Women Narrow Gender Gap in Medical Research

BOSTON, July 20 -- Women have risen to considerable prominence since the 1970s as lead authors of research papers in top echelon of medical journals, but a clear gender gap remains.

But although women make up half of all medical students and one-fourth of all practicing physicians today, female researchers still have a distance to go to achieve parity in publishing in the top-tier journals, wrote Reshma Jagsi, M.D., D.Phil., of Harvard and colleagues, in the July 20 New England Journal of Medicine.

For medical researchers, the lead or senior author of an original research paper in a prestigious publication such as the New England Journal of Medicine, Journal of the American Medical Association, or Annals of Surgery is a significant measure of career achievement.

"I must say that clinically, with my patients, it probably doesn't matter that much, but amongst my peers, my colleagues, it does buy respect," said Ruth C. Fretts, M.D., an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. She has been a lead author of papers in both NEJM and Obstetrics & Gynecology.

Since 1849, when Elizabeth Blackwell became the first woman to graduate, (first in her class) from a medical school in the United States, women have struggled to have their achievements recognized by their peers in practice and in academic medicine.

"Advancement in academic medicine is largely contingent on productivity and the measured external influence of one's scholarly work," Dr. Jagsi and colleagues wrote. "Objective measures of the effect of one's work include the publication of original research in prominent journals and invitations by editors to provide scientific opinions on the published research of others."

They reviewed the medical literature spanning nearly four decades to determine what percentage of female physician-investigators were among the first and senior authors of original research papers in NEJM, JAMA, Annals of Internal Medicine, Annals of Surgery, Obstetrics & Gynecology and The Journal of Pediatrics.

They found that in 1970 only 5.9% of all original research papers in the six journals had a woman as the first author, and only 3.7% had a female senior author.

Interestingly, women in 1970 were most heavily represented in the two journals dealing with motherhood (Obstetrics & Gynecology) and children (Journal of Pediatrics), with women accounting for 6.7% and 15% of lead authors in the two journals, respectively.

Fast forward to 2004, where the authors found that a woman's name was first on 29.3% of all articles in the journals studied, and that women were senior authors on 19.3% of all papers.

Once again, women as first authors were represented best by Obstetrics & Gynecology (40.7% of first authors, and 28% of senior authors) and by the Journal of Pediatrics (38.9% of first authors, and 38% of senior authors).

The investigators also looked at the percentage of women called on to provide commentary or editorials in JAMA and NEJM, They found that among authors of guest editorials in NEJM, only 8.8% overall were women, ranging from 1.5% in 1970 to 11.4% in 7004 (P for trend

They noted that women have traditionally received less lab space and research support at the start of their careers, and are promoted less frequently than men, despite equivalent numbers of hours worked or papers published.

Women may also choose more often to pursue careers in clinical medicine rather than in research, or may try harder to balance work with their personal lives than men, they noted.

"I think what's a challenge is that if you happen to go the route of having a family that you're just not going to write as many papers; you just won't have the opportunity, because you're busy," said Dr. Fretts, herself a parent.

Another issue pointed out in the editorial is the critical importance of mentoring in career development. In several surveys they wrote that female faculty members reported having fewer mentorship relationships or receiving less effective mentoring than that reported by male faculty members.

In their study, Dr. Jagsi and colleagues noted that inequities in career development paths between men and women could be partly ironed out by programs such as the administrative supplements added to National Institutes of Health research grants that help women re-enter biomedical and behavioral researchers careers after a hiatus.

"On the basis of a similar logic, it may also be appropriate to consider making awards for career development independent of the number of years since medical school or since one's first faculty appointment," they added.

Dr. Fretts noted that regardless of where they are in their careers, those who do the bulk of the research and authorship work should get the bulk of the credit, which is not always how it works in the real world.

"At least in my group, when I'm the one who's doing all the work there's no question about who's going to be first author, but I think when you are in larger groups, such as the women's health studies, there is probably a pre-determined pecking order as to who's the first author and who's the senior author," she said.