Women Underrepresented in Medical Leadership Roles

Troy Brown, RN

February 08, 2016

The numbers of men and women in medical school and medical residency programs are approximately equal, but the proportion of women in leadership positions in nine major clinical specialties is much lower, according to a new study.

"It is notable that both obstetrics and gynecology and pediatrics, specialties with the highest proportion of department-based leaders who were women, did not fare better when comparing representation ratios," Lisa G. Hofler, MD, MPH, from the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, and colleagues write in their article, published in the March issue of Obstetrics & Gynecology. "Both specialties also had the highest proportion of residents in 1990 that were women, and representation ratios were calculated to account for historical residency cohorts."

The researchers searched the websites of 950 academic departments of nine specialties to determine the gender of department-based leaders (chair, vice chair, and division director) and residency program directors. The specialties the investigators analyzed were anesthesiology, diagnostic radiology, general surgery, internal medicine, neurology, obstetrics and gynecology, pathology, pediatrics, and psychiatry.

The researchers then calculated each specialty's representation ratio by dividing the proportion of leadership roles held by women in 2013 by the proportion of medical residents in 1990 who were women. A representation ratio of 1 demonstrates proportionate representation.

There were more men than women in the major department-based leadership roles in all nine specialties. Overall, women accounted for 13.9% of department chairs, 22.6% of vice chairs, 21.6% of division directors, and 39.0% of residency program directors. The highest proportion of women department chairs (24.1%) and vice chairs (38.8%) were in obstetrics and gynecology.

The highest proportion of women division directors (31.5%) and residency program directors (64.6%) were in pediatrics. The proportion of women division directors and residency program directors in obstetrics and gynecology were 30.2% and 61.7%, respectively.

Women Underrepresented in Three of Four Leadership Roles

Women were significantly underrepresented among department chairs in all specialties (all ratios 0.60 or less; all P ≤ .02). The specialty with the highest representation ratio of women in the department chair role was diagnostic radiology (0.60; 95% confidence interval [CI], 0.38 - 0.95). The representation ratio for women in the department chair role in obstetrics and gynecology was 0.51 (95% CI, 0.36 - 0.71).

The representation ratios for women in the vice chair role were below 1.0 for all specialties except anesthesiology, but this finding was not statistically significant for several specialties. The representation ratio for women in the vice chair role in obstetrics and gynecology was 0.82 (95% CI, 0.64 - 1.06), but this was not statistically significant.

Women were significantly underrepresented in the division director role in all specialties except anesthesiology (ratio, 1.13; 95% CI, 0.87 - 1.46) and diagnostic radiology (ratio, 0.97; 95% CI, 0.81 - 1.16). All other representation ratios were 0.63 or less (all P ≤ .001). The representation ratio for women in the division director role in obstetrics and gynecology was 0.62 (95% CI, 0.53 - 0.72).

When the researchers combined all three major department-based leadership roles, the highest representation ratios were in anesthesiology (ratio, 0.96; 95% CI, 0.79 - 1.16) and diagnostic radiology (ratio, 0.87; 95% CI, 0.75 - 1.02).

Women were significantly underrepresented in the three combined major department-based leadership roles in neurology, psychiatry, pathology, pediatrics, internal medicine, general surgery, and obstetrics and gynecology (all representation ratios 0.61 or less; all P ≤ .001).

The highest representation ratio of women in the residency program director role was in general surgery (ratio, 1.55; 95% CI, 1.08 - 2.21). Women were significantly overrepresented among residency program directors in the specialties of general surgery, anesthesiology, obstetrics and gynecology, and pediatrics (all representation ratios 1.19 or greater; all P ≤ .046).

Women were not significantly underrepresented as residency program directors in any of the specialties. And when the researchers combined all specialties, there were significantly more women than men in the residency program director role (16.9% vs 8.0%; P = .004).

"Although women were overrepresented in the residency program director role in four specialties, with the highest representation ratio in general surgery, this finding may not be cause for celebration," the authors write. "Many medical schools now have clinician–educator faculty tracks, which may not lead to major department-based leadership roles at the same rates as research-based tracks."

This research was first presented at the Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, May 2 to 6, 2015, in San Francisco, California.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2016;127:442-447.

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