Sex Differences in Faculty Rank Among Academic Surgeons in the United States in 2014

Daniel M. Blumenthal, MD, MBA; Regan W. Bergmark, MD; Nikhila Raol, MD, MPH; Jordan D. Bohnen, MD, MBA; Jean Anderson Eloy, MD; Stacey T. Gray, MD

Disclosures

Annals of Surgery. 2018;268(2):193-200. 

In This Article

Abstract and Introduction

Abstract

Objective: The aim of this study was to evaluate sex differences in full professorship among a comprehensive, contemporary cohort of US academic surgeons.

Summary of Background Data: Previous work demonstrates that women are less likely than men to be full professors in academic medicine, and in certain surgical subspecialties. Whether sex differences in academic rank exist across all surgical fields, and after adjustment for confounders, is not known.

Methods: A comprehensive list of surgeons with faculty appointments at US medical schools in 2014 was obtained from Association of American Medical Colleges (AAMC) faculty roster and linked to a comprehensive physician database from Doximity, an online physician networking website, which contained the following data for all physicians: sex, age, years since residency, publication number (total and first/last author), clinical trials participation, National Institutes of Health grants, and surgical subspecialty. A 20% sample of 2013 Medicare payments for care was added to this dataset. Multivariable regression models were used to estimate sex differences in full professorship, adjusting for these variables and medical school-specific fixed effects.

Results: Among 11,549 surgeon faculty at US medical schools in 2014, 1692 (14.7%) were women. Women comprised 19.4% of assistant professors (1072/5538), 13.8% of associate professors (404/2931), and 7.0% of full professors (216/3080). After multivariable analysis, women were less likely to be full professors than men (adjusted odds ratio: 0.76, 95% confidence interval: 0.6–0.9).

Conclusion: Among surgical faculty at US medical schools in 2014, women were less likely than men to be full professors after adjustment for multiple factors known to impact faculty rank.

Introduction

Sex disparities in medicine—including in the availability of medical training, hiring, and advancement—have improved significantly over the past 50 years. Even so, these disparities remain prevalent in academic medicine. For example, a recent analysis of than 91,000 physicians with faculty appointments at US Medical Schools found that women were less likely than men to be full professors after adjustment for several measures of research and clinical productivity known to influence the likelihood of promotion.[1] A follow-up analysis of 3800 US academic cardiologists yielded similar results.[2] Within the same specialty and same medical school, female physicians earn less than their male counterparts, after adjustment for several factors that impact physician salary.[3]

Sex disparities in academic surgery have also improved somewhat over time; for example, the number of female residents in general surgery doubled between 1999 and 2014, and the number of women assistant professors increased nearly threefold over this time.[4] However, women remain underrepresented in academic surgery at almost every level.[5–8] For example, women comprise a minority of trainees in all surgical fields, accounting for 38% of all surgical residents and fellows, and 14% of neurosurgery and orthopedic surgery trainees.[5,9,10] In 2014, just 1% of chairs of surgical departments at US Medical schools were women.[10]

Prior studies on sex disparities in surgery have several limitations, including a focus on single surgical subspecialties or surgical trainees, which limits efforts to compare disparities across surgical fields;[4–6,8,11–17] inconsistent adjustment for potential confounders of the relationship between surgeon sex and academic rank, including measures of experience and clinical and research productivity; and use of noncontemporary data, which may limit how well they reflect contemporary associations between sex and faculty rank among academic surgeons.[18–20] Therefore, we conducted a comprehensive, contemporary investigation of associations between surgeon sex and academic rank among 11,549 surgeon faculty at US medical schools in 2014. All analyses were conducted using data from Doximity, an online networking website for physicians, and methods identical to those employed in recent prior analyses of sex differences in academic rank.[1,2,21] We hypothesized that female surgeons would be less likely than male surgeons to be full professors both before and after adjustment for several factors that may influence academic promotion.

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