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Analysis & Perspective

Association of Academic Physiatrists Women’s Task Force Report

Silver, Julie K. MD; Cuccurullo, Sara J. MD; Ambrose, Anne Felicia MD; Bhatnagar, Saurabha MD; Bosques, Glendaliz MD; Fleming, Talya K. MD; Frontera, Walter R. MD, PhD; Karimi, Danielle Perret MD; Oh-Park, Mooyeon MD; Sowa, Gwendolyn MD, PhD; Visco, Christopher MD; Weiss, Lyn MD; Knowlton, Tiffany JD, MBA

Author Information
American Journal of Physical Medicine & Rehabilitation: September 2018 - Volume 97 - Issue 9 - p 680-690
doi: 10.1097/PHM.0000000000000958

Abstract

In 2016, the Association of Academic Physiatrists (AAP) organized a presidential task force to advance women physicians in academic physiatry. The president at the time, Gerard Francisco, MD, outlined the purpose as follows: The AAP, the home of academic physiatry, is interested in learning how to more effectively support the academic careers of women physiatrists. The task force, which consisted of 12 academic physiatrists and was supported by two AAP staff members, was convened in December 2016 and charged with identifying priority areas, needs, existing resources, opportunities, barriers, and other issues related to achieving the goal of advancing the careers of women in physiatry.

METHODS

To identify priority areas, needs, existing resources, opportunities, and barriers, the task force members agreed on a list of metrics that would permit retrospective data review pertaining to the representation and hence advancement of women in the society. Categories examined included: membership (i.e., physiatrist member status), leadership (i.e., board membership, board presidents, committee membership, committee chairs, and resident fellow physician chairs), conference presentations (i.e., annual meeting session proposals, annual meeting faculty, annual meeting plenary speakers), awards (i.e., recognition award nominations and recipients), training (i.e., Program for Academic Leadership [PAL] candidates and Rehabilitation Medicine Scientist Training Program [RMSTP] applicants), and journal (i.e., American Journal of Physical Medicine and Rehabilitation [AJPM&R] Editorial Board Members). The task force members convened in person at the AAP 2017 annual conference and then participated in regularly scheduled conference calls through September 2017.

The focus of the analysis was the representation of women versus men physiatrists, and thus, nonphysiatrists were generally excluded unless noted. Throughout, the term “all physiatrists” refers to the sum of physiatrists and physiatrists-in-training. The AAP staff provided the task force members with data that were available for the past 10 yrs (2008–2017), although data were not available for the entire 10-yr period for some metrics. Notably, 2017 membership data were incomplete and represented information garnered through April. During each of the years for which data were available, 7 to 15 physiatrist members were reported as unknown gender, accounting for at most 1.2% of all physiatrists. The members of unknown gender were not included in gender-related analyses, and therefore, the number of members reported in gender-related analyses differs slightly from those reported for overall physiatrist membership. This study did not involve work with human subjects, and therefore, approval from the institutional review board was not necessary. This study conforms to all STROBE guidelines and reports the required information accordingly (see Checklist, Supplemental Digital Content 1, https://links.lww.com/PHM/A611).

RESULTS

Physiatrist Membership

Before 2013, there was no accurate mechanism for the reporting of membership data. During the subsequent 5-yr period studied (2013–2017), the number of all member physiatrists demonstrated growth of 55.1%. Within this group, membership of physiatrists-in-training increased 143% and membership of physiatrists who completed training increased 15.7% (Table 1).

TABLE 1
TABLE 1:
Physiatrist membership in the AAP, 2013–2017

For the same 5-yr period, the number of all AAP women physiatrists increased 74.1%, whereas the number of all men physiatrists increased 43.5%. Within these groups, the number of women physiatrists-in-training increased 171.2% and the number of men physiatrists-in-training increased 120.5%. Membership of physiatrists who had completed training increased 25.3% for women and 10.8% for men.

The percentage of all women physiatrists in the AAP increased from 37.4% in 2013 to 42.0% in 2017 (Fig. 1). Similarly, the percentage of women physiatrists-in-training increased from 40.1% in 2013 to 45.1% in 2017. Among those who had completed training, the percentage of women increased from 36.2% in 2013 to 39.1% in 2017.

FIGURE 1
FIGURE 1:
Trends in AAP physiatrists member gender, 2013–2017.

Proportional membership in the AAP was similar to the most recent physician gender data reported by the Association of American Medical Colleges (AAMC). The AAMC reported in the 2014 Physician Specialty Data Book that 34.7% (n = 3083) of active physical medicine and rehabilitation (PM&R) specialty physicians were women.1 Moreover, by 2014, 41%2 of full-time PM&R faculty were women.

Board of Trustees Membership

The AAP Board of Trustees and voting Board of Trustees data were available for the past 10 and 5 yrs, respectively. Board members who were not physiatrists were excluded from the review. Between 2008 and 2017, women among the physiatrist members of the Board of Trustees ranged from 18% to 38%. Comparison with membership data collected after 2013 revealed that other than in 2015, the representation of women on the Board of Trustees was equitable with respect to the representation of women physiatrists within the organization as a whole (Fig. 2).

FIGURE 2
FIGURE 2:
Distribution of women physiatrists among Board of Trustees, voting Board of Trustees, and general AAP physiatrist membership, 2013–2017.

In contrast, between 2015 and 2017, there was an ongoing gap between the percentage of women physiatrists in voting Board of Trustees positions and women among the general physiatrist membership. In 2013, women represented 37.4% of all physiatrist general members and 36.4% of physiatrist voting Board Members. By 2017, the disparity grew to 17% despite an increase in women physiatrists in the organization and equitable representation of women physiatrists on the Board of Trustees overall. Of note, in 2014, new bylaws changes were approved to allow committee chairs to become voting members on the Board, and because most committee chairs were men, this caused gender inequities shifting the ratios from 60:40 in 2013–2014 to 75:25 in 2015–2017. Notably, because the total Board of Trustees membership is small, the difference in representation between 2013 and 2017 equates to the loss of one voting position.

The AAP presidential leadership during the last 10 yrs was also reviewed. The President of the AAP Board of Trustees serves one 2-yr term. Since 2008, one woman physiatrist served a term as president (20%), whereas men physiatrists held all other presidential positions (80%).

Committee Membership and Resident Fellow Council Chair

There were seven committees within the AAP; including education, governance, leadership development and recognition, membership, program, public policy, and research. AAP committee membership data were available for the most recent 4 yrs (2014–2017). Between 2014 and 2017, the number of physiatrist committee members as a whole increased from 76 to 96 (Fig. 3A). The number of men physiatrist committee members was approximately the same in 2014 (n = 54) and in 2017 (n = 53). However, during that same period, the total number of women physiatrist committee members nearly doubled (n = 22–43) and the percentage of women physiatrists serving as committee members increased from 28.9% to 44.8%. This trend coincided with the increased representation of women physiatrists in the specialty and in the society. However, until 2017, the representation of women physiatrists on committees lagged behind the overall percentage of women physiatrists in the AAP.

FIGURE 3
FIGURE 3:
A and B, Physiatrist committee members (A) and chairs by gender (B), 2014–2017.

A separate analysis demonstrated that in 2014 and 2015, there were equal numbers of men and women physiatrists in committee chair positions. In 2016, after the formation of a new committee, there were four men and three women physiatrists in chair positions. In 2017, there were seven men and no women physiatrists serving as committee chairs (Fig. 3B). Notably, the proportion of women physiatrists among 2008–2017 AAP Resident Fellow Council chairs was 20% (n = 2 of 10). The Resident Fellow Council leadership process begins with a resident or fellow self-submitting an application to the Leadership Development and Recognition Committee (LDRC). If there are more than three applicants, they are ranked by the LDRC, and the three highest-ranked residents/fellows are listed on a ballot. The Council chair is then selected by vote of the attendees at the Resident Fellow Council meeting held during the annual national conference.

Annual Meeting Session Proposals, Faculty, and Plenary Speakers

The AAP annual meeting session proposal data were unavailable before 2015 because sessions were developed internally by the program committee. In 2015, the first year during which there was a call for session proposals, the annual meeting consisted of proposed sessions as well as sessions developed internally by the program committee. Of the 2015 faculty, 29% were women. Thereafter, calls for session proposals were released in advance of the annual meeting. Women were identified as the lead faculty on 47% (n = 22 of 47), 40% (n = 33 of 82), and 45% (n = 43 of 96) of session submissions for 2016, 2017, and 2018 meetings, respectively. The overall percentage of women physiatrists presenting at the annual meeting increased from 21% in 2010 to 44% in 2017 (Fig. 4A).

FIGURE 4
FIGURE 4:
A and B, Gender distribution among annual meeting physiatrist faculty (A) and plenary speakers (B).

One to four plenary speakers were invited to present each year at the annual meeting, comprising both physiatrists and nonphysiatrists. During the study period, there were a total of 31 plenary speakers, 12 of which were physiatrists. Two women physiatrists were scheduled as plenary speakers between 2010 and 2017, with one additional woman physiatrist filling in after cancellation by another woman who was not a physiatrist (Fig. 4B).

Recognition Award Recipients

Between 2008 and 2017, a total of 55 recognition awards were given to physicians in 8 categories with 13 (23.6%) women recipients (Fig. 5A). During the last 4 yrs (2014–2017), there was one woman among 22 physician awardees (4.5%) for all 8 categories, markedly lower than the proportion of women members in the AAP during that time (39.3%–42%).

FIGURE 5
FIGURE 5:
A and B, Gender distribution among physician recognition award recipients 2008–2017 (A) and physician recognition award nominees and recipients 2014–2017 (B). ND, No nomination data available; NA, not applicable since all authors are considered as potential nominees for the award.

Within recognition awards for multiple accomplishments for period, the proportion of women among physician awardees was 20% for the Distinguished Member and the Distinguished Academician Awards. No woman physician received the Carolyn Braddom Ritzler Research or the Outstanding Service Award during the last 10 yrs. Within early career/trainee awards, the proportion of women among physician recipients of the Early Career Young Academician Award was 36.4%. However, no woman received the McLean Outstanding Resident Fellow Award during the past 10 yrs. Within award categories recognizing a single achievement, two women (22.2%) received the AJPM&R Excellence in Research Writing Award and four women (66.7%) received the Ernest Johnson Excellence in Research Writing In-Training Award.

Coordinate nomination data were available for the past 4 yrs (2014–2017) for five award categories (Fig. 5B). Although the overall proportion of women among nominees was 26.2%, no women were nominated for three awards recognizing multiple accomplishments, whereas 12, 4, and 6 men were nominated for the Distinguished Academician, Carolyn Braddom Ritzler Research, and Outstanding Service Awards, respectively. In contrast, the proportions of women nominated for early career and resident/fellow awards were 41.1% and 45.5%, respectively. Despite the relatively equitable proportion of women nominees in these two categories, no women received these awards during the last 4 yrs.

Program for Academic Leadership and Rehabilitation Medicine Scientist Training Program

Program for Academic Leadership is currently a 3-yr mentored program to enhance leadership skills and has run annually in its current form since 2007. The AAP members are eligible for PAL if they are at the level of instructor, assistant professor, or associate professor and have at least 2 but no more than 8 yrs of experience after the completion of their training. For the past 10 yrs, the PAL has accepted 37 (58%) men and 26 (42%) women. Between 2013 and 2017, the percentage of women among PAL candidates ranged from 28% to 60% (Fig. 6A). During that same period, the percentage of women physiatrists in the AAP ranged from 37% to 42% and among the early career members ranged from 37% to 47%. There was a decline in the percentage of women in PAL in 2015 and 2016, but this trend seemed to be reversing in 2017. The overall odds ratio of a woman becoming a PAL candidate was 1.7 among the early career members.

FIGURE 6
FIGURE 6:
A–D, Trends in representation of women among early career training program participants and graduates: PAL candidates (A), PAL graduates (B), RMSTP pre-applicants (C), and RMSTP graduates (D).

A separate analysis of the current rank of all PAL graduates since the program's origin in 1999 was also done to assess career achievements. Only one rank was assigned to each graduate. For example, if a graduate was both chair and professor, then only the higher rank (chair) was assigned. There was no pronounced difference between the number of men and women at the assistant and associate professor levels (Fig. 6B). However, there were pronounced differences at professor, chief/chair, program director, and medical director positions. The results mirror the AAMC's data3 in that women have equal representation to men at the assistant and associate professor levels, but not at the professor, chief/chairman, medical director, or program director levels.

The RMSTP accepts pre-applicants on a competitive basis into the workshop and training program. Successful completion of the program includes funding via a K12 mechanism and continued participation in training workshops and mentorship. From 2006–2016, the RMSTP included 53 men pre-applicants (46%) and 62 women pre-applicants (54%). The total number of pre-applicants accepted into the RMSTP from 2013–2016 (the years for which member gender data were available) was 49, with 25 men and 24 women. The percentage of women pre-applicants accepted into the program exceeded the percentage of women physiatrist members of the AAP during all years examined (Fig. 6C). In addition, the percentage of women pre-applicants also exceeded or matched the percentage of women members in the early career or in-training categories.

Of the 27 RMSTP graduates for the years analyzed, 11 (41%) were women, demonstrating more than equitable representation of women members in this important career development program. These findings are comparable with a previous report examining the characteristics of scholars from 48 institutions receiving K12 training awards from 2006–2013, demonstrating representation of women scholars at 53%.4 Again, the current ranks held by men and women were fairly equal at the assistant professor level. However, in all higher ranks, men tended to dominate, even within this small sample (Fig. 6D).4

American Journal of Physical Medicine and Rehabilitation Editors

The AJPM&R is the official journal of the AAP and is published by Wolters Kluwer. The gender distribution among AJPM&R editorial board members from 2005–2017 was analyzed. Included in the analysis were the editors-in-chief, all associate editors, and all editorial board members. Excluded were an emeritus editor, executive editors, managing editors, and special section editors because historical data on these categories were not available. Most of the editors were physiatrists from the United States. There were nonphysician (PhD) members, as well as international nonphysiatrist and physiatrists members.

The AJPM&R editors have been predominantly men physiatrists for the 13-yr study period. In 2005, there were 41 editors. Of these, 35 (85%) were men and 6 (15%) were women. Both the number of editorial positions as well as the representation of women editors increased for the 13-yr study period, and in 2017, there were 51 editors of which 39 (76%) were men and 12 (24%) were women. The US physiatrist editors consisted of 27 (87%) men and 4 (13%) women in 2005 increasing to 28 (72%) men and 11 (28%) women in 2017 (Fig. 7).

FIGURE 7
FIGURE 7:
Gender distribution among US physiatrist editors of the AJPM&R.

In American academia, women PM&R faculty members in medical schools reached the 30% mark in 1992,5 and by 2014, 41% of full-time physician PM&R faculty were women (n = 372).2 However, women physician PM&R faculty made up 23% of full professors.2 Therefore, although there was an increasing trend in the representation of women in all three groups of AJPM&R editors (all editors, US editors, and US physiatrist editors) from 2005 to 2017 that was faster than that reported by the AAMC for PM&R faculty from 1992 to 2014, the percentage of women editors did not reach the representation of women among the AAP general membership, or in the field in general or in academic full-time physician PM&R faculty as reported by the AAMC.

LIMITATIONS

Although attempts were made to clarify any discrepancies, the task force members were not able to account for errors in the reporting of the data. Employment factors such as full-time versus part-time and practice setting, each of which may impact an individual physician's career growth and participation in the AAP, were not evaluated. Notably, data sets were often small. Data were generally not available to explain causality.

DISCUSSION

In a recent report from the AAMC that highlighted increased faculty diversity with persistent gaps, the authors provided a call to action for medical schools to move “diversity from the periphery to the core of institutional excellence.”6 Professional societies have an opportunity to do this as well and partner with medical schools and academic medical centers.

Physiatrist Membership

While it is important for the AAP to support all members, membership data highlight that two groups are growing more than others: women physiatrists and all physiatrists in-training. Given the growth of these two particular groups, it is worthwhile for the AAP to consider how to enhance support for these members and encourage retention as well as further growth. Strategies to encourage the recruitment and retention of women physicians in medical societies have not been well described in the literature. However, retention of members-in-training, regardless of gender, as these individuals transition to early career positions, is a well-described problem.5

Specific recommendations to consider include:

  • Survey several different stakeholder groups for input regarding addressing gaps and fostering career advancement for AAP members. Groups may include AAP members who are women physiatrists, early career physiatrists, chairs of PM&R departments, and residency/fellowship program directors. Surveys may also include nonmembers to better understand why they are not members and how the AAP may be able to enhance services to encourage their membership.
  • Foster a commitment to accountability through transparency and action consistent with the peer-reviewed literature. Leaders in physiatry, cardiology, surgery, and neurology suggested a six-step action plan that the AAP is in the process of implementing (examine gender diversity and inclusion data; transparently report the results; investigate potential causes of underrepresentation; implement strategies to improve inclusion; track outcomes; and, publish the results).7
  • To foster transparency, publish diversity data and ongoing efforts towards inclusion8 as internal committee reports and external reports that can be shared with stakeholders, including but not limited to, AAP members.

Board of Trustees Membership

While there is a paucity of literature on representation of women in professional society Board positions, especially with regard to voting versus nonvoting positions, the literature has shown that men occupy more than 80% of “top” positions on professional Boards.9 The AAP data for 2017 showed a similar outlook. Despite overall equity with respect to women physiatrists' representation on the Board, men occupied 75% of voting physiatrist positions on the Board of Trustees and 80% of all AAP presidential positions in the recent past.

Specific recommendations to consider include:

  • Develop an active plan to ensure women have an equitable representation on the Board and include an analysis of gaps.10
  • Actively solicit/recruit women to the Board to close any gaps.10
  • Attempt to close the gap (ensure an equitable representation) and re-evaluate numbers on a regular basis to determine success.10,11
  • When considering changes to the bylaws, examine how the proposed changes may affect diversity and inclusion at various organizational levels.

Committee Membership

While all of the 2017 AAP physiatrist committee chairs were men, previous years showed a more equitable distribution among men and women. This leadership trend is especially important because a study by Lincoln et al.12 linked the influences of implicit bias and committee chair gender and the prevalence of men receiving a higher proportion of awards for scholarly research. The AAP should look to other industries such as business,13,14 sports,15 and education16 for recommendations to improve gender balance and decrease gender bias.

Specific recommendations to consider include:

  • Ensure policies for committee selection address gender bias by encouraging inclusion.17
  • Ensure transparency by assessing and disclosing gender balance on all committees.15
  • Assign a diversity advocate to educate committee members and encourage proactive changes that support gender equity.16

Resident Fellow Council

There is a strong need to train and support future women physiatry leaders, and the Resident Fellow Council provides a unique opportunity for early career physiatrists. Ideally, the composition should proportionally reflect the percentage of women physiatrist residents and fellows in the AAP. Although this Council operates independently and the data set was small, it is worthwhile investigating potential reasons for the noted disparity, including whether concepts such as implicit bias (unconscious bias) and stereotype threat (underperformance of negatively stereotyped members in group situations)18 influenced how the fellows approached their election process.

Specific recommendations to consider include:

  • Seek to better understand the nomination and election processes of the Resident Fellow Council in an effort to help future leaders develop diversity and inclusion as core leadership competencies as well as to ensure that the nomination and election process is equitably and fairly conducted.
  • Provide formal training for all early career physiatrist members, but particularly for members of the Resident Fellow Council, in implicit bias, cultural competency, diversity and inclusion and stereotype threat.18

Annual Meeting Session Proposals, Faculty, and Plenary Speakers

Recent years have seen improvements in the gender distribution of faculty delivering annual meeting content. Some of this improvement may be attributed to the more open and natural process for submission selection instituted in 2015. This process solicited submissions from the entire membership and ranked submissions based on academic merit. However, the most striking imbalance in the annual meeting data is the underrepresentation of women physiatrists invited as plenary speakers. Unfortunately, this is a common occurrence for academic conferences.19–21 Because physiatrists-in-training comprise nearly half of the AAP annual meeting attendees, there is potential for those in prominent speaking positions to serve as role models to these future physiatrists. Thus, the choice of prominent speakers delivers an unspoken statement of how the AAP views the future of physiatry.

Specific recommendations to consider include:

  1. The program planning committee may establish an inclusive policy for plenary speakers19,22 with specific attention to physiatrists.
  2. Collect and track data on women physiatrists in speaking roles at the annual and other meetings.21,23
  3. As additional regional meetings are added to the calendar, consider tracking and intermittently reviewing data from those as well.
  4. Create a family friendly environment that supports all speakers.23
  5. Continue programs aimed at obtaining high quality academic content which represents the AAP membership.
  6. Closely examine any future changes (planned/unplanned) to the methodology of meeting programming for the potential to create an unbalanced representation.

Recognition Awards

Awards given by professional societies are one important mechanism for recognizing the accomplishments and talents valued in academic medicine. They not only are a major indication of professional achievement and prestige but also have a compounded effect on the career of the recipient.24 The underrepresentation of women physicians as recognition award recipients is known to be an issue in the field of PM&R25,26 as well as other specialties including dermatology, neurology, anesthesiology, orthopedic surgery, head and neck surgery, and plastic surgery.7 The complete absence of women among nominees may deserve particular scrutiny and support that the underrepresentation of women may lie on the nomination process that conventionally relies on physiatrists, particularly those in leadership positions. For the early career/trainee awards, nomination did not seem to be a large barrier for women as more than 40% of the nominees were women. Nevertheless, no women received the awards. This suggests that there may be a barrier at the level of the selection process.

Although it is plausible that the men who were nominated and received the awards were more deserving, it is also important to consider implicit bias in the selection process. For example, selection committees that are exclusively or predominantly men have been postulated as one reason for the underrepresentation of women recipients,12 and at least in one study focused on physicians, the gender proportion of the juries reflected the gender proportion of the doctors who were recipients.27 Other proposed reasons for barriers to women receiving awards at the level of the selection committee include a lack of women chairs, nomination letters that use stereotypical gender language that may unintentionally marginalize women's reputations (e.g., cooperative and dependable) and enhance men's reputations (e.g., decisive and confident), are shorter, and/or contain fewer descriptions of accomplishments. Multiple organizations focusing on disparities in women receiving awards have suggested reviewing and potentially revising the criteria to be consistent with the modern-day physician workforce, assessing the language for implicit bias and making it gender-neutral, establishing selection criteria before reviewing the nominees, and educating committee members about the impact of implicit bias.28

Specific recommendations to consider include:

  • Educate all members of the LDRC on the evidence-base and best practices regarding gender and evaluation.29
  • Ensure the LDRC has women physiatrists as members, including possibly a chair position.12
  • Examine and, if appropriate, revise each award's criteria to ensure that it is up to date and equitably supports the membership.24
  • Examine and, if appropriate, revise the language regarding each award's description so that it is devoid of known issues with implicit bias.24
  • Examine and determine if the current nomination process is effective, particularly for the more senior and prestigious awards in which no women physicians were nominated.30
  • Examine the selection committee and process for implicit bias, particularly for the early career awards in which many women have been nominated but none were selected. This includes increased awareness regarding the length and language of nomination letters for women that may have been influenced by nominators' own potential implicit bias.29
  • Transparently report the results to members and other stakeholders including medical schools and medical centers.26
  • Charge the AAP Women's Task Force, if it continues to exist, with submitting the names of qualified women to the nomination committee for each award category every year.30

The PAL and RMSTP

A recent report focused on changing the culture in academic medicine applied a theory called “critical mass” to gender equity in academic health centers, predicting that once the proportion of faculty who are women rises above a threshold of 30–35%, their impact on culture change will be evident.31 This report noted that women physicians achieved critical mass of 30% by 2006, without any significant increase in top leadership roles when compared with 1975 when women made up less than 10% of the physician workforce. The authors suggested that a better way to see evidence of change was to focus on “critical actor” leaders (those who initiate cultural transformation and sponsor others to advance gender equity, even when women form a small minority). Other reports have shown that women lag behind men in access to quality mentorship and effective networks.32,33

Specific recommendations to consider include:

  • PAL and RMSTP should focus on developing “critical actor” leaders.34
  • PAL and RMSTP should analyze how prior graduates have been able to develop and maintain effective mentoring and network and use this data as a guide to enhance quality mentorship and effective networks for future graduates, particularly women physiatrists.33,34
  • AAP should consider developing and enhancing later career mentorship programs to facilitate career advancement and promotion, as the benefits of current programs appeared to drop off at higher academic ranks. Such programs should highlight the importance of pursuing academic promotion35 and potential benefit of considering geographically diverse mentorship and career opportunities.36

The AJPM&R Editors

The findings in this report were consistent with previous studies demonstrating that women physiatrists report fewer leadership roles as journal reviewers and editors than male counterparts.37 Moreover, PM&R was previously found to be one of six specialties that had a statistically significant difference between the percentage of women on society and journal editorial boards and the total percentage of women physicians in the specialty (20.4% vs. 34.0%, P < 0.03).9

Previous studies on gender-related issues in academia and professional societies have identified several important factors that could explain this underrepresentation of women. For example, women physiatrists may be underrepresented in the academic ranks usually associated with membership on editorial boards.9 Further, a decline in women pursuing research careers may contribute to their absence in editorial boards.9 Morton and Sonnad9 have suggested that “women are more likely than men to choose clinical academic careers rather than highly competitive research and teaching positions, which are much more likely to lead to higher professional prestige and subsequent positions on journal editorial boards.”

Specific recommendations to consider include:

  • Evaluate the process for identifying the pool of qualified candidates in an effort to enhance representation of women physiatrists serving in an editorial capacity.9
  • Analyze the recent history of invited contributions to the journal and assess for gaps in the representation of women physiatrists as invited first or senior author contributors.
  • Consider a special supplement to the journal on diversity and inclusion to educate the physiatry workforce on the current evidence base and best practices.38

CONCLUSIONS

The AAP data showed that more than 40% of the membership are women physicians and the number of women among members is growing at a faster pace compared with men in recent years. Retaining and supporting this population are critically linked to achieving the mission of the organization, creating the future of academic physiatry through mentorship, leadership, and discovery.

Because pay and promotion gaps are well documented for women and other underrepresented minority physicians, perhaps the greatest value of medical societies in the future will be their contribution to closing these gaps. The academic curriculum vitae is a formulaic document that is crucial for career advancement and this provides an opportunity for societies to partner with medical schools and academic medical centers.7 The AAP-owned or -controlled resources that populate an academic CV and may support faculty promotion and/or compensation, should be given high priority among efforts to address gaps and enhance equitable representation among AAP physiatrist members (e.g., AJPM&R editorial board positions and invited perspectives/reviews, committee assignments and chair positions, invited annual conference speaking opportunities, and recognition awards).

This report highlights areas in which the AAP has been successful in supporting gender equity and other areas in which women physiatrists have been underrepresented. The task force worked with the Board of Trustees to construct an action plan, asking the respective committees to address areas of underrepresentation. A volunteer from each committee was deemed a “diversity steward,” and going forward will work directly with the task force as a liaison to document an action plan and collect data. The board plans to transparently report progress to members and other stakeholders, and the task force aims to publish a follow-up report within the next 5 years. The Board is also looking at opportunities to assess the inclusion of members from other underrepresented groups.

ACKNOWLEDGMENT

The authors thank Julie A. Poorman, PhD, for her assistance with manuscript preparation.

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Keywords:

Physicians, Women; Leadership; Societies; Education, Medical

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