Women are more apt to be lead authors of research in major medical journals today than they were a generation ago, but they still lag significantly behind men, a recent study suggests.
The gender gap matters because lead authors make key decisions on what topics to research, who to include in studies, which outcomes to examine and how to interpret the data, said lead author of the current study, Giovanni Filardo of Baylor University Medical Center in Dallas.
It also matters because early-career researchers depend on publications to advance to more senior positions, meaning the gender gap in medical journals may contribute to a gender disparity in leadership roles at universities and teaching hospitals down the line.
"A lot has been written about the `leaky pipeline' for women in academic medicine," Filardo said by email. "No one seems to have identified any gaping holes - such as an identifiable process excluding women from receiving research funding - that could be relatively easily and quickly fixed with a policy change."
"Rather, the problem seems to be multiple, small, insidious leaks that are hard to pin down precisely for repair and that, at the level encountered by the individual, may seem too small or even petty to be worth drawing attention to," Filardo added.
To explore the gender divide in published work, Filardo and colleagues analyzed authorship over two decades for six prominent journals: Annals of Internal Medicine, The BMJ, JAMA, Archives of Internal Medicine, The Lancet and the New England Journal of Medicine (NEJM).
In 1994, women were lead authors on just 27 percent of articles in these journals, the research team reported in The BMJ.
Some journals published more work led by women than others, the study also found.
The BMJ had the highest total proportion of female first authors, at 39 percent, while the lowest proportion was found in the NEJM, at 24 percent.
While most journals increased female lead authors over time, NEJM actually had a smaller proportion by the end of the study than it did twenty years earlier.
Female lead authors also had better odds of placing non-experimental studies - such as those based on analysis of existing database information - in these prominent journals than they did of placing experimental research.
The proportion of non-experimental studies with female lead authors increased from 31 percent to 40 percent over the study period.
For experimental studies, which might include the gold-standard randomized controlled trial design, female first authors advanced from 20 percent to 35 percent over the study period.
Women were most likely to be lead authors on articles about general medicine, followed by cardiology. They were much less likely to be first authors on studies focused on specialties like infectious disease, cancer or HIV.
While it's hard to say exactly why women may be underrepresented in these journals, it's possible that their lack of representation on editorial boards and as reviewers who critique and select research for publication may play a role. Male reviewers are more likely to publish work by other men, the authors note.
To close the gender gap in lead authorship, journals may need to diversify their editorial staff and to do a better job of addressing unconscious gender bias, Kathryn Rexrode, a researcher at Harvard Medical School and director of the Office for Women's Careers at Brigham and Women's Hospital in Boston, noted in an accompanying editorial.
"The influx of women in medicine and science has changed some of the questions that are asked," Rexrode said by email.
Until recently, most clinical research was done in men and lab research was done in male animals, Rexrode noted.
"Women researchers were a large part of the impetus to ask, `but what about women?'" Rexrode added. "This has led to increased research in sex differences, and the `every cell has a sex' campaign - which will hopefully benefit both men and women patients."