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Gender Distribution of the American Board of Anesthesiology Diplomates, Examiners, and Directors (1985–2015)

Fahy, Brenda G. MD, MCCM*; Culley, Deborah J. MD; Sun, Huaping PhD; Dainer, Rupa MD§; Lutkoski, Benjamin P. MSIS; Lien, Cynthia A. MD

doi: 10.1213/ANE.0000000000003399
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To understand the potential role of women in leadership positions, data from the American Board of Anesthesiology (ABA) were analyzed to explore the impact of women in the specialty of anesthesiology. The number of newly certified ABA diplomates, oral examiners, and directors from 1985 to 2015 was obtained from the ABA database. The percentages of women in each group were calculated for each year. Because it took an average of 10 years for a diplomate to become an oral examiner and an average of 7 years for an oral examiner to be elected as a director during the study period, the following percentages were compared: women oral examiners versus newly certified women diplomates 10 years prior and women directors versus women oral examiners 7 years prior. The correlation coefficients between the percentages of women oral examiners and of newly certified women diplomates 10 years prior and between the percentages of women directors and women oral examiners 7 years prior were calculated. From 1985 to 2015, the percentage of newly certified women diplomates increased from 15% to 38% with an average annual increase of 0.74%, percentage of women oral examiners increased from 8% to 26% with an average annual increase of 0.63%, and percentage of women directors increased from 8% to 25% with an average annual increase of 0.56%. The percentage of women examiners consistently lagged behind the percentage of women diplomates who were certified 10 years earlier; the average difference over 21 years from 1995 to 2015 was −3.7% with a standard deviation of 2.1%. The correlation coefficient between the percentages of women examiners and newly certified women diplomates 10 years earlier from 1995 to 2015 was 0.86 (P < .001). However, the percentage of women directors was generally higher than that of women examiners 7 years earlier; the average difference over 24 years from 1992 to 2015 was 3.5% with a standard deviation of 4.0%. The correlation coefficient between the percentages of women directors and women examiners 7 years prior from 1992 to 2015 was 0.86 (P < .001). The percentage of newly certified women diplomates, examiners, and directors increased steadily from 1985 to 2015. The percentage of women examiners lagged behind that of women diplomates 10 years prior from 1995 to 2015; however, the percentage of women directors was, on average, higher than that of the women examiners 7 years prior from 1992 to 2015.

From the *Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts

The American Board of Anesthesiology, Raleigh, North Carolina

§Ambulatory Surgical Center, Pediatric Specialists of Virginia, Fairfax, Virginia

Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Published ahead of print April 19, 2018.

Accepted for publication March 15, 2018.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Brenda G. Fahy, MD, MCCM, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100254, Gainesville, FL 32610. Address e-mail to bfahy@anest.ufl.edu.

Currently, half of the graduates from US medical schools are women, yet men exceed women in the number of faculty positions in US medical schools by a 2:1 ratio, according to recent data from the Association of American Medical Colleges.1 Although the reasons why there are fewer women faculty is likely multifactorial, one of the issues commonly cited includes a lack of role models that are women in leadership positions.2–4

The American Board of Anesthesiology (ABA) was created in 1938 as the certifying body for physician anesthesiologists. The directors of the ABA work closely with the Accreditation Council for Graduate Medical Education (ACGME), to ensure that residency training standards are optimal, and the American Board of Medical Specialties, to ensure that the ABA diplomates meet the highest standards of our specialty. Accordingly, candidates for ABA certification must have satisfactorily completed an ACGME-accredited anesthesiology residency training program and successfully go through a rigorous certification process to earn the status of diplomate of the ABA. Being chosen from a larger pool of oral examiners, the directors represent a small number of practicing anesthesiologists who are recognized experts in the field to develop and administer in-training and certifying examinations and to create and enforce certification standards and other ABA policies. Being chosen as a director is widely considered to be a mark of a leader within the field of anesthesiology. The ABA thus is an organization that could provide role models for women desiring to further advance their careers.

Because all oral examiners and ABA directors are required to be certified by the ABA, these individuals are chosen from the diplomate pool. One would expect that the oral examiners and directors would reflect the diversity of the diplomate pool and that the number of oral examiners who were women would increase as the number of directors who were women increased. To identify the potential role of the ABA on the impact of women in the specialty, this study examined data from the ABA to determine whether there were changes in the proportion of women anesthesiologists in its diplomates, oral examiners, and directors from 1985 to 2015.

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METHODS

The numbers of women and men who were newly certified diplomates, oral examiners, and directors from 1985 to 2015 were obtained from the ABA database. The self-identified gender is 1 piece of demographic information that the ABA collects when the residency program submits a resident enrollment form for each newly enrolled resident and thus the physician is added to the ABA database.

To become an ABA diplomate is a prerequisite of becoming an ABA examiner, and to be an ABA examiner is a prerequisite of becoming an ABA director. An anesthesiologist must complete 48 months of satisfactory training in an ACGME-accredited residency program, pass both written and oral examinations, in its traditional primary certification system, to become certified in anesthesiology (ie, a diplomate of the ABA). Most often, candidates take the written examination the same year they complete residency, and if they pass the written examination, they take the oral examination the following year.

Diplomates who have been certified for at least 5 years can be nominated to become oral examiners. The ABA regularly monitors the oral examiner’s pool and periodically calls for nominations for oral examiners. The notice is posted at the ABA website and American Society of Anesthesiologists’ newsletter and is also sent to Program Directors and current oral examiners. The physicians can be self-nominated or nominated by another ABA diplomate. During the study period, eligible diplomates must have been certified for at least 5 years, have acceptable clinical activity, and actively participate in the Maintenance of Certification in Anesthesiology™ program to be eligible. Four ABA directors who serve on the Assessments Committee independently use a point system to evaluate the nominee’s qualifications mainly based on their curriculum vitae and references (at least 3) and collectively select the oral examiners based on combined points from the Committee members. The selected examiners commonly wait at least 1 year for an invitation to be trained and begin examining. In 2015, there were approximately 250 oral examiners. During the study period, it took an average of 10 years for newly certified diplomates to become oral examiners.

ABA director candidates are chosen from the oral examiner pool and elected to the position from the Certified Slate of Nominees as determined by the Joint Committee of the ABA–American Society of Anesthesiologists–American Medical Association (ie, Triple Committee). The Triple Committee selects 3 nominees for each vacancy when the incumbent director is not eligible for reelection and at most 2 nominees when the incumbent is eligible for reelection. Any member of the Triple Committee, including the Chair, may submit names of candidates to be considered as nominees for the ABA Board of Directors. The ABA Board of Directors then votes to elect directors from the Certified Slate of Nominees. Each term of a director is 4 years and 1 director can serve up to 3 terms for a maximum of 12 years. The ABA Board of Directors was always composed of 12 physician anesthesiologists; in 2011, a public member was added. The first woman director, Judith H. Donegan, MD, PhD, joined the Board in 1983. During the study period, it took an average of 7 years for an oral examiner to be elected as a director, with great variability in the time interval (range, 2–15 years).

The percentages of women ABA diplomates, examiners, and directors were calculated and plotted for each year of the study period. To assess the trend of the women percentage change over the study period, the average annual women percentage change was reported for diplomates, examiners, and directors. The interquartile range of the annual women percentage change was also reported for diplomates and oral examiners. This statistic was not reported for directors due to the small number of director members (ie, 12), and new directors typically are elected to the board when the incumbent directors have completed their 3 terms of service.

Because it took an average of 10 years for newly certified diplomates to become oral examiners during the study period, the percentages of women oral examiners were compared with those of new women diplomates 10 years prior. Similarly, since it took an average of 7 years for an oral examiner to be elected as a director, the percentages of women directors were compared with those of women examiners 7 years prior. The correlation coefficients between the percentages of women oral examiners and of newly certified women diplomates 10 years prior and between the percentages of women directors and women oral examiners 7 years prior were calculated.

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RESULTS

The percentage of women in all 3 ABA groups—newly certified diplomates, oral examiners, and directors—increased steadily over the study period. From 1985 to 2015, the percentage of newly certified women diplomates increased from 15% to 38%, percentage of women oral examiners increased from 8% to 26%, and percentage of women directors increased from 8% to 25% (Figure 1). Figure 1 shows that while there was a steady increase in the percentage of women examiners between 1991 and 2015, the greatest increase occurred between 2009 and 2015, the last 6 years of the study. From 1986 to 2015, the percentage of women diplomates increased an average of 0.74% annually, with interquartile range of 3.10% (2.19%− [−0.91%]); the percentage of women examiners increased an average of 0.63% annually, with interquartile range of 1.80% (1.47%− [−0.33%]); and the percentage of women directors increased an average of 0.56% annually.

Figure.

Figure.

The percentage of women examiners consistently lagged behind the percentage of women diplomates who were certified 10 years earlier, with −7.7% in 2013 as the maximum difference and +0.6% in 2015 as the minimum difference (Table 1). The average difference over 21 years from 1995 to 2015 was −3.7% with a standard deviation of 2.1%. The correlation coefficient between the percentages of women examiners and newly certified diplomates 10 years earlier from 1995 to 2015 was 0.86 (P < .001). As seen in Table 2, the percentage of women directors in general outpaced the percentage of women examiners 7 years earlier with +11.4% in 2010 as the maximum difference and

Table 1.

Table 1.

Table 2.

Table 2.

−0.1% in 1993 as the minimum difference. The average difference over 24 years from 1992 to 2015 was +3.5% with a standard deviation of 4.0%. The correlation coefficient between the percentages of women directors and examiners 7 years earlier from 1992 to 2015 was 0.86 (P < .001).

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DISCUSSION

In this study, the percentages of newly certified women diplomates, oral examiners, and board directors of the ABA were analyzed to evaluate whether the percentage of women oral examiners was representative of that in the diplomate pool, and whether the gender composition of the ABA Board of Directors was representative of that of the oral examiners from which directors are selected. Our findings demonstrate that the percentage of women who were diplomates, examiners, and directors increased from 1985 to 2015, that the percentage of women examiners of the ABA lagged behind that of the newly certified women diplomates 10 years prior, and that the percentage of women directors outpaced that of women examiners 7 years prior.

There are fewer women anesthesiologists than men. In addition, recent publications have highlighted gender disparities in academic medicine in both academic rank and institutional support.1,5 Compared to faculty who are men, medical school faculty who are women were 15% less likely to achieve the rank of full professor and often have received less institutional research support.1,5 Still, women have consistently been underrepresented in leadership role as department chairs. A 2006 Internet survey of academic anesthesiology chairs demonstrated that 92% were men, with a response rate of 55%.6 A later study in 2008 looking at changes in the department chair leadership found a small increase in the percentage of chairs who are women of academic departments from 1993 to 2006, with 10% of chairs being women in 1993 and 12.7% in 2006.7

Other anesthesiology leadership opportunities in which women remain underrepresented include professional society boards and journal editorial boards.8 Anesthesiology was identified as 1 of the 6 specialties that had significantly fewer women on boards compared to the total number of women in the specialty.8 In the top 5 journals ranked in the field of anesthesiology, no woman held the position of editor-in-chief.9 Morton and Sonnad8 opine that the presence of women on professional society boards and journal editorial boards serves as a marker of whether equity had been achieved by women physicians within that field. They also comment that to ensure women’s success, efforts should be made to increase the numbers of women on these boards so that they are representative of the gender composition of the specialty. Serving as a board member of a society or a journal represents recognition within one’s specialty. One of the many factors required for selection on a journal’s editorial board is an established academic career. Selection to serve as a society board member typically reflects similar career accomplishments. Service in either of these capacities provides professional contacts and future career opportunities.

A recent study10 evaluating the gender composition of each of the 24-member boards of the American Board of Medical Specialties, including the ABA, demonstrated that 12 had a board of directors with a gender composition representative of their specialties as determined by data obtained for practicing physicians and physicians in training from the Association of American Medical Colleges and the American Medical Association. The ABA was one of 7 specialty boards in this study that had a larger proportion of board directors who are women (30.8%) in 2016 than women physicians in practice (21.1%) in 2013.10 Another study specifically examining ABA examiners noted a significant increase in the number of women examiners over 20 years.7 In 1985, women represented 8% of examiners, and in 2007, they represented 18%. A greater percentage of women examiners (25%) were junior examiners, indicating that they had more recently been selected to participate in the examination process. This percentage is greater than that of women who are associate and full professors.

Skaggs et al11 found that women’s advancement was positively associated with the representation of women on boards of directors, particularly once that representation exceeded 15%. Other studies have reported that the social capital gained from networking with influential leaders, such as ABA directors, is important for career advancement.12,13 In addition to fulfilling their responsibilities in these roles, women in leadership positions frequently serve as mentors and role models for other women.14 As with other studies’ findings of disparities in gender distribution, the causes of the findings in this study are likely to be multifactorial—beginning with childhood and continuing through medical school, residency, and early career experiences. Women in medicine are less likely to have sought out and identified a sponsor; sponsorship is associated with more rapid advancement.15 In addition, mentoring activities vary. Even in academic departments, mentoring is not routine, varies significantly from one department to another, and is inconsistent in terms of its efficacy.16 While the finding in this study that the increase in the percentage of women directors generally outpaced that of women examiners 7 years prior is encouraging and indicates the ABA’s effort to achieve diversity of board members, the factors influencing the selection of examiners and the cohort from which the directors were selected remains to be determined. It has been shown that a critical mass of women holding leadership positions is required before its influence on women becomes apparent.12

Underrepresentation of women in leadership positions is common and, without purposeful action, will most likely persist.11 Although the ABA has been proactive in establishing a woman:man composition in its examiners reflective of practicing anesthesiologists, the percentage of women examiners only reached a level where positive gains were noted in 2015, the last year of the study period. The impact of these advances will require time to establish. In the interim, maintaining the gains that have been made will be of paramount importance.

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DISCLOSURES

Name: Brenda G. Fahy, MD, MCCM.

Contribution: This author helped design the study, manage and analyze the data, and draft the manuscript.

Conflicts of Interest: B. G. Fahy serves as a director for the American Board of Anesthesiology.

Name: Deborah J. Culley, MD.

Contribution: This author helped design the study, manage and analyze the data, and draft the manuscript.

Conflicts of Interest: D. J. Culley serves as a director for the American Board of Anesthesiology.

Name: Huaping Sun, PhD.

Contribution: This author helped design the study, manage and analyze the data, and draft the manuscript.

Conflicts of Interest: H. Sun is employed by the American Board of Anesthesiology.

Name: Rupa Dainer, MD.

Contribution: This author helped manage and analyze the data and draft the manuscript.

Conflicts of Interest: R. Dainer serves as a director for the American Board of Anesthesiology.

Name: Benjamin P. Lutkoski, MSIS.

Contribution: This author helped with management of the data.

Conflicts of Interest: B. P. Lutkoski is employed by the American Board of Anesthesiology.

Name: Cynthia A. Lien, MD.

Contribution: This author helped design the study, manage and analyze the data, and draft the manuscript.

Conflicts of Interest: C. A. Lien has served as a director for the American Board of Anesthesiology.

This manuscript was handled by: Jean-Francois Pittet, MD.

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REFERENCES

1. Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex differences in academic rank in US medical schools in 2014. JAMA. 2015;314:1149–1158.
2. Westring AF, Speck RM, Dupuis Sammel M, et al. Culture matters: the pivotal role of culture for women’s careers in academic medicine. Acad Med. 2014;89:658–663.
3. Wilkinson CJ, Linde HW. Status of women in academic anesthesiology. Anesthesiology. 1986;64:496–500.
4. Rose SH, Burkle CM, Elliott BA. Trends in gender distribution among anesthesiology residents: do they matter? Anesth Analg. 2006;103:1209–1212.
5. Sege R, Nykiel-Bub L, Selk S. Sex differences in institutional support for junior biomedical researchers. JAMA. 2015;314:1175–1177.
6. Mets B, Galford JA, Purichia HR. Leadership of United States academic anesthesiology programs 2006: chairperson characteristics and accomplishments. Anesth Analg. 2007;105:1338–1345.
7. Wong CA, Stock MC. The status of women in academic anesthesiology: a progress report. Anesth Analg. 2008;107:178–184.
8. Morton MJ, Sonnad SS. Women on professional society and journal editorial boards. J Natl Med Assoc. 2007;99:764–771.
9. Amrein K, Langmann A, Fahrleitner-Pammer A, Pieber TR, Zollner-Schwetz I. Women underrepresented on editorial boards of 60 major medical journals. Gend Med. 2011;8:378–387.
10. Walker LE, Sadosty AT, Colletti JE, Goyal DG, Sunga KL, Hayes SN. Gender distribution among American Board of Medical Specialties Boards of Directors. Mayo Clin Proc. 2016;91:1590–1593.
11. Skaggs S, Stainback K, Duncan P. Shaking things up or business as usual? The influence of female corporate executives and board of directors on women’s managerial representation. Soc Sci Res. 2012;41:936–948.
12. Eagly AH, Carli LL. Through the Labyrinth: The Truth About How Women Become Leaders. 2007:Boston, MA: Harvard Business School Press143–146.
13. Hewlett SA, Peraino K, Sherbin L, Sumberg K. The Sponsor Effect: Breaking Through the Last Glass Ceiling [HBR Research Report]. 2010.Brighton, MA: Harvard Business Review
14. Konrad AM, Kramer V, Erkut S. Critical mass: the impact of three or more women on corporate boards. Organ Dyn. 2008;37:145–164.
15. Catalyst. Sponsoring women to success. Available at: www.catalyst.org/system/files/sponsoring_women_to_success.pdf. Accessed July 6, 2017.
16. Ehrich LC, Hansford B, Tennent L. Formal mentoring programs in education and other professions: a review of the literature. Educ Admin Q. 2004;40:518–540.
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