Association of Academic Physiatrists Women’s Task Force Follow-up Report : American Journal of Physical Medicine & Rehabilitation

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Analysis & Perspective

Association of Academic Physiatrists Women’s Task Force Follow-up Report

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

Author Information
American Journal of Physical Medicine & Rehabilitation 100(6):p 610-619, June 2021. | DOI: 10.1097/PHM.0000000000001670

Abstract

Gender disparities for women in academic medicine are well documented,1–8 and there are numerous studies that have focused on the specialty of physical medicine and rehabilitation (PM&R).9–14 Thus, in 2016, the Association of Academic Physiatrists (AAP), the sole professional society, focused on academic physiatry organized a presidential task force to identify priority areas, needs, existing resources, opportunities, barriers, and other issues related to advancing female physicians in the field and achieving the goal of gender equity in physiatry. The members included a group of 12 academic physiatrists with diversity in gender, race/ethnicity, career stage, geographic region, institution, and subspecialty focus. The task force also received support from AAP staff members. Meetings were held on a regular basis from 2016 to 2020, and throughout, the task force followed a six-step process that has been previously described in the literature.14 The steps included the following: (1) examining data; (2) transparently reporting results to stakeholders; (3) investigating causality; (4) implementing strategic interventions; (5) tracking outcomes and adjusting strategies; and (6) publishing and disseminating results.

In 2018, the task force published an initial report that focused on a retrospective analysis of AAP staff-supplied society data from 2008 to 2017 in relevant categories such as leadership positions (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), and recognition awards (i.e., recognition award nominations and recipients).9 The findings highlighted areas in which the AAP had been successful in supporting gender equity as well as areas in which female physiatrists were underrepresented. These data provided a base from which to strategically focus on closing gaps in representation where they existed. Thereafter, the task force developed an action plan, approved by the AAP’s Board of Trustees on November 2, 2017, which included strategies aimed at closing gender equity gaps and collecting data to determine effectiveness. The Board of Trustees, in making a commitment to transparency and reporting to members and stakeholders, requested the task force to generate an approximately 3-yr follow-up report including data acquired after the original report was published.

METHODS

In this approximate 3-yr update to an original report analyzing society metrics for 2008 through 2017, the focus again was the representation of female versus male physiatrists. Nonphysiatrists were generally excluded (unless noted). Like the initial report, this study did not involve work with human subjects and did not require institutional review board approval. This study conforms to all Consolidated Standards of Reporting Trials (CONSORT) guidelines and reports the required information accordingly (see Supplemental Checklist, Supplemental Digital Content 1, https://links.lww.com/PHM/B193).

To facilitate the update of society metrics for 2008 through 2019 or 2020 depending on the category, the task force convened in-person meetings annually at the AAP 2017 through 2020 conferences and participated in regularly scheduled conference calls. The task force members, having agreed on a list of metrics in the original report,9 used the same categories to prospectively collect an additional approximately 3 yrs of data for this follow-up report. The previously mentioned six-step process was used,14 and the task force created a list of goals and recommendations that was shared with key stakeholders. Categories examined are listed in Table 1.

TABLE 1 - Summary of changes in AAP gender equity–related metrics between original and follow-up Association of Academic Physiatrists Women’s Task Force reports
Category Original Report Outcomes 2019 Follow-up Report Outcomes (Change From Original Report, %) 2020 Follow-up Report Outcomes (Change From Original Report, %)
General membership
 Female physiatrists 2017: 40.8% 40.7% (−0.1%) NA
President a
 Presidential years since 2008 2017: 10 12 13
 Female presidential years since 2008 2017: 20.0% 16.7% (−3.3%) 15.4% (−4.6%)
 Equity indicator 2017: −20.8 −24.0% (−3.8%) NA
Board of Trustees
 Board physiatrist members 2017: 16 17 (+6.25%) 17 (+6.25%)
 Female physiatrists 2017: 37.5% 47.1% (+9.6%) 47.1% (+9.6%)
 Equity indicator 2017: −3.3% +6.4% (+9.7%) NA
Voting Board of Trustees
 Voting physiatrist members 2017: 12 12 (no change) 12 (no change)
 Female physiatrists 2017: 25.0% 41.7% (+16.7%) 50% (+25.0%)
 Equity indicator 2017: −15.8% +1.0% (+16.8%) NA
Committee membership
 Committee physiatrist members 2017: 96 100 (+4.2%) 103 (+7.3%)
 Female physiatrists 2017: 44.8% 44.0% (−0.8%) 45.6% (+0.8%)
 Equity indicator 2017: +4.0% 2019: +3.3% (−0.7%) NA
Committee chairs
 Committees 2017: 7 7 (no change) 7 (no change)
 Female physiatrists 2017: 0% 2.9% (+42.9%) 42.9% (+42.9%)
 Equity indicator 2017: −40.8% +2.2% (+43%) NA
Resident Fellow Council chair
 Chairs since 2008 2017: 10 12 (+20%) 13 (+30%)
 Female chairs since 2008 2017: 20% 25% (+5%) 31% (+11%)
 Equity indicator 2017: −20.8% −15.7% (+5.1%) NA
Annual meeting session proposals
 Session proposals 2017: 82 171 (+108.5%) 343 (+318.3%)
 Female lead faculty 2017: 40.2% 40.4% (+0.2%) 39.1% (−1.1%)
 Equity indicator 2017: −0.6% −0.3% (+0.3%) NA
Annual meeting presenters
 Physiatrist presenters 2017: 100 159 (+59.0%) 324 (+224.0%)
 Female physiatrist presenters 2017: 44.0% 43.4% (−0.6%) 39.8% (−4.2%)
 Equity indicator 2017: +3.2% +2.7% (−0.5%) NA
Annual meeting plenary speakers
 Physiatrist faculty 2017: 2 1 (−50%) 5 (+150%)
 Female physiatrist faculty 2017: 50% 0% (−50%) 60% (+10%)
 Equity indicator 2017: +9.2% −40.7% (−49.9%) NA
Recognition award recipients since 2008
 Physiatrist recipients 2017: 55 72 (+30.9%) 82 (+49.1%)
 Female physiatrist recipients 2017: 23.6% 31.9% (+8.3%) 32.9% (+9.3%)
 Equity indicator 2017: −17.2% −8.8% (+8.4%) NA
Recognition award nominations since 2014
 Nominees 2017: 63 125 (+98.4%) 160 (+154.0%)
 Female nominees 2017: 28.6% 36.8% (+8.2%) 36.3% (+7.7%)
 Equity indicator 2017: −12.2% −3.9% (+8.3%) NA
 Difference between women’s and men’s likelihood of success in receiving an award 2017: −41.1% −11.5% (+29.6%) −6.5% (+34.6%)
PAL candidates
 Physiatrist candidates/year 2017: 6 10 (+66.7%) 10 (+66.7%)
 Female physiatrist candidates 2017: 50.0% 40.0% (−10.0%) 40.0% (−10.0%)
 Equity indicator 2017: +9.2 −0.7% (−9.9%) NA
PAL graduates since 1999
 Graduates 2016: 98 108 (+10%) NA
 Female graduates 2016: 35% 34% (−1%) NA
 Equity indicator 2016: −5.8% −6.7% (−0.9%) NA
RMSTP preapplicants
 Physiatrist preapplicants/year 2017: 9 20 (+122.2%) 8 (−11.1%)
 Female physiatrist preapplicants 2017: 44.4% 55.0% (+10.6%) 25.0% (−19.4%)
 Equity indicator 2017: +3.6% +14.3 (+10.7%) NA
RMSTP Graduates since 2006
 Graduates 2016: 27 38 (+41%) NA
 Female graduates 2016: 41% 37% (−4%) NA
 Equity indicator 2016: +0.2% −3.7% (−3.9%) NA
AJPM&R editors
 US physiatrist editors 2017: 39 48 (+23.1%) 47 (+20.5%)
 Female physiatrist editors 2017: 28.2% 37.5% (+9.3%) 37.5% (+9.3%)
 Equity indicator 2017: −12.6% 2019: −3.2% (+9.4%) NA
Because the original and follow-up task force reports were written mid-year, not all data for each category were available for 2017 and 2020. For data related to the original report, data are labeled with the applicable year (2016 or 2017). For data related to the follow-up report, 2020 data that were unavailable at the time of writing are marked as not available (NA). For each category, the equity indicator represents the difference between the percentage of women in the respective data category and the percentage of women among AAP physiatrist members. Because complete membership data were NA for 2020 at the time of writing, 2020 equity indicators are marked NA. Negative numbers reflect less than equitable representation of women in a category (i.e., percentages of women in the category that are lower than percentages of women among physiatrist members), with the value of the equity indicator reflecting the magnitude of the underrepresentation of women in the category. Positive numbers reflect better than equitable representation of women (i.e., percentages of women in the category that are higher than percentages of women among physiatrist members).
aPresidential leadership was predetermined for the follow-up study period. In contrast to other study categories, there was no opportunity to make changes either positive or negative to equity in the representation of women.

From the initial Women’s Task Force publication in 2018, key targeted areas were identified as areas that could be improved upon, and an initial action plan was formulated to address these findings. Each of the key targeted areas was specific to an AAP committee that was responsible for the oversight. For example, recognition awards fell under oversight of the Leadership Development and Recognition Committee. A Diversity Data Steward (DDS) was chosen from each of the committees. The Women’s Task Force worked with the DDSs collaboratively to develop and execute an action plan specific for their targeted area.

The DDSs were asked to educate their AAP committee members on the metrics and results and investigate possible causality (e.g., whether lack of nominations was one factor why women were underrepresented in the recognition award category). Each committee was challenged with the development and implementation of a specific action plan that was to be directed at the gaps that were identified in the data presented (e.g., include more female faculty presenters at the annual AAP meetings). The task force met with the DDSs at the national meeting annually and during the year via phone conference for the duration of the data collection. Updated data were shared with the DDSs. All members of the Leadership Development and Recognition Committee, a committee that has considerable influence over some of the key metrics, also participated in mandatory implicit bias training.

The AAP staff provided the task force members with medical society data that were used in both this and the original report. During each year for which subsets of membership data were available (2013–2019), 0–20 (average [SD] = 11 [6.7]) physiatrist members were reported as unknown gender; accounting for 0%–1.4% (average [SD] = 0.9% [0.5%]) 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. In this report, the term “all physiatrists” refers to the sum of physiatrists and physiatrists-in-training.

RESULTS

To facilitate comparison, findings for each of the examined categories are presented in Table 1 alongside data from the original report.

Physiatrist Membership

Key Point

Compared with the original report, membership in the AAP increased by 11%, but the proportion of female physiatrists remained stable at 41%, consistent with the representation of female physicians in academic PM&R nationally.

Physiatrist membership in the AAP before and after the follow-up study period is summarized in Tables 1 and 2 and Figure 1. Overall, the number of physiatrist members (Table 2) increased by 157 individuals (10.9%) between 2017 and 2019. The proportion of female physiatrists (Table 1) remained consistent at approximately 41%.

TABLE 2 - Physiatrist members in the AAP, 2017–2019
Category 2017, n 2018, n 2019, n Change 2017–2019, %
General membership
 Physiatrists—all 1438 1464 1595 10.9
 Physiatrists—in training 663 672 814 22.8
 Physiatrists—completed training 768 789 781 1.7
Female physiatrist membership
 Physiatrists—all 579 590 649 12.1
 Physiatrists—in training 282 287 328 16.3
 Physiatrists—completed training 297 303 321 8.1
Male physiatrist membership
 Physiatrists—all 839 867 946 12.8
 Physiatrists—in training 374 383 486 29.9
 Physiatrists—completed training 465 484 460 −1.1
Female physiatrist proportional membership
 Physiatrists—all 40.8% 40.5% 40.7% −0.1
 Physiatrists—in training 43.0% 42.8% 40.3% −2.7
 Physiatrists—completed training 39.0% 38.5% 41.1% 2.1

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FIGURE 1:
Trends in AAP member gender, 2013–2019.

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 that the percentage of active female PM&R physicians in 2017 was 35.3% (n = 3284 of 9316)15 and the percentage of female physicians in academic PM&R departments in 2018 was 41.9% (n = 487 of 1162).16 Thus, the gender membership of the AAP is very similar to the percentages of male and female physicians in academic PM&R.

Board of Trustees Membership

Key Point

Compared with the original report, there was an increase in the percentage of female physiatrists overall and among the voting members of the AAP Board of Trustees, with female physiatrists equitably represented when compared with their percentages among the general membership.

There was an improvement in the representation of female members on the AAP Board of Trustees and Voting Board of Trustees. Board members who were not physiatrists were excluded from these data. From the original report, between 2008 and 2017, the percentage of women among the physiatrist members of the Board of Trustees ranged from 18% to 38%. Follow-up analysis revealed overall progress as demonstrated in Table 1 and Figure 2. Importantly, a key marker of equitable inclusion is voting membership, and the representation of female voting members doubled from 25% in 2017 to 50% in 2020.

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FIGURE 2:
Distribution of female physiatrists among Board of Trustees, Voting Board of Trustees, and general AAP physiatrist members, 2013–2020.

Presidential Leadership

Key Point

Compared with the original report, there was a decrease in the percentage of female physiatrist—years as president because the succession order was set, and male physiatrists were slated for president during the follow-up study period. However, between 2021 and 2025, 2 women are slated to be president.

The AAP has 2-yr presidential terms, and from 2008 to 2020, a woman was president for 2 yrs (15.4%, a decrease from the original study at 20%; Table 1). However, at the time of the original report, the presidential succession plan was already set for the follow-up study period, and therefore, there was no opportunity to make changes either positive or negative. Notably, between 2021 and 2025, 2 women will serve in successive terms as president.

Committee Membership

Key Point

Compared with the original report, there was progress in closing the gender gap among committee members and chairs; women were equitably included as committee members from 2017 to 2020 and as committee chairs from 2019 to 2020.

There were seven committees within the AAP. These included the following: education, governance, leadership development and recognition, membership, program, public policy, and research. Until 2017, the representation of female physiatrists on committees lagged the overall percentage of female physiatrists in the AAP. Notably, in 2017, there were seven male and no female physiatrists serving as committee chairs. From 2018 to 2020, female physiatrists became equitably represented as committee members and chairs at approximately 45% (Table 1; Fig. 3A). In 2018, because one woman was included as a committee chair, the proportion increased from 0% to 14%. In 2019 and 2020, there were three female and four male chairs, so female physiatrists were equitably represented at 42.9% (Table 1; Fig. 3B).

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FIGURE 3:
Physiatrist committee members (A) and chairs (B) by gender, 2014–2020.

Resident Fellow Council Chair

Key Point

Compared with the original report, there was progress in closing the gap regarding the representation of female physiatrists-in-training among chairs of the AAP’s Resident Fellow Council.

The Resident Fellow Council leadership process begins with an application from a resident or fellow, which is reviewed by the Leadership Development and Recognition Committee. If there are more than three applicants, they are ranked by the Leadership Development and Recognition Committee, 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. During the original study period (2008–2017), the proportion of women in-training physiatrists among council chairs was 20%. The follow-up 2018–2020 study period included one male and two female chairs (n = 2 of 3, 66.7%). This increased the proportion of female Resident Fellow Council chairs from 20% to 33.3% (n = 4 of 12) over the entire study period (2008–2020). For comparison, women comprised approximately 40% of AAP’s physiatrists-in-training in 2019 (Table 1) and 39.6% of Accreditation Council for Graduate Medical Education residents and fellows in PM&R in 2017.17

Annual Meeting Session Proposals, Faculty, and Plenary Speakers

Key Point

Compared with the original report, there was progress in maintaining the equitable inclusion of female faculty in the sessions presented at the AAP annual meeting overall. Female physiatrist plenary speakers were not included in the AAP’s 2018 or 2019 stand-alone annual meetings. However, the 2020 combined AAP/International Society of Physical and Rehabilitation Medicine (ISPRM) meeting included 60% (n = 3 of 5) female physiatrist plenary speakers.

There was an upward trend in female physiatrists presenting at the annual meeting before the work of this task force, and the trend was further supported by members’ general awareness of the task force’s efforts (e.g., the original published report) and the diversity steward’s work with the program committee and the Women’s Task Force. For example, 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. Regarding session submissions, 29% were submitted by women in 2015. Representation markedly improved the following 2 yrs, 2016 and 2017, and women comprised 47% and 40%, respectively, of lead faculty on submissions. The percentage of female physiatrists presenting at the annual meeting increased from 21% in 2010 to 44% in 2017. In 2018 and 2019, slightly more than 40% of submissions were led by women, and female physiatrists comprised approximately 44% of presenters. In 2020, the AAP held a combined meeting with the ISPRM, and the number of presenters approximately doubled with women comprising 39.8% (n = 129 of 324; Fig. 4A).

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FIGURE 4:
Gender distribution among annual meeting physiatrist faculty (A) and physiatrist plenary speakers (B). In 2020, the number of faculty and plenary speakers increased when the AAP and the ISPRM hosted a combined meeting.

In the original report, female physiatrists were represented at low levels as plenary speakers at AAP annual meetings. Because no female physiatrists were selected as plenary speakers for the 2018 and 2019 meetings, this gap increased in this follow-up report. At stand-alone AAP meetings during 2010–2019 among plenary speakers who were physiatrists, 3 (21.4%) were women and 11 (78.6%) were men. In 2020, at the combined AAP/ISPRM meeting, women were included among physiatrist plenary speakers (n = 3 of 5, 60.0%) for the first time since 2017 (Fig. 4B). The AAP and ISPRM worked together to select plenary speakers, and there was a different format than the usual three plenary speakers allotted 1 hr each. At the AAP/ISPRM joint meeting, 11 plenary speakers were allotted 30 mins each. Notably, the AAP attempts to find nonphysiatrist experts on a broad range of topics for plenary speakers.

Recognition Award Recipients

Key Point

Compared with the original report, there was progress from 23.6% to 32.9% of the AAP recognition awards being received by women.

Between 2008 and 2017 (original report), a total of 55 recognition awards were given to physicians in 8 categories with 13 female recipients (23.6%). In the follow-up report (2008–2020), there were 82 awards and the proportion of female recipients increased to 32.9% (n = 27). During the 4 yrs leading up to our original report (2014–2017), there was 1 woman among 22 physician recipients (4.5%) across all categories. In contrast, during the follow-up study period (2018–2020), 14 women (53.8%) received awards. Although progress has been made, female physicians were underrepresented in all award categories except the two early career awards. Award categories in which female physicians continue to be underrepresented were as follows: Carolyn Braddom Ritzler Research (0%), American Journal of Physician Medicine & Rehabilitation (AJPM&R) Outstanding Reviewer (0%), Distinguished Member (14%), AJPM&R Excellence in Research Writing (33%), McLean Outstanding Resident/Fellow (22%), Outstanding Service (25%), Distinguished Academician (31%), and Innovation & Impact in Education (33%; Fig. 5A).

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FIGURE 5:
Gender distribution among physician recognition award recipients 2008–2020 (A), physician recognition award nominees and awardees 2015–2017 (B), and physician recognition award nominees and awardees 2018–2020 (C). For writing awards, all eligible authors are considered.

Corresponding nomination data were available for 2014–2020. In the original report of award and nomination data from 2014 to 2017, comparison of the likelihood of success (percentage of awardees/nominees) revealed that men (46.7%) were far more likely to win an award than women (5.6%). Moreover, a lack of nominations was identified as 1 causal factor. For example, no women were nominated for the Distinguished Academician and Outstanding Service Awards during the original study period. To determine the impact of recent efforts to increase the nomination of women since our original report, success analysis was performed on equal subsets of years during which nomination data were available (i.e., 2015–2017 vs. 2018–2020). During 2015–2017, even when women were nominated, their likelihood of success in winning awards was zero, as evidenced by the absence of female awardees in the Carolyn Braddom Ritzler Research, Early Career Young Academician, and McLean Outstanding Resident/Fellow categories (Fig. 5B). Concerted effort during 2018–2020 resulted in an approximately 10% increase in the nomination of women for awards (Fig. 5C). A woman’s likelihood of success in winning any award during these years increased to 35.0% and was higher than that of men (21.1%). Specifically, a woman’s likelihood of success increased from 15.4% to 50.0% for all awards except the Carolyn Braddom Ritzler Research award, which remained at 0%. During 2018–2020, men had greater likelihood of success than women in winning the Outstanding Service, Carolyn Braddom Ritzler Research, and Distinguished Academician Awards. In contrast, women had greater likelihood of success than men in winning the Innovation & Impact in Education, McLean Outstanding Resident/Fellow, and Early Career Young Academician Awards.

Program for Academic Leadership and Rehabilitation Medicine Scientist Training Program

Key Point (Program for Academic Leadership)

Compared with the original report, inclusion of women among Program for Academic Leadership (PAL) candidates decreased overall, although equity was maintained with both the general and early career member groups because women were previously overrepresented.

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. Early career members of the AAP who are between 2 and 8 yrs after training and are at or below the associate professor level are eligible to apply. Since 2007, PAL has accepted 54 men (59%) and 37 women (41%). Between 2013 and 2017, the percentage of women among PAL candidates ranged from 28% to 60% (Fig. 6A). There was a decline in the percentage of women in PAL in 2015 (33%) and 2016 (29%). Although this trend began reversing in 2017 (50%), it declined again thereafter, albeit not to the same degree (range = 38%–40%).

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FIGURE 6:
Representation of women among training program participants and graduates: PAL candidates (A), PAL graduates (B), RMSTP preapplicants (C), and RMSTP graduates (D).

Compared with the original report, the representation of women among PAL graduates since 1999 remained consistent, with women accounting for 35% (34 of 98) of PAL graduates through 2016 and 34% (37 of 108) of PAL graduates through 2019. Although graduates were tallied according to their highest combined (academic and administrative) rank in the original report, for this follow-up report, graduates were tallied separately according to their highest academic and highest administrative ranks (Fig. 6B). This change reflects that promotion along academic and administrative ladders may be independent but inhibits direct comparison with the original data. Academically, male and female PAL graduates were equally represented among assistant professors (men, 48%; women, 52%). However, female PAL graduates were represented at progressively lower levels than men as rank advanced to associate professor (men, 66%; women, 34%; difference, 32%) and full professor (men, 87%; women, 13%; difference, 74%). Administrative rank analysis revealed a similar pattern, with female PAL graduates represented at progressively lower levels than men as rank advanced from director (men, 59%; women, 41%; difference, 18%), to vice-chair (men, 75%; women, 25%; difference, 50%), and department chair or chief (men, 86%; women, 14%; difference, 72%).

The Rehabilitation Medicine Scientist Training Program (RMSTP) accepts preapplicants on a competitive basis. Successful completion of the program includes participation in training workshops and mentorship. From 2006 to 2016, the RMSTP included 53 male preapplicants (46%) and 62 female preapplicants (54%). As described in the original report, between 2013 and 2016 (the years for which comparable membership data were available), the percentage of female preapplicants accepted into the RMSTP exceeded the percentage of female physiatrist AAP members and exceeded or matched the percentage of female members in the early career or in-training AAP membership categories. In this follow-up report (2017–2019), the percentages of female RMSTP preapplicants (range = 44%–55%) continued to meet or exceed the proportion of female physiatrists in general, early career, and in-training AAP membership categories (Fig. 6C). Comparison of data from 2019 and 2020 revealed a considerable decrease in both the numbers of RMSTP preapplicants (n = 20 vs. n = 8, respectively) and in the percentage of women among RMSTP preapplicants (55% vs. 25%, respectively).

In the original report including data through 2016, women accounted for 41% (11 of 27) of RMSTP graduates. In this follow-up report, women accounted for 37% (14 of 38) of RMSTP graduates through 2019. Although graduates were tallied according to their highest combined (academic and administrative) rank at the time of the original report, for this follow-up report, graduates were tallied separately according to their current highest academic and highest administrative ranks (Fig. 6D). This change reflects that promotion along academic and administrative ladders may be independent but prevents direct comparison with the original data. Academically, the representation of women was lower than men at the ranks of assistant professor (difference, 18%) and associate professor (difference, 38%). However, equal numbers of men and women ranked as full professors (n = 3 each of 6, 50%). Administrative rank analysis revealed similar results, with the representation of women lower than that of men at the ranks of director (difference, 28%) and vice-chair (difference, 20%). However, there were more women than men ranked at the level of department chair or chief (n = 2 vs. 1, respectively) in 2019.

American Journal of Physician Medicine & Rehabilitation Editors

Key Point

Compared with the original report, there was progress in closing the gender gap for all female editors and US female physiatrist editors, with the percentages of women increasing from 24% to 33% and 28% to 38%, respectively.

The AJPM&R is the official journal of the AAP. The gender distribution of AJPM&R editorial board members from 2005 to 2020 was analyzed, including 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 although there were also US nonphysician (PhD), international physiatrist, and international nonphysiatrist editors. In the original report, both the number of editorial positions as well as the representation of female editors increased during the 13-yr study period (2005–2017). At the end of the original study period (2017), 24% of the national and international editors were women (n = 12 of 51). At the end of the follow-up study period (2019), this percentage increased to 37.5% (n = 18 of 48). Similarly, 28% of the US physiatrist editors were women in 2017, increasing to 38% (n = 18 of 47) in 2020 (Fig. 7).

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

DISCUSSION

Professional societies are critically important to the advancement and representation of academic faculty. Overall, this follow-up report demonstrates progress in the equitable representation of female physicians in the AAP when compared with the original report. Stability in the equitable inclusion of women between the original report and this follow-up report was found in the General Membership, Committee Membership, Annual Meeting Session Proposal, Annual Meeting Faculty, PAL candidate, and RMSTP preapplicant (through 2019) categories. Improvement in the representation of women between the original report and this follow-up report was found in the Board of Trustee Membership, Voting Board of Trustee Membership, Committee Chair, Resident Fellow Council Chair, aggregate Recognition Award Recipient and Nominee, and AJPM&R Editor categories. However, there were several categories in which women remain represented at much lower levels than their representation among the membership and in the field: Presidential Leadership (which is prospectively set to improve from 2021 through 2025), Resident Fellow Council Chair, Plenary Speaker at stand-alone (non–ISPMR-combined) Annual Meetings, seven of nine individual Recognition Award Recipient, PAL Graduate in higher rank academic and administrative position, RMSTP preapplicants (in 2020), and RMSTP graduate in intermediate rank academic and administrative position categories.

Regarding future efforts, the AAP has conveyed an ongoing commitment to diversity, equity, and inclusion for female physiatrists. The AAP is also focusing its efforts on people across the gender spectrum and who identify with racial/ethnic groups that are underrepresented in medicine. A commitment to supporting physiatrists with disabilities also remains strong. In alignment with these efforts, the AAP Board of Trustees created a new committee focused on diversity and inclusion. The AAP Board Action is a positive outcome related to the diversity work initiated by the Women’s Task Force started in 2016. It speaks to the AAP’s commitment to supporting the diversity of the AAP Membership.

LIMITATIONS

Although attempts were made to clarify any discrepancies, the task force members were not able to account for errors in 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. In addition, data were generally not available to explain causality.

CONCLUSIONS

More than 40% of the AAP members are female physicians. 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. This report demonstrates that in a relatively short period, 2–4 yrs, important gains were made in closing gender gaps at the AAP by using a data-driven approach with an action plan that included goal setting, diversity stewards, and implicit bias training. The AAP’s approach may serve as a model for other professional organizations addressing workforce equity issues.

ACKNOWLEDGMENTS

The authors thank the AAP Diversity Stewards for their support: Adam Stein, MD, Thiru Annaswamy, MD, Michael Saulino, MD, Miguel Escalon, MD, William Bockenek, MD, Gary Clark, MD, and John Whyte, MD, PhD. The authors also thank Julie A. Poorman, PhD, for her assistance with manuscript preparation.

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16. Association of American Medical Colleges: AAMC faculty roster: Table 14. U.S. medical school faculty by sex, degree, and department, 2018. Association of American Medical Colleges. Available at: https://www.aamc.org/system/files/2020-01/2018Table14.pdf. Accessed November 17, 2020
17. Association of American Medical Colleges: Table 2.2. Number and percentage of ACGME residents and fellows by sex and specialty, 2017. Association of American Medical Colleges. Available at: https://www.aamc.org/data-reports/workforce/interactive-data/acgme-residents-and-fellows-sex-and-specialty-2017. Accessed November 17, 2020
Keywords:

Physicians; Women; Leadership; Societies; Education; Medical; Female Physicians; Medical Education

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