Article In Brief
Women neurologists have become more prominent in leadership at the AAN by serving on committees—from 14 percent in 1997 to 36 percent in 2017. And significantly, their academic achievement improved when first and last authorship in Neurology were analyzed.
The last two decades have ushered in a growing number of women in neurology. Still, representation in positions of leadership, publication, and award appointments has often been far from equitable. A Neurology study published online ahead of print on September 15 found some encouraging trends in the recognition of women from recent years (between 2007 and 2017), based on data from US-based AAN members.
However, there is a lot more work to be done.
“Given the large inequity prior to 2007, it will likely take until 2047 for women to reach 50 percent of US neurologist members,” study author Janis Miyasaki, MD, MEd, FRCPC, FAAN, director of the Parkinson and Movement Disorders Program at the University of Alberta in Edmonton, Canada, told Neurology Today.
“Despite this, we found that women have become more prominent in leadership at the AAN by serving on committees—from 14 percent in 1997 to 36 percent in 2017. And significantly, their academic achievement improved when first and last authorship in Neurology were analyzed.”
The analysis showed that, while in 1997 and 2007 US female AAN members were equally as likely as male members to be first author on papers in Neurology, by 2017, women were more likely to have first authorship than men (p <0.001). Further, the rate ratio of a woman being a last author in a Neurology publication was 0.38 in 1997, but by 2017, it had grown to 1.06.
“At the medical student level, as each year achieves a greater proportion of women in neurology, women medical students can see themselves as belonging to neurology. Each intervention [to improve representation] has an effect on other measures that we looked at in an almost endless cycle,” Dr. Miyasaki said.
“When you read articles written by women, you imagine that you could be an investigator or scientist. When you see women at the podium, you believe you could be there some day. My personal experience with the AAN has been that it was progressive when other organizations or institutions were not.”
For a long time, the argument has been that “the pipeline will solve all problems of women's participation,” Dr. Miyasaki continued. “But if we wait passively for the pipeline to fix everything, women will not progress.”
Recognizing this, she said, the AAN has made a concerted effort to champion women in neurology, and the analysis shows these labors are beginning to pay off.
“When I first started as a volunteer with the AAN in 1999, I was often the only woman on a committee or work group. And I was often the only person who was not White. When I look around the room now, I see many more individuals from varied backgrounds. This can only help make our organization stronger because we better represent the demographic in medicine and, hopefully, we will come to represent the demographic in society as a whole,” Dr. Miyasaki said.
Study Findings, Next Steps
Using membership data from the AAN, Dr. Miyasaki and colleagues reported that in 1997, US male AAN members outnumbered US women 4:1; in 2007 and 2017, the ratio of US women to men increased to 1:2.3 and 1:1.5, respectively. Additionally, American Medical Association and the Accreditation Council for Graduate Medical Education data showed that while female medical students were less likely than male medical students to enter neurology residency programs in 1997, in 2007 and 2017, there was no significant difference between these groups.
And although there were fewer women receiving AAN awards in absolute terms, when analyzed proportionately, women were more likely to receive recognition awards in all years studied (1997, p=0.008; 2007, p<0.001; 2017, p<0.001), according to the analysis.
Dr. Miyasaki suggested that some of these improvements may stem from the growing trend of equity, diversity, and inclusion officers in departments of neurology across the country, as well as the AAN's leadership programs for women and those underrepresented in medicine (UIM).
“In the leadership cohorts, there is a concerted effort to ensure that each ‘class’ is representative of our membership in sex (women and men) and UIM, and thus ensure that women are better represented,” she added.
Still, it is important to remember that the AAN is just one influencer in neurology and neuroscience, Dr. Miyasaki said. “Universities, research institutes, granting agencies, and editorial boards have significant influence on attracting women into neurology and also supporting their careers. Until we see women in the highest positions in significant numbers as chairs of neurology departments, or—dare we dream—deans of medical faculties or presidents of universities, women will still have challenges in achieving equity and inclusion in their local institutions,” she said.
Dr. Miyasaki noted that many AAN members are in community practices and should be asking the same questions of their own organizations and leadership.
The Neurology paper had some notable limitations, including its inability to examine ethnicity, gender identity, geographic location, or other factors that may result in marginalization of neurologists; its use of a single journal (Neurology) for authorship data; and its inclusion of US-only AAN members.
In the future, “we should also examine the intersectionality of gender, gender minorities and ethnicity for these same metrics.” Research shows that participating in education on this topic is not enough, she added; we need to examine what steps can change behavior—for example, hiring more diverse faculty, choosing more diverse trainees, collaborating with those outside your usual research group.
Women Neurology Leaders Respond
Responding to the findings, neurology leaders—all of whom were involved in the AAN's Gender Disparity Task Force Report—said the results were “encouraging” and further evidence of the importance of continuing to fight for representation of women, as well as other minority groups.
“The most important takeaway from this article is that an inclusive and proactive approach to recognizing and identifying talent among women can lead to real change within an organization, whether it is a professional society like the AAN or a university, medical school, or neurology practice,” said Nassim Zecavati, MD, MPH, FAAN, associate professor of neurology at Virginia Commonwealth University and director of epilepsy at the Children's Hospital of Richmond.
“There has undoubtedly been a concerted effort by the AAN to ensure the Academy's leaders and publications reflect the diversity of its members. The breadth and growth of the AAN's leadership programs reflect this. However, there is much work left to be done as women make up a dismal 13 percent of health care CEOs in the United States (according to the Oliver Wyman Report),” Dr. Zecavati emphasized.
In senior positions in academia and large health systems, she added, we continue to see the underrepresentation of women. “It is incumbent upon organizations to scrutinize their leaders and ask, ‘do these leaders reflect the diversity of our organization, both in terms of gender and ethnicity?’ If the answer is ‘no,’ then concrete steps need to be taken to promote gender equity and parity in the organization.”
Lynne P. Taylor, MD, FAAN, Alexander M. Spence Endowed Chair in Neuro-Oncology and clinical professor of neurology and neurologic surgery and medicine at UW Medicine, remembers in 1992, after Patty Murray was elected as the first female Senator from Washington State. It made an impression on her then and inspired her determination to become involved in the AAN, but, she said, couldn't see her way into what appeared to be an “old man's society.”
Dr. Taylor wrote a letter addressed to the Academy declaring, “This is the year of the woman in politics and I think you need more female representation in the AAN.” Without any connections to the organization, she never expected to hear back, but less than a week later she received a phone call from Robert C. Griggs, MD, FAAN, who was then the chair of the AAN's Education Committee.
“I couldn't believe he was calling me. He said, ‘how would you like to be involved?’ With that phone call, he put me on a committee, and I have been very involved in the AAN ever since.”
The lesson, perhaps, is that “you can't be who you can't see.” She continued: “When academies and organizations put their annual meeting together or decide who will give their annual lecture, they should always ask the question, ‘Is it equitable?’”
“Since the publication of a number of articles showing disparities in pay based on gender within medicine, there has been concern with the equity of professional achievement for women in medicine,” Elaine C. Jones, MD, FAAN, a member of the AAN's Board of Directors, said.
“With neurology showing some of the largest disparities in pay based on gender and subsequent research suggesting lower rates for awards to female neurologists compared to males, AAN leadership focused on this area. One important point that came up was that transparency was vital to understanding the issues and dealing with any discrepancies.”
Dr. Jones said she was “pleased” to see the investigation by Dr. Miyasaki and colleagues, as well as the results. “While there are some limitations to the conclusions, as pointed out in the article, the overall findings suggest that as of 2017 and within the AAN's scope of leadership roles, awards and publications, women are equal or even slightly ahead of men in these areas.”
She added that these findings, though encouraging, will need to be monitored over time to ensure continuity. “I would like to see similar investigations of other underrepresented groups, including by race, geographic location, and age, although these are harder factors to determine with this type of data analysis.”
In the future, it will also be important to look at how gender roles in society factor into women's professional achievement, she said. “It is well documented that women tend to be the caregivers for the family and so some women may be unable to pursue professional advancement due to these other demands on their time. Is there a selection bias for the type of women that are able to achieve these goals?”
Due to loss of school and extracurricular participation, the current pandemic has created a need for one parent to be home more than in the past, Dr. Jones said. “Women have borne the brunt of some of this and may have had to forego work opportunities that could lead to future professional advancement. It is important to continue to monitor these areas for impact in the future.”
There is also the possibility telecommunication will encourage and allow more women and underrepresented groups to become involved, Dr. Taylor said.
It will likely take years to fully understand the effects of the pandemic on the workforce Dr. Zecavati agreed, “but it is a very concerning possibility that women and minorities will be disproportionately affected.”