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Research Reports

Women’s Representation Among Members and Leaders of National Medical Specialty Societies

Jagsi, Reshma MD, DPhil; Means, Olivia MD; Lautenberger, Diana MAT; Jones, Rochelle D. MS; Griffith, Kent A. MS; Flotte, Terence R. MD; Gordon, Lynn K. MD, PhD; Rexrode, Kathryn M. MD, MPH; Wagner, Lori W. MD, MA; Chatterjee, Archana MD, PhD

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doi: 10.1097/ACM.0000000000003038
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Abstract

Women constitute half of the medical student body1 and half of the patient population served by physicians, but they remain underrepresented in senior positions in the profession of medicine. In 2017, only 16% of deans and 17% of department chairs at US medical schools were women.2 Moreover, women’s distribution among the trainees and practicing physician workforce varies dramatically across specialties.3,4

The National Academies identified the important potential for professional and specialty societies to advance women in science as long ago as 2002,5 but little is known, even 17 years later, about women’s participation and leadership within the national organizations or societies that represent and support the medical profession. National medical specialty societies speak for the profession of medicine and for the fields they represent in policy debates. They also influence the direction of research, affect trainees’ decisions about which specialty to pursue, provide career development opportunities for physicians, and confer awards and important recognitions.6 A comprehensive understanding of the demographics of the membership and leadership of specialty societies is therefore essential.

Reports from select fields suggest that few women have served as officers of national medical specialty societies. A 2006 report from radiation oncology was among the first to raise concerns about a possible glass ceiling in these organizations.7 A 2013 report from general surgery reported that in its 100 years of existence, the American College of Surgeons had had only 4 women chairs of its board of governors and that 2012 marked the first year in which a woman was elected to serve as chair of its board of regents.8 A 2017 report noted that women’s representation among overall membership of the American College of Radiology and their participation in certain leadership roles, including on the national board of chancellors, increased from 2001 to 2015, but representation at the highest-national-officer level did not.9 A 2018 report10 noted that at the time of writing, the American College of Cardiology had had only 3 female presidents (out of a total of 6611): the author, who was then serving in the role, and 2 others, whose terms were in, respectively, 1982–1983 and 2005–2006. Recently, a report described the dearth of women holding the senior-most elected positions within multiple professional specialty societies from 2008 to 2017, but the authors did not have access to full data on women’s representation in overall membership or other leadership positions.12

Through the current study, we sought to provide a more systematic and comprehensive analysis of women’s participation in medical specialty societies than previously reported. We included a broad array of large societies representing all major medical specialties, and we collected and evaluated data on both membership and leadership in the same years across all societies.

Method

In 2016, the Group on Women in Medicine and Science (GWIMS, a constituent group of the Association of American Medical Colleges [AAMC]) initiated a query to characterize the gender of members and leaders of specialty societies from 2000 to 2015. GWIMS requested that medical societies provide the following: (1) the gender of the highest-ranking elected officer (president or chair), (2) the number of total and female members among its governing body (e.g., board of directors) in each year from 2000 to 2015, and (3) the total number and percentage of female members in 2005 and 2015. We allowed societies to define for themselves “full and active members” but guided societies to omit trainees and emeritus members if possible. We made initial contacts with each society’s membership director or, where present, with our own contacts who served on the senior staff (in positions such as executive director) at each society. When initial requests were not answered, we made follow-up requests to ask senior female leaders within the society (identified through the societies’ public-facing websites) to facilitate contact with an appropriate society staff member. We collected all data using a standardized Microsoft Excel spreadsheet (version 1907; Redmond, Washington).

This report provides descriptive analyses of data received from the largest societies providing responses from each of the major specialties of medicine. We have included a specialty if, based on AAMC data, 300 or more residents were enrolled in its training programs in 2015 (21 specialties, including, for example, anesthesiology, ophthalmology, urology) or if the specialty was one of 9 major internal medicine subspecialties (internal medicine is a broad category with over 11,000 total residents enrolled in training programs in 2015).13

For context, we included data on the proportion of trainees who were female in each field, as collected, by the AAMC2 for all major specialties and by the Accreditation Council for Graduate Medical Education (ACGME)14 for the internal medicine subspecialties whose data had not been reported by the AAMC. We calculated percentages from the ACGME data (derived from the 2005–2006 and 2015–2016 ACGME resource books)14,15 following the same approach the AAMC used (i.e., by dividing the number of women by the total number of men and women in each field). For hematology, we included trainees in hematology programs and in combined hematology/oncology. Likewise, for oncology, we included trainees in oncology programs and those in combined hematology/oncology. For each specialty, we have reported the proportion of trainees and corresponding specialty society members who were female in 2005 and 2015. We have calculated and reported, for each society, the proportion who were female among the highest-elected leaders from 2000 to 2015. We have also calculated and reported, for each society (1) the mean of the proportion who were female on its governing body in each year from 2000 to 2015 and (2) the mean of the proportion who were female for the governing body in the first 8 years of the study period (2000–2007) and the last 8 years (2008–2015). We have further summarized these data across all reporting specialties by describing the mean and range of the proportion who were female among members, highest-elected leaders, and governing bodies (weighting each society equally rather than by the size of its membership or governing bodies).

We evaluated how many organizations had an increase in the percentage of women who were members or leaders. We specifically investigated how many organizations had more than a 10% increase in the percentage of women serving on governing boards between the first half and the second half of the study period. A priori, we designated 10% as a threshold for representing a substantial change over time.

We compared the percentage of women serving on governing bodies in 2008–2015 with the percentage of women who were full and active members in 2005 so as to identify specialties with a large difference (either positive or negative) between the proportion of women among those eligible and those selected for leadership (we have presented these results fully and then summarized using a threshold of > 5% divergence).

Finally, we summarized women’s representation among leadership in the subset of specialties in which women constituted a majority of trainees in 2005.

This work was considered research on organizations and not human subjects research requiring institutional review board approval.

Results

We received data from societies in all 30 specialties that met inclusion criteria. The proportion of women among those serving as highest-ranking leader from 2000 to 2015 ranged from 0% to 37.5% (Figure 1); the mean proportion across societies was 15.8%. Five specialty societies (in urology, thoracic surgery, radiology, orthopedic surgery, and neurosurgery) had no women as the highest-ranking leader from 2000 to 2015. The mean proportion of women serving on governing boards ranged from 0% to 37.3% (mean of means, 18.8%) in 2000–2007 and from 0% to 47.6% (mean of means, 25.2%) in 2008–2015 (Figure 2). Only one specialty society (in urology) had no women serving on its governing board from 2000 to 2015.

Figure 1
Figure 1:
Proportion of women among those serving as the highest-ranking elected officer (e.g., president, chair) from 2000 to 2015 for a large medical specialty society representing each of 30 specialties. Data were reported by each organization; detailed numerical results are provided in Table 2. The proportion for 5 societies was 0.
Figure 2
Figure 2:
Mean proportion of women serving on the governing body (e.g., board of directors, executive council) for a large medical specialty society representing 28 of 30 specialties (2 societies were unable to provide the data requested). Data were reported by each organization; detailed numerical results are provided in Table 2.

Table 1 lists the proportion of women among trainees and among professional society members in each of the 30 specialties in 2005 and 2015. In all but 2 specialties (radiation oncology and radiology, in which the proportion fell by, respectively, 3.1% and 1.6%), the proportion of women among trainees was higher in 2015 than in 2005. The smallest increase in trainee percent female was by 0.6% (in pathology) and the largest was by 14.9% (in plastic surgery). Similarly, in all societies for which data were available in both years excepting one (pathology, in which the proportion fell by 4%), the proportion of women among full and active members was higher in 2015 than in 2005. The mean of the proportion of women among full and active members in each society was 25.4% in 2005 (reported by 21 societies) and 29.3% in 2015 (reported by 29 societies). When restricted to the 21 societies reporting data in 2005, the mean of the proportion of women among full and active members in 2015 was 31.2%.

Table 1
Table 1:
Proportion of Women Among Trainees and Specialty Society Members in 30 Medical Specialties in 2005 and 2015
Table 2
Table 2:
Women Among Specialty Society Members and Specialty Society Leaders in 30 Medical Specialties, 2005–2015

Table 2 lists the proportion of women among professional society members and leaders in each of the 30 specialties from 2000 to 2015. In 25 of 28 specialties with data for both time periods evaluated in this study (2000–2007 and 2008–2015), the mean percentage of women serving on governing boards increased; in 9 of these, it increased by > 10% from the first to second half of the study period. The 3 exceptions were emergency medicine, family medicine, and thoracic surgery.

For 16 of the 21 specialties with available data on both the proportion of women among the highest-ranking elected officers during the study period and among membership in 2005, the percentage of females as the highest-ranking elected officer from 2000 to 2015 was lower than the percentage of females among society members in 2005 (Table 2). The 5 exceptions were as follows: internal medicine (the American College of Physicians), oncology (the American Society of Clinical Oncology), endocrinology (the Endocrine Society), otolaryngology (the American Academy of Otolaryngology), and psychiatry (the American Psychiatric Association). Table 2 also shows the difference between the mean percentage of women serving on a society governing body in 2008–2015 and the proportion of women among full and active members in 2005. In 4 of 19 specialties with data available, the mean percentage of women serving on governing bodies in 2008–2015 was more than 5% lower than among full/active members in 2005; in 6, it was more than 5% higher.

Data regarding trainees in 2005 reveal that 8 specialties had greater than 50% female trainees: dermatology, family medicine, endocrinology, rheumatology, obstetrics–gynecology, pathology, pediatrics, and psychiatry. Yet the percentage of females on the governing boards of these societies from 2008 to 2015 (Tables 1 and 2; data are available for all but psychiatry) was substantially lower. In those 8 societies, the mean percentage of women serving as highest-elected leader was 23.5% (range, 12.5% to 37.5%) for 2000–2015. In the 7 societies with available data, the mean of the mean percentage of women serving on governing boards was 31.2% (range, 22.4% to 37.3%) for 2000–2007 and 36.3% (range, 25.5% to 47.6%) for 2008–2015.

Discussion and Conclusions

This overview of women’s participation as members and leaders of large medical specialty societies reveals that although women generally represent a growing proportion of trainees in many fields, the gender demographics among full members and leaders of professional societies vary considerably across specialties—both in absolute magnitude and in change over time. Only a minority of leaders of national medical specialty societies during the study period were female. Even in specialties where women constitute the majority of trainees, and in societies with thousands of female members theoretically eligible for consideration for leadership positions, few women have served as the senior-most leader. This report establishes a baseline from which to evaluate the effectiveness of societies’ laudable efforts to improve diversity.

In most societies included in this study (25 of 28 reporting data on membership), the representation of women among members increased from 2005 to 2015. Societies varied in whether the proportion of women among leaders changed between the earlier and later halves of the study period and in how closely the proportion of women among leaders mirrored the proportion of women among members. In some societies, the proportion of women among leaders was similar to or even exceeded the proportion of women among members; understanding the processes those specific societies use to develop their leaders may provide valuable lessons.

A key insight from this study is that using the pipeline to explain why so few women are in leadership positions in certain societies (i.e., women leaders are fewer because fewer women have trained in the specialty) is insufficient. Certainly, women have only recently begun to join certain specialties, and promotions processes take many years causing a delay before any members of a cohort reach the seniority necessary for consideration for the prestigious positions considered in this study. However, even in several specialties where women have long constituted a substantial proportion of trainees (e.g., pediatrics, obstetrics–gynecology), remarkably few women (especially when considered in absolute numbers rather than percentages) have achieved leadership positions. A number of other well-recognized phenomena, including stereotype threat16 and implicit bias,17 likely contribute to the relative paucity of women seeking or receiving leadership positions. Male-dominated nomination processes, frequently led by former elected leaders, may perpetuate a lack of diversity if leaders focus on identifying and cultivating those who remind them of their younger selves. Further complicating the situation are the greater work–life integration challenges faced by women in a society that still generally expects a gendered division of domestic labor, including among physicians.18–20 Research suggests, for example, that attending meetings and conferences may be particularly difficult for women with families21—and, this should motivate further research to determine whether creative solutions such as on-site childcare, as implemented by some societies,22 might help.

Specialty societies offer multiple opportunities and resources for enhancing and advancing physicians’ careers. They engage in political advocacy and quality improvement, facilitate the development of mentoring relationships, and provide a host of educational opportunities for members at all levels of seniority.23 For these reasons, national specialty societies are uniquely positioned to facilitate gender equity within medicine,24 and monitoring women’s inclusion at both the member and leadership levels is critically important.

Leaders of specialty societies have a critical influence on the direction of scholarly inquiry and research in each of their fields. As Ioannidis has noted:

Each professional society creates its cadre of leaders, with meetings making these leaders visible to the members who usually participate passively by listening. Given the dynamics of large professional societies and conferences, leadership is sometimes judged not on scientific merit, hard work, and organization of thought, but on the ability to navigate power circles.25

Ensuring that leadership selection processes favor those who are most able—not simply the best-networked—is essential to ensure the rigor and integrity of the broader scientific and medical enterprise. Given documented gender differences in behaviors ranging from social interactions to self-promotion,26 monitoring the demographics of leaders is one way to evaluate whether processes are likely to have been fair or systematically biased against certain subgroups.

Limitations of the current study include the restriction to large societies in major specialties. Other professional societies, including societies of chairs or other subgroups within a field, may differ meaningfully in the diversity of their members and leaders. Several included societies (including ones listed at 0%) have elected female leaders since this study has ended, and future analyses should document whether sustained and consistent increases in female representation occur over time.

Medical professional specialty societies have good reasons to consider diversifying their leadership. Visible female role models are needed not only to encourage half of the available talent pool to consider a specialty but also to reflect patient populations. Diversity also broadens the viewpoints represented and improves collective intelligence.27 The time is overdue for organizations to ensure that all members are aware of opportunities for service and advancement, so that each specialty, and medicine overall, may reap the benefits of the diversity and inclusion of the full talent pool.

Acknowledgments:

The authors gratefully acknowledge the contributions of Barbara Fivush, Rebecca Ganetzsky, Marin Gillis, Martha Gulati, and other members of the Association of American Medical Colleges (AAMC) Group on Women in Medicine and Science (GWIMS) Steering Committee for their assistance in data collection, which they provided without compensation, along with the staff supporting the AAMC’s GWIMS and Council of Faculty and Academic Societies.

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