Introduction & Objectives
The number of women in medicine continues to increase, with current medical school graduating classes comprising approximately 50% women. In comparison, 50 years ago, women made up less than 10% of medical school graduating classes and academic faculty. Rheumatology has seen a dramatic increase in the number of women in the specialty, with the 2015 ACR Workforce Study reporting that women currently represent 41% of the rheumatology workforce and 66% of rheumatology fellows. Projections suggest that women will make up the majority of the rheumatology workforce by 2025. Because rheumatology is a specialty comprising men and women equally, it is of interest to determine the gender equity among faculty and leadership positions, as well as the opportunity for men and women to achieve professional growth.
It is well documented that a gender gap exists between men and women regarding academic rank, leadership roles, and remuneration across U.S. academic medical centers. In a study of the U.S. academic physician workforce, women were less likely than men to achieve academic ranks of associate or full professor, even after adjustment for age, experience, specialty and productivity. Similar studies in internal medicine have found variation across subspecialties with regard to the likelihood of women achieving faculty promotion. Differences in academic promotion and leadership positions among women and men in rheumatology have not been previously evaluated.
Jorge et al. set out to determine the potential association between physician gender and academic advancement among U.S. rheumatologists.
Methods
The researchers performed a nationwide, cross-sectional study of all rheumatologists practicing in the U.S. in 2014 using a comprehensive database of all licensed physicians. Among academic rheumatologists, they estimated gender differences in faculty rank, adjusting for differences in physician age, years since residency graduation, publications, National Institutes of Health (NIH) grants, registered clinical trials and appointment at a top 20 medical school using a multivariate logistic regression model. They also estimated gender differences in leadership positions (i.e., division director and fellowship program director).
Results
Among 6,125 total practicing rheumatologists, 941 (15%) had academic faculty appointments in 2014. Female academic rheumatologists (41.6%) were younger and had completed residency more recently than men. Women had fewer total publications, publications on which they were the first or last author, and NIH grants. In fully adjusted analyses, women were less likely to be full or associate professors than men, with an adjusted odds ratio (OR) of 0.78 (95% confidence interval [95% CI] 0.62–0.99]). Women in rheumatology had similar odds as men of being a fellowship program director or division director (adjusted OR 0.90 [95% CI 0.69–1.43] and adjusted OR 0.96 [95% CI 0.66–1.41], respectively).
Conclusion
Among academic rheumatologists practicing in 2014, women are less likely than men to be full or associate professors, but have similar odds of being fellowship program directors or division directors, when adjusting for several factors known to influence faculty promotion.
“While barriers to academic promotion may negatively impact the opportunities for women in rheumatology to achieve senior faculty positions, we found that women and men were similarly likely to occupy key leadership positions within rheumatology divisions,” the authors wrote. “These differences may reflect how decisions regarding who will be advanced through academic and leadership ranks are based on different factors.”
These differences suggest barriers to academic promotion despite representation in leadership positions within rheumatology divisions.
“As the workforce gender balance continues to shift, equity in the academic advancement of women in rheumatology must be ensured,” the authors conclude.
Refer to the full study for all source material.
Excerpted and adapted from:
Jorge A, Bolster M, Blumenthal DM, et al. The association between physician gender and career advancement among academic rheumatologists in the United States. Arthritis Rheumatol. 2021 Jan;73(1).
