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Gender Representation Among Physician Authors of Practice Guidelines Developed, Endorsed, or Affirmed by the American
Lindsay Ross1, Catherine Hassett2, Peter Brown2
1From the Mellen Center for Multiple Sclerosis Treatment and Research (L.R., M.R.), Cerebrovascular Center (C.H., M.S.H.), Center for General Neurology (P.B.), Epilepsy Center (E.S.), Neurological Institute (R.M., G.B.), Cleveland Clinic, Cleveland, OH; Division of Pediatric Critical Care Medicine (A.M.), Department of Pediatrics, Central Michigan University, Detroit; and Department of Physical Medicine and Rehabilitation (J.K.S.), Harvard Medical School, Boston, MA. rossl9@ccf.org.
Background And Objectives:
To assess American Academy of Neurology (AAN)-recommended Practice Guidelines (PGs) for equity in gender representation among physician authors.
Methods:
This cross-sectional study included AAN-recommended PG publications from January 1, 2015, to December 31, 2020. Author degrees and gender were identified by 2 reviewers using the publication and/or online searches. Gender was determined from pronouns or photographs. Gender representation was compared with Association of American Medical Colleges (AAMC) data on academic neurologists. Data were analyzed using Z tests of 2 proportions and descriptive statistics.
Results:
AAMC benchmarks report academic women neurologists represented 35% of the specialty in 2015, 38% in 2018, and 39% in 2020. We identified 68 unique PG publications with 709 physician authors, 31% (223) women, 68% (484) men, and 0.3% (2) gender could not be identified. Representation of women physicians was low among PG authors across all benchmarks, significantly so for 2018 and 2020 (p < 0.01). Among physician first authors, women were significantly underrepresented across all benchmarks (18% [12/65], p < 0.01). Representation of women physicians was lower when men physicians were first authors vs women physicians (31% [161/524] vs 43% [50/118], p = 0.02). Among subspecialties with 10+ PGs, women physician authorship was highest in child neurology (48% [57/120]) and lowest in stroke and vascular neurology (16% [18/113]).
Discussion:
We found that women physicians were underrepresented as authors of AAN-recommended PGs. This suggests a missed opportunity for neurology because PGs that include expertise from women physicians may improve care and translation into practice. In addition, women physicians lose out on professional development from authorship. Further research is needed to understand causality and address gaps.
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