A 1998 study projected that the number of women in the specialty of obstetrics and gynecology would exceed the number of men by 2014.1 By 2010, women constituted 45% of the specialty in practice.2 A 2012 study reported that over the past three decades, the female-to-male rate of new obstetrics and gynecology faculty members increased steadily to two to one.3
A 35-year review of authorship in six prominent medical journals found a significant increase in the percentage of articles authored by women as first and last authors in the United States with the largest increase noted in the journal of Obstetrics & Gynecology. In 1970, women comprised 6.7% of the first authors and 6.8% of the last authors; in 2004, women were first authors on 41% of the articles and last authors on 28% of the original research articles.4
We followed this line of inquiry in our study to see whether this trend in female first- and last-authored publications continued in two prominent journals in the specialty over a 15-year span from 2000 to 2015. We also sought to compare trends of coauthorship by pairing the gender of first and last authors. Finally, we wanted to assess whether the rate of female authorship over this time was commensurate with the percentage of women in the academic specialty of obstetrics and gynecology based on faculty data.5
We formulated three research questions given this evidence on gender trends: Has there been an increase over time in the number of female first and last authors of original research publications in two U.S. journals of obstetrics and gynecology? Did women, when paired as first and last authors, publish more articles than men paired as coauthors over this time? Has the rate of these publications kept pace with the percentages of women in academic institutions in the specialty? Based on the trends cited, we could expect to observe a steady increase in female authorship over time; however, it is unclear whether their publication rates kept pace with the percentages of women faculty in obstetrics and gynecology.
MATERIALS AND METHODS
The University of Tennessee Graduate School of Medicine institutional review board granted this retrospective study an exemption based on the collection and analysis of existing publicly available data.
We selected original research articles from the table of contents in Obstetrics & Gynecology and the American Journal of Obstetrics and Gynecology for the years 2000, 2005, 2010, and 2015 to represent a 15-year publication period. We coded first and last authors by gender based on their first name, degree(s), country of practice (U.S., non-U.S.), and affiliation (academic or other). We coded medical degrees as MD. We used the Google search engine to verify the gender of the author when name alone was insufficient or questionable for identification.
We analyzed the entire data set after removing records with missing data. We treated the number of publications each year as the dependent variable and gender of the first and last authors as the independent variable. We analyzed changes in the number of articles written by women as first authors, last authors, and paired as first and last authors. We paired first and last authors by gender to create four categories (ie, male–male, male–female, female–male, and female–female) of coauthors. We used the Z test to assess the change in the percentage of articles written by women at 5-year intervals beginning with the year 2000. The χ2 test determined whether these changes demonstrated a significant linear trend over time.
We compared the percentage of women who were first and last authors with the actual percentage of women in the academic specialty at each 5-year interval. To derive these percentages, we created a data subset of first authors with MDs who had U.S. academic affiliations. We calculated the percentages of men and women with MDs in the academic specialty from the Faculty Roster data published by the Association of American Medical Colleges. The χ2 goodness-of-fit test determined whether these percentages differed significantly at each interval and the χ2 test for linear trends assessed the overall pattern of these changes.
We conducted the data analysis using IBM SPSS Statistics for Windows 22.0. We set the α value at .05 to assess the statistical significance (P<.05) of all test results.
Collectively, the journals published 2,772 original research articles for the years 2000, 2005, 2010, and 2015. After the deletion of articles with missing data (3%), 2,699 records were complete for the analysis.
Table 1 summarizes the results of the descriptive analysis. There was a steady increase over time in the number of articles published by women as first authors, last authors, and paired as first and last authors. The Z test showed significant gains between the time points in the number of articles written by women as first authors and between the years 2005 and 2010 and 2010 and 2015 as last authors. The Z test detected significant changes in the number of articles written by women paired as coauthors between the years 2000 and 2005 and 2010 and 2015.
Figure 1 displays the percentages of publications cowritten by men and women based on the gender pairings of the first and last authors. This graph reveals that men as coauthors showed a steady decline in publications, whereas women as coauthors steadily published more articles over time. The other coauthor pairings showed declines as well; however, both genders served as senior authors in support of first authors of the opposite gender. A χ2 test for linear trends for each of the four lines demonstrated that the male–male and female–male gender pairings showed significant declines, whereas the female–female pairing significantly increased over time.
The selection of MD-only first authors from U.S. academic institutions produced a subset of 1,621 (60% of 2,699) articles. We compared the percentages of articles written by first and last authors who were female with the percentages of women with MDs in U.S. academic institutions in the years 2000, 2005, 2010, and 2015. Table 2 shows the difference between the observed percentages and the percentages of women faculty reported by the Association of American Medical Colleges. A χ2 goodness-of-fit test demonstrated that women as first authors published at rates higher than expected in the years 2005 and 2015 and kept pace for the years 2010 (P<.09) and 2000. Women published significantly fewer articles as last authors than expected for all 5 years relative to their faculty percentages.
Our study demonstrated that women published more articles over time as first authors, last authors, and as coauthors in two leading journals of obstetrics and gynecology. Paired as first and last authors, women showed the most dramatic increase in the number of coauthored publications over time relative to the other coauthor gender pairings. As first authors, they kept pace and even exceeded the expected rate based on the percentages of women faculty in academic institutions. However, as last authors, they lagged behind their percentages in academics.
These findings further extend the 35-year study of female authorship study published in 2006 showing women are publishing more over time in two specialty journals of obstetrics and gynecology. In addition, our study demonstrated the pattern of collaboration of first and last coauthors paired by gender over this 15-year period. This study goes further to demonstrate that these publication rates should be understood relative to the number of women faculty in the specialty. The Association of American Medical Colleges data indicate that the percentage of women in obstetrics and gynecology academic programs increased over this 15-year period such that by 2010, the percentage of male and female MDs had reached parity.
This study limits the analyses to original research articles. We excluded authors of editorials, commentaries, and other works at the risk of missing the bigger picture of gender influence given that these works often appear at the invitation of the journal. We excluded international journals with the recognition that U.S. authors often publish in them. To establish comparability between our data set and the Association of American Medical Colleges faculty roster data, we selected MD-only first authors. When we selected both first and last authors as MDs only and reran the analysis, we found the same results as reported. Our findings depend in part on the self-reported data sent to the Association of American Medical Colleges by medical schools and the assumption that the selected authors were included in these numbers. Prolific authors may be overrepresented in the publication data. The number of authors on an article may have some influence on the gender balance; however, we did not track this information. This study would have benefited by comparing academic rank with authorship position; however, rank was not included in the author information in these two journals.
Women as first authors clearly embraced the importance of conducting and reporting research for their academic advancement during this period. Women also supported each other as first and last authors in coauthoring articles, yet, as senior authors, women fell short of their expected rates based on their faculty numbers. It could be a function of the limited pool of senior faculty who are women.4 Perhaps this issue will resolve as women become the majority in the specialty and more women achieve senior faculty status.
Does research productivity translate into gender equity in academic promotion? The evidence to date indicates that research productivity does not explain the gender differences in the promotion rates of men and women to the rank of full professor in the major specialties.6 Trends indicate that women entering the academic specialty of obstetrics and gynecology, as generalists on a nontenure track, have the lowest rate of promotion relative to men on both tracks, women on a tenure track, and subpecialists.3 Women leave academics at higher rates than men, a phenomenon described as the “leaky pipeline.”7
Gender bias, that views men as more competent than women, can be overt or subtle and be held by both sexes.8,9 Gender affects the likelihood of tenure when women receive less recognition than men for the same work contributions on publications.10 Women have yet to achieve parity in rank and leadership in academic departments.7 Women are more likely to be in traditional educational roles rather than administrative leadership positions in a department of obstetrics and gynecology.11 Women in the educator and clinical tracks may be perceived as less valued and prestigious than those on a research track.7 Women tend to have greater caregiving responsibilities than men, which can create work-to-family conflicts that negatively affect their pursuits of personal and professional outcomes.12 In such cases, women may have insufficient time to produce scholarly work or to pursue leadership positions. The larger issue of gender equity in academic promotion and position must continue to be addressed at the department, institution, and societal levels.
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