6 (10.3)	97 (16.6)
≥3 (3–8)	36 (5.6)	5 (8.6)	59 (10.1)

^a Unique recipients.

^b Includes MA, MBA, MPH, JD.

Time trend

Looking at individual awards, 77 of the 921 (8.4%, 95% CI [6.6%–10.1%]) were given to women and 844 (91.6%, 95% CI [89.8%–93.4%]) to men. There was a significant increase in the proportion of women award recipients over time, from 0% (95% CI 0%–0%) in 1970–1984 to 22.0% (95% CI 15.1%–28.9%) in 2015–2019 (p for trend <0.0001) (Fig. 1).

FIG. 1.

Women recipients of gastrointestinal society awards ranged from 4% between 1941 and 1969 to 22% between 2015 and 2019.

Among physicians

In total, there were 873 awards given to a total of 599 individual physician recipients, of which 555 were men physicians (92.7%, 95% CI [90.6%–94.7%]) and 44 were women physicians (7.4%, 95% CI [5.2%–9.4%]). One hundred sixty-one physicians received multiple awards. The mean number of awards per physician was 1.4 (95% CI 1.4–1.5). There was no significant difference in the number of awards by gender (mean for women physicians 1.4 [95% CI 1.1–1.7] vs. men physicians 1.5 [95% CI 1.4–1.5]; p = 0.6). Women physician award recipients were more likely to have a combined MD/PhD degree compared with men physician award recipients (18.2% vs. 6.3%) and less likely to have an MD degree alone (81.8% vs. 94.0%) (p = 0.003).

Time trend among physicians compared with specialty representation

Looking at individual awards, 61 of the 873 (6.9%, 95% CI [5.3%–8.7%]) were given to women physicians and 812 (93.0%, 95% CI [91.3%–94.7%]) to men physicians. There was a significant increase in the proportion of women physician award recipients over time, from 0% (95% CI 0%–0%) in 1970–1984 to 19.3% (95% CI 13.2%–25.3%) in 2015–2019 (p for trend <0.0001). Year for year, the representation of women physician award recipients compared with the concurrent representation of women in the specialty varied. Women physicians were underrepresented among award recipients from 1970 to 2014, except from 1985 to 1989 when they were equally represented, and slightly overrepresented from 2015 to 2019 (Fig. 2).

FIG. 2.

The representation of women physician award recipients compared with percentage of women physicians in the specialty.

Award type and society

There were a total of 212 highest achievement awards among the 4 societies, of which women have received 8 (3.8%). Of these achievement awards, 124 (58.5%) were awarded to past presidents of the respective societies (Appendix Table A3). Women recipients of the highest achievement award were equally likely to have been a past president as men recipients (50% vs. 58.8%, p = 0.62). Women were less likely to receive the “highest achievement” award (3.8%) and more likely to receive teaching/mentorship awards (13.8%; p = 0.002) or named lectureships (10.9%; p = 0.005) (Fig. 3). The proportion of AASLD women award recipients (14.5%) was significantly higher compared with other societies: AGA (6.0%), ACG (7.5%), and ASGE (7.7%) (p = 0.008) (Fig. 4).

FIG. 3.

Women are least likely to receive the highest recognition awards and most likely to receive teaching/mentorship awards.

FIG. 4.

Representation of women award recipients by society (1981–2019). The proportion of women receiving awards varied among the societies from 6.8% to 14.5%. AASLD, American Association for the Study of Liver Disease; ACG, American College of Gastroenterology; AGA, American Gastroenterological Association; ASGE, American Society for Gastrointestinal Endoscopy.

Factors that influence gender of award recipient

In univariable logistic regression analysis exploring factors associated with having a women recipient of a recognition award, educational degree, type of award, awarding society, and time period were all significant (Table 3). In adjusted analyses accounting for all factors, educational degree and time period remained significant. Women with a PhD degree alone were more likely to receive an award compared with women with an MD degree alone (aOR = 8.8; 95% CI [3.7–21.1]), whereas men with a PhD alone were less likely to receive an award compared with men with an MD degree alone (aOR = 0.1; 95% CI [0.05–0.3]).

Table 3.

Logistic Regression Exploring Factors Associated with the Likelihood of Having a Women Recipient of a Recognition Award from a National Gastroenterology or Hepatology Society between 1941 and 2019 with Presentation of Both Unadjusted and Adjusted Results

	Likelihood of a women award recipient
	Unadjusted		Adjusted
	OR [95% CI]	p	aOR [95% CI]	p
Educational degree		<0.0001		<0.0001
MD	Ref.		Ref.
MD/PhD	2.9 [1.3–6.5]		1.9 [0.8–4.6]
PhD	8.9 [4.3–18.2]		8.8 [3.7–21.1]
Other	3.2 [0.7–15.4]		3.8 [0.7–21.7]
Award category		0.01		0.9
Highest achievement	Ref.		Ref.
Research/clinical	1.5 [0.6–4.0]		1.4 [0.5–4.3]
Service	2.7 [1.1–6.7]		1.4 [0.5–3.9]
Teaching/mentoring	4.1 [1.6–10.4]		1.8 [0.6–5.2]
Named lectureship	3.2 [1.4–6.9]		1.6 [0.6–4.1]
Society		0.02		0.6
AASLD	Ref.		Ref.
ACG	0.4 [0.2–0.8]		0.7 [0.3–1.5]
AGA	0.5 [0.3–0.9]		0.6 [0.3–1.4]
ASGE	0.5 [0.2–0.9]		0.6 [0.3–1.4]
Time period		<0.0001		<0.0001
1941–1979	Ref.		Ref.
1980–1989	1.2 [0.2–8.9]		1.0 [0.1–7.7]
1990–1999	1.0 [0.2–6.4]		0.7 [0.1–4.5]
2000–2009	2.9 [0.6–13.2]		1.8 [0.3–8.8]
2010–2019	10.4 [2.5–43.5]		7.2 [1.6–32.3]

C = 0.79.

aOR, adjusted odds ratio; CI, confidence interval; OR, odds ratio.

Discussion

In this study of gastroenterology and hepatology society recognition award recipients, we identified the following key points:

• 1.Representation of women physician award recipients as compared with representation of women in the specialty has varied over time. It has generally been lower and most recently surpassed the representation of women in gastroenterology and hepatology;
• 2.Women were more likely to receive teaching/mentoring awards or distinguished lectureships compared with awards identified by the society's as the “highest honor” awards;
• 3.Women award recipients were more likely to have a PhD or combined MD/PhD degree compared with men recipients and less likely to have an MD degree alone;
• 4.Women with a PhD degree alone were more likely to receive an award compared with women with an MD degree alone; in contrast, men with a PhD alone were less likely to receive an award compared with men with an MD degree alone;
• 5.Representation of women award recipients varied among the societies, from 6.8% to 14.5%.

Our study shows that in the most recent years, the representation of women among award winners has surpassed the representation of women in the specialty. This is similar to a study of twenty surgical societies, in which the representation of women award winners increased significantly from 1998–2007 to 2008–2017 and surpassed representation of women in the specialty.⁵ In the specialty of physical medicine and rehabilitation, the representation of women physician award winners has varied by society. In one society, there was an upward trend over time in women award winners, but proportions were still below the percentage of women in the specialty⁸ and in another society, there was a decrease in the proportion of awards given to women from 2007–2016 compared with 1990–2006 and compared with the specialty, women physicians were underrepresented for the entire 27-year history of that society's awards.⁷

In the specialty of anesthesiology, there was no significant increase of women award winners over time and the overall low levels of women awardees was in sharp contrast to the increasing number of women training in the specialty.⁴ In neurology, women were far underrepresented among award winners and no temporal trend was seen, despite the increase in women within the specialty.⁶ Other specialties, including dermatology, orthopedic surgery, head and neck surgery, and plastic surgery, have had so few women award winners and some awards never won by women that no temporal trends could be conducted.³

This is an observational study, and we were not able to evaluate causality, which is likely to be multifactorial. Comparing data on award nominees to that of award recipients could provide insight into whether women are being nominated for awards at a level on par with their representation in the society and specialty, and whether once nominated, they are being selected at an expected rate.

Numerous other reports have explored possible reasons for disparities.^3–8 For example, one potential factor may be the lag time necessary to establish one's career and achieve accomplishments recognizable by professional society awards. Descriptions of women's work and accomplishments are well known to contain gender-related bias, often seeping into written documents such as letters of reference^15–17 or performance evaluations^18,19 that may put them at a disadvantage for hiring, compensation, promotions, and awards. Studies also demonstrate similar issues for people who identify with race or ethnicity minority groups,²⁰ potentially putting women with intersectional identities at greater disadvantage. This gender-related bias often begins during training^20,21 and lasts throughout their career. It is also possible that the pool of potential women recipients thins in the higher ranks. This may be particularly true within academic medicine, as women leave academic medicine at higher rates than men, frequently before the associate professor and professor rank, and overall, hold fewer leadership roles.^22–25

Implicit (unconscious) bias has been proposed as well as organizational and structural bias.²⁶ The increase in women award recipients in recent years may be due to conscious efforts by societies to address gender equity, including the implementation of initiatives to improve opportunities for women and minorities within the societies and to address overall diversity and inclusion among membership and the field at large.^27,28 While women have comprised 5.3% of the 300 society presidents across the four societies, it is notable that in 2017, the presidents of all four societies included in this study were women and each of the four societies outlined increasing diversity and inclusion in their mission.^29–32

Although recent trends for award recipients within gastroenterology and hepatology are encouraging, these data should be tracked proactively. Societies should collect demographic information, such as gender and race, of their membership as well as of award nominees and award winners, and other society-related activities, such as course faculty, committee appointments, etc.²⁸ Societies should also have transparent, unbiased processes regarding nomination for awards, award selection criteria, and the composition of award committees, as well as for other society opportunities. In addition, they should develop and continue initiatives to promote women and minorities to increase the diversity within their profession.^2,28

Women were more likely to receive teaching and mentorship awards compared with other award types, in particular the awards described by the societies as the “highest honor.” While our study does not evaluate causality, possible reasons include that women excel at teaching and mentorship; teaching and mentorship have been perceived as more traditionally female roles, or that women provide more service duties within their institutions, such as teaching, mentorship, or unnamed administrative roles.³³ We also found that women with a PhD were more likely to receive an award compared with those with MDs alone, whereas men with a PhD were less likely to receive an award compared with those with MDs alone. Similar findings have been noted in other studies on deans³⁴ and plenary speakers.³⁵

While the exact reasons for this differential by terminal degree type is not well understood, potential reasons include more implicit bias regarding physicians compared with nonphysicians, higher sponsorship among those with degrees other than MD or equivalent such that women physicians are less frequently proposed as award recipients, higher visibility and recognition of women with terminal degrees other than MD perhaps via published scholarship, and differential nomination rates by degree type.³⁶

Our study did find that AASLD had significantly more women award recipients compared with the other societies. While this is encouraging, the specific reasons require evaluation. AASLD may have a higher representation of women through the years of this study and women who hold a PhD or MD/PHD. Published membership data from 2017 does show higher women membership in AASLD at 33% compared with ACG 21.5%, AGA 24%, and ASGE 16%.^29–32 AASLD is a newer organization and began distributing awards in the 1980s; however, sensitivity analysis limiting data to 1981 and beyond showed no difference in results.

Another striking observation of this work is the lack of reporting of gender within societies. Without these data, there is no denominator by which to accurately calculate the proportion of award winners, or other outcomes, by gender for each society. As such, we have used the proportion of women with specialty training in gastroenterology and hepatology as a surrogate, with acknowledgment that it is imperfect. While this is a limitation of the study, it is also a critical call to action. Measuring gender composition of membership within societies, as well as other important metrics, such as race and ethnicity, as women with intersectional identities often face greater levels of bias, would be the first step toward ensuring equity in award recipients and beyond.

Our study adds to the growing body of gender equity research within gastroenterology and hepatology. Among the five highest impact U.S.-based gastroenterology and hepatology journals, the percentage of U.S. women physician authors of original research has increased over time. While the percentage of women with the first author position mirrors that of the percentage of women in academic gastroenterology and hepatology, the percentage of women in the senior author position remains lower than expected.¹¹ However, when accounting for career duration, academic productivity measures that account for quantity and impact are similar for men and women gastroenterology faculty, meaning women holding senior faculty positions are equally productive as their counterparts who are men.¹²

Within ASGE, there has been a significant increase in the proportion of women that served as faculty of ASGE-sponsored programming over time, and that women faculty participation exceeded the ASGE female domestic membership rate in all years.¹³ Prior work has also shown that while women make fewer requests for ASGE leadership assignments, when they do make these requests, they are granted more frequently.¹⁴

Societies play an important role in supporting women physicians' careers.³⁷ While awards are just one component of how physicians are valued, these awards may provide a reflection of the values and overall culture of the society and profession at large. In addition, award recipients serve as the face of the profession and role models for young trainees and members, which are important to recruit a diverse, talent pool.³⁸ In addition, awards may also enhance career satisfaction, which has been shown to be lower in women versus men gastroenterologists.³⁹ Some have suggested that analyzing gender distribution of awards could provide insight into how organizations may have contributed to career development of members over decades.⁴⁰ All four gastroenterology and hepatology societies in this current study have outlined programs and opportunities designed specifically for women.^29–32

The strengths of our study include its novel focus. To our knowledge, awards in the field of gastroenterology and hepatology have not been evaluated before and has direct relevance for stakeholders within this specialty. Our methodology was unique in the inclusion of a multivariable model evaluating factors associated with receipt of an award. We were able to capture data from four leading U.S. societies and thus could paint a comprehensive picture of the specialty. Data from the AMA and AAMC allowed us to put these observed trends in the broader context, by having a comparison with women within the field of gastroenterology and hepatology in the United States. We also captured multiple types of awards.

We acknowledge certain limitations. We did not have data on the age or race of award recipients, the years since completion of training, their practice setting or career track, or the potential overlapping membership among the four societies. Since data on gender composition of membership for each society over time were not available, comparison of percentage of women award recipients to membership was not feasible. Because there were few women award recipients overall, subgroup analysis is limited. For example, there were too few women recipients per award to track the same award over time. We identified the current process for award selection among the four societies, but this has certainly changed over time. We are mindful that gender is a spectrum and the inherent limitations of gender equity research which handle gender is a binary variable. Our study does not evaluate causation and therefore we cannot comment on the reasons behind our findings. Rather, our study motivates further investigation into these observations. Lastly, the study only assessed U.S. societies and the results may not be generalizable to non-U.S. societies.

Recognition through professional societies is an important component of career advancement. Creating opportunities for women significantly expands the talent pool, enhances mentor and coaching access, and provides role models for women in gastroenterology and hepatology. Our data offer encouragement that representation of women physician award recipients was low for many years than trended upward to become equitable and more recently women physicians have been overrepresented compared with the proportion of women in gastroenterology and hepatology.

Professional societies should proactively monitor award-related data around gender across the spectrum, as well as other types of diversity inclusive of but not limited to racial and ethnic diversity. Transparent processes should be put into place that aim to identify and reduce various forms of bias in all phases of award recognition, including award criteria, nomination, and selection. The composition of the awards committee should reflect the society's membership and all members should be knowledgeable about gender-related and other forms of bias.

Appendix

Appendix Table A1. URL to Online Award Descriptions for Each Society

Society	URL to online award descriptions for each society
AASLD	https://www.aasld.org/about-aasld/governance/distinguished-awards
ACG	https://gi.org/about/awards
AGA	https://www.gastro.org/membership/recognition-awards
	https://www.gastro.org/membership/recognition-awards/research-service-award
ASGE	https://www.asge.org/home/about-asge/grants-awards/honorary-awards

AASLD, American Association for the Study of Liver Diseases; ACG, American College of Gastroenterology; AGA, American Gastroenterological Association; ASGE, American Society for Gastrointestinal Endoscopy.

Appendix Table A2. Description of Award Nomination Requirements and Selection Process for Each Society

Society	Description of award selection process	Composition of the awards committee	Data source
AASLD	AASLD member nominator	Governing board members (7), including president, president elect, past president	AASLD staff
	Nominating letter, up to two letters of recommendation and nominee's CV
	Awards Committee recommends finalists for selection by the Governing Board
ACG	ACG member nominator	ACG members (8); current roster includes 5 past presidents	Website
	Two letters of recommendation and nominee's CV
	Awards Committee does comprehensive evaluation of award nominees and presents to the Board of Trustees for discussion and approval
AGA	AGA member nominator	Governing board (13), including president, president elect, past president	Website
	Nomination letter, including other names of member who support nomination and nominee's CV
	AGA Governing Board reviews and selects winner
ASGE	ASGE member nominator or self-nominationa	3 immediate past presidents	ASGE staff
	Nomination letter, two additional letters of recommendations and nominee's CV
	Awards Committee reviews and presents final recommendations to ASGE Governing Board for approval

^a International Committee recommends nominee for the International Service Award.

Appendix Table A3. Recipients of the Highest Achievement Award by Society, Gender, and Whether the Recipient Had Served As a President of That Society in the Past

Society	Recipients of highest achievement award			Past president recipients of highest achievement awardsa
	Total, n	Women, n (%)	Men, n (%)	Total, n (%)	Women, n (%)	Men, n (%)
AASLD	32	3 (9.4)	29 (90.6)	11 (34.4)	0 (0)	11 (37.9)
ACG	33	2 (6.1)	31 (93.9)	19 (57.6)	1 (50.0)	18 (58.1)
AGA	79	1 (1.3)	78 (98.7)	56 (70.9)	1 (100.0)	55 (70.5)
ASGE	68	2 (2.9)	66 (97.1)	38 (55.9)	2 (100.0)	36 (59.5)
Total	212	8 (3.8)	204 (96.2)	124 (58.5)	4 (50.0)	120 (58.8)

^a Percent denotes the number of highest achievement award recipients (total, women, or men) who have been a past president of that society divided by the number of highest achievement award recipients (total, women, or men).

Author Contributions

Conception and design of the study (A.H.C.); acquisition of data (J.A.R., A.H.C.) analysis and interpretation of data (J.A.R., B.K.E., C.M.S., A.H.C.); statistical analysis (A.H.C.); drafting of the article (A.H.C.); critical revision of the article (J.A.R., B.K.E., C.M.S., A.H.C.); study supervision (A.H.C.); approval of the final version of the article (J.A.R., B.K.E., C.M.S., A.H.C.).

Author Disclosure Statement

No competing financial interests exist.

Funding Information

Dr. Calderwood is supported by 1R21CA227776-01A1, The Dartmouth–Hitchcock Cancer Research Fellows Program, and by the NCI Cancer Center Support Grant 5P30CA023108 to the Dartmouth–Hitchcock Norris Cotton Cancer Center as well as The Dartmouth Clinical and Translational Science Institute, under award number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The funding agencies played no role in the design, conduct, or interpretation of this study.