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Professionalism-The Gender Gap: And the Award Goes to ... a Man. Again. Report Highlights Gender Disparities in AAN Awards

Shaw, Gina

doi: 10.1097/01.NT.0000546217.20488.83
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ARTICLE IN BRIEF

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A study in Neurology reported a disparity in AAN awards to women. The AAN and other subspecialty organizations responded, however, that that efforts are underway to address those concerns.

Women are significantly underrepresented as recipients of major named awards presented by the American Academy of Neurology (AAN) over the Academy's 63-year history, and the disparity is most pronounced for the most prestigious awards, according to a report in the July 20 online edition of Neurology.

Investigators from Harvard, Brigham and Women's Hospital, and Massachusetts General Hospital analyzed data on 20 awards intended primarily for physician recipients that recognized a body of work over the course of a career. Of the 323 physician recipients of the awards studied, 264 (81.7 percent) were men and 59 (18.3 percent) were women. During the most recent 10-year period studied (2008-2017), 187 awards were presented to physician recipients, comprising 146 men (78.1 percent) and 41 women (21.9 percent).

“Although the number and percentage of individual awards presented to women physicians trended upward during the study period, 65 percent of all recipient lists and 25 percent of recipient lists for awards presented to physicians for more than 10 years were associated with representation of women at levels ≤18%,” the authors wrote. “Notably, as the selectivity of the recipient category increased from unrestricted through senior author to lifetime achievement, the proportion of years during which women were absent from recipient lists increased from 40 percent to 85.7 percent. This suggests that some of the greatest gaps for women neurologists receiving awards are in the more prestigious categories.”

The “pipeline” of qualified women candidates to receive such awards, to which such disparities are often attributed, does not explain these gaps, the authors added, noting that the proportion of women among US neurologist members of the AAN has been at least 18 percent for two decades, and is now at or above 30 percent. “Moreover, the US pool of women neurology award candidates currently comprises, but is not limited to, 400+ successful and high-achieving women physicians including more than 170 full professors and more than 280 associate professors, suggesting that there were and are likely numerous qualified candidates for each award offered by the AAN and that pipeline is unlikely to be a major contributing factor,” they wrote.

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Corresponding author Anna Bank, MD, a former Harvard neurology resident who is now pursuing an epilepsy fellowship at Columbia, told Neurology Today that she was inspired to investigate disparities in neurology awards after reading various research articles on other gender disparities in the specialty. “These disparities become more apparent as we advance in our careers. Women represent nearly half of all neurology residents, but at higher levels — assistant and full professors, division directors and chairs, especially at elite institutions, we see a sharp drop-off in the number of women in academic neurology.”

The data on major AAN awards correspond with a number of other recent findings showing gender disparities in pay, recognition, and leadership in neurology: Men hold approximately seven in 10 of all academic neurology positions at top-ranked programs overall, with the discrepancy increasing with advancing rank, according to a study published in JAMA Neurology in April. In addition, after adjustment for years since medical school graduation, men published a significantly larger number of publications than women at all academic positions. Women academic neurologists are paid approximately $30,000 annually less than men, or about 85 cents on the dollar — one of the largest pay gaps in academic medicine, according to several 2016 studies in JAMA Internal Medicine. And according to the Association of American Medical Colleges' 2013-2014 report on the state of women in academic medicine, just 11 percent of the 101 chair positions in neurology are held by women — ranking below psychiatry, radiology, dermatology, and anesthesiology, and above only seven other specialties, including surgery and otolaryngology.

Natalia Rost, MD, MPH, FAAN, director of the Acute Stroke Service at Massachusetts General Hospital, associate professor of neurology at Harvard Medical School, and chair of the AAN Science Committee, acknowledged the new paper as an important addition to the body of work on gender-specific disparities in academic medicine and neurology in particular. “I think of current times as a watershed moment when the gates of transparency have been opened,” she said. “The body of evidence on this issue is growing. It's not like we just found this out, but we're now talking about it and it's a good thing, and this paper contributes nicely to this conversation.”

Dr. Rost noted that a major bias of this reporting is that it does not reflect the AAN awards recognizing young neurologists, where women recipients comprised 46 percent of the awards on average over the last five years. Also, encouraging, she said, is the fact that this year's high school neuroscience awards were awarded to a group of young women. “But it's about retaining and recognizing women neurologists at every level of their academic career,” said Dr. Rost, “and while we can do a better job doing that, I am proud that the AAN is taking the lead on this.”

Within the Science Committee, Dr. Rost and her colleagues have been brainstorming on how to address these disparities. “Over the past several years, there has been a growing presence of women speakers in plenary and other premier sessions at the AAN. That's not by accident. We have been educating our committee members about nominating and selecting qualified women in every category of scientific awards. The named awards, such as the ones described in the Neurology paper, have their own committees, and we need to make a concerted effort instructing them.”

Dr. Bank said that her group chose to focus on the AAN because it is the largest and most prestigious professional society in the specialty, but disparities can be found in other neurologic society awards as well.

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AWARDEES: OTHER SOCIETIES

The Child Neurology Society (CNS) has four named awards recognizing noteworthy careers: the Arnold P. Gold Foundation Humanism in Medicine Award, the Bernard Sachs Award, the Hower Award, and the Roger and Mary Brumback Memorial Lifetime Achievement Awards.

“From 2000 forward, four Hower Award recipients were women and six Sachs recipients were women,” noted CNS Executive Director Roger Larson. “The lifetime achievement awards have largely gone to gray-haired men. In stark contrast, however, all four of last year's Outstanding Junior Member awards went to women, and seven of the eight Junior Member Awards to be given this year will go to women residents. Of the 45 Outstanding Junior Member Awards presented to residents in the past 10 years, two-thirds (30) have gone to women. Not surprisingly, as these residents move into junior faculty positions, the balance of research grants and awards given by the Child Neurology Society and the Child Neurology Foundation to men and women is shifting: In 2017 all three went to women, while this year two of the three will be presented to women.”

A review of leading awards from the American Neurological Association (ANA) shows a similar pattern: Prominent honors like the Raymond D. Adams, Bennett and Soriano lectureships, and the George W. Jacoby Award have far more commonly been awarded to men. (In 2017, however, the Adams and Soriano lectureships both went to women.) Even the prestigious Derek Denny-Brown Young Neurological Scholar Award, which is focused on young and mid-career scientists, has gone to only a smattering of women.

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The American Epilepsy Society (AES) did not have any current data to share about female representation in its awards and lectureships, but AES Executive Director Eileen Murray said in a statement, “We agree that more must be done to address any disparities, and have conscious efforts underway within our Society regarding gender and other types of diversity.”

“I think there need to be more women involved in all areas, including award selection committees, and there needs to be adequate sourcing for awards committees so that it's a diverse panel,” said Allison Brashear, MD, FAAN, professor and chair of neurology at Wake Forest School of Medicine and chair of the ANA Awards Committee, who also co-authored an editorial accompanying the Neurology paper. “There's a 2016 Harvard Business Review that says that if there is only a woman or minority candidate on the panel to be hired, the chances of that person being hired is close to zero. But if you have two or more women or minority candidates in your panel of finalists, their chance of being selected is very high. The ANA, under my leadership of this committee, has been mindful about sourcing and making sure that we have a diverse panel to review.”

Dr. Brashear helped to establish the AAN's Women Leading in Neurology program, part of the Academy's Leadership University and one of the first such specialty-specific programs for women in academic medicine. “This is a stepping stone into more senior leadership positions for women, aimed at retaining talented young women and giving them a stepping stone into more senior leadership positions. This is about being intentional in our pipeline.”

Dr. Brashear noted that we need to sponsor women, not just mentor them, to advance to more senior leadership positions. Often the sponsor is a senior male. In this case, the sponsor would nominate a woman for one of these prestigious awards.

The AAN could also find ways to recognize departments of neurology that are doing well in closing the gender gap, suggested Jennifer Graves, MD, PhD, assistant professor of neurology and director of neuro-immunology at the University of California, San Francisco, who co-authored the accompanying editorial. “We should honor and reward people and places that are succeeding, and help with practical things such as tracking this data in departments,” Dr. Graves said. “Everyone in a position of leadership who assigns committee positions and recognition and these types of opportunities for advancement should be aware of these disparities and where we are.”

The recent article has been a major topic of conversation on the AAN's women in neurology listserv, Dr. Bank said. “No one has been particularly surprised about these findings, but they're all happy to get it out there. It's led to some great discussions. The more people who know and care about this, the more we can go to our chairs and senior leaders and advocate, and build a great community of women neurologists who can nominate and recruit each other for these positions.”

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LINK UP FOR MORE INFORMATION:

•. Silver JK, Bank AM, Slocum CS, et al Women physicians underrepresented in American Academy of Neurology recognition awards http://n.neurology.org/content/early/2018/07/20/WNL.0000000000006004. Neurology 2018; Epub 2018 Jul 20.
    •. Graves JS, Brashear A. Editorial: Gender bias in American Academy of Neurology recognition awards http://n.neurology.org/content/early/2018/07/20/WNL.0000000000006025. Neurology 2018; Epub 2018 Jul 20.
      •. Johnson SK, Hekman DR, Chan ET. Diversity: If there's only one woman in your candidate pool, there's statistically no chance she'll be hired https://hbr.org/2016/04/if-theres-only-one-woman-in-your-candidate-pool-theres-statistically-no-chance-shell-be-hired. Harvard Business Review 2016.
        •. McDermott M, Gelb DJ, Wilson K, et al Sex differences in academic rank and publication rate at top-ranked US neurology programs https://jamanetwork.com/journals/jamaneurology/fullarticle/2676799. JAMA Neurol 2018: Epub 2018 Apr 2.
          •. Pakpoor J, Liu L, Yousem D. A 35-year analysis of sex differences in neurology authorship. http://n.neurology.org/content/90/10/472 Neurology 2018; 90(10): 472–475.
            •. Jena AB, Olenski AR, Blumenthal DM. Sex differences in physician salary in US public medical schools https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2532788. JAMA Intern Med 2016; 176(9):1294–1304.
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