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Change Is Happening: An Evaluation of Gender Disparities in Academic Plastic Surgery

Smith, Brandon T. M.S.; Egro, Francesco M. M.B.Ch.B., M.Sc.; Murphy, Carolyn P. B.A.; Stavros, Alex G. B.S.; Kenny, Elizabeth M. B.S.; Nguyen, Vu T. M.D.

Plastic and Reconstructive Surgery: October 2019 - Volume 144 - Issue 4 - p 1001-1009
doi: 10.1097/PRS.0000000000006086
Plastic Surgery Focus: Special Topics
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Background: Gender disparities in academic plastic surgery are known; however, recently, professional societies have endorsed a culture of gender diversification. This study aims to evaluate the effects of these changes at faculty and leadership positions.

Methods: A cross-sectional study was conducted in June of 2018 to evaluate gender representation among U.S. academic plastic surgery faculty, and compare career qualifications, years of experience, and faculty positions.

Results: A total of 938 academic plastic surgeons were identified, of which only 19.8 percent were women. Female surgeons graduated more recently than men (2009 versus 2004; p < 0.0001) and predominantly from integrated residency programs (OR, 2.72; 95 percent CI, 1.87 to 3.96), were more likely to be an assistant professor (OR, 2.19; 95 percent CI, 1.58 to 3.05), and were less likely to be a full professor (OR, 0.20; 95 percent CI, 0.11 to 0.35) or program chair (OR, 0.32; 95 percent CI, 0.16 to 0.65). After adjustment for differences in years of postresidency experience, only disparities at the full professor position remained significant (OR, 0.34; 95 percent CI, 0.16 to 0.17), indicating that experience-independent gender inequality is prominent at the full professor level and that current differences in cohort experience are a significant contributor to many of the observed positional disparities. Lastly, programs led by a female chair employed significantly more female faculty (32.5 percent versus 18.2 percent; p = 0.016).

Conclusions: Gender diversity in academic plastic surgery remains a significant issue, but may see improvement as the disproportionately high number of junior female academics advance in their careers. However, leadership and promotion disparities between men and women still exist and must be addressed.

Pittsburgh, Pa.

From the Department of Plastic Surgery, University of Pittsburgh Medical Center.

Received for publication July 20, 2018; accepted February 1, 2019.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

Francesco M. Egro, M.B.Ch.B., M.Sc., Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, Pa. 15261, francescoegro@gmail.com, Instagram: @francescogro, Twitter: @FrancescoEgro, Facebook: @francescogro

Plastic surgery has historic gender disparities that have been well documented in the academic literature.1–5 Women practicing in the field face higher attrition rates, scarce role models, workplace dissatisfaction, pregnancy discrimination, and even issues finding a suitable partner.2,3,5–10 Furthermore, the challenges for female academic plastic surgeons wishing to seek career advancement are widely known to include disparities in authorship, editorial board leadership, and workplace bias.6,11–14

In an effort to mitigate gender discrimination, the American Society of Plastic Surgeons and other national societies have made concerted efforts to reform discriminatory practices and make diversity a front-of-mind topic for their members.15,16 The Plastic and Reconstructive Surgery series on “women in plastic surgery” created a public forum to highlight gender issues as diverse as sexism, retirement, and parenting.3,5,8,17 New policies, including the recommendation of more flexible time in residency for parental leave and the formation of groups such as the Women Plastic Surgeons Forum for female networking, have been implemented to address some of the many issues facing women in academic plastic surgery.8,16,18

Are these efforts to advance women in academic plastic surgery effective? This question remains largely unanswered. Measurements of institutional diversity have thus far been limited, with recent studies occurring in a timeframe several years before the implementation of current policies.13 Two decades of rising female residency enrollment have been well documented.1,19 However, little has been done to establish a timeline of when these women should obtain leadership positions in proportion to their representation. Furthermore, for women already in these positions, the tertiary benefits of gender diversity in roles central to faculty hiring and advancement have yet to be explored. Therefore, the aims of this study were to (1) measure current qualifications and representation of women in academic plastic surgery and leadership positions, (2) compare the career progress of men and women in academic plastic surgery, and (3) understand the role that women in leadership positions plays in departmental diversity and positional advancement.

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METHODS

Study Sample

This cross-sectional study comparing gender disparities in academic plastic surgery was conducted in June of 2018. A search of the 2018 Accreditation Council for Graduate Medical Education program listings identified current accredited plastic surgery training programs (n = 140). Institutions identified as having either an integrated residency or an independent plastic surgery fellowship or both were unified under a single listing with duplications removed (n = 100). Corresponding institution websites were located for all but one of the listed programs (n = 99). Faculty directories on these websites were used to identify the cohort of the study, which included clinical, adjunct, and tenure-track and non–tenure-track plastic surgery faculty belonging to each institution. Faculty without plastic surgery training, emeritus professors, and research faculty without medical degrees were excluded from the analysis.

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Data Collection

Online faculty profiles, Doximity, LinkedIn, private-practice, and public records websites were used to obtain faculty data, including age, sex, race, type of plastic surgery training (independent/integrated), year of graduation from training program, subspecialty or research fellowship completion, advanced degrees obtained, academic rank (assistant/associate/full professor), and leadership positions obtained (residency director/fellowship director/chair). Determinations of gender and race were made during data collection using faculty profile information, photographs, and surnames, as established by previously published work.13,20,21 Racial groups were categorized broadly as “white” or “nonwhite,” and more specifically as Asian, Black, Caucasian, or Hispanic. Faculty size and city size were both collected as continuous variables, with faculty size calculated from the total faculty size listed on the program website and city size obtained from the U.S. Census Website 2017 Population Estimates.22 The term “chair” is broadly used to describe a chair or chief of a department or division of plastic surgery. Clinical fellowships were subdivided into craniofacial surgery, microsurgery, burn surgery, hand surgery, aesthetic surgery, body contouring, wound care, and other categories. Additional program characteristics were recorded, including the structure of employing institutions (division/department), faculty size, and city size of the program. Historical data documenting previous society presidents were obtained from the American Association of Plastic Surgeons, American Society of Plastic Surgeons, and Plastic Surgery Research Council by search of leadership profiles on corresponding society websites.

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Analysis

Initial comparisons of continuous faculty demographics were made using the t test. Median year of integrated or independent training completion and years of postresidency experience were calculated and compared by using the Wilcoxon rank sum test. Proportional comparison of gender differences in race, region of practice, type of plastic surgery training, subspecialty or research fellowship completion, advanced degree attainment, differences in academic rank, and leadership positions were conducted through Pearson chi-square analysis. Categories that did not have enough subjects to meet Pearson chi-square criteria were tested by the Fisher’s exact test. Odds ratios were calculated for each Pearson chi-square and Fisher’s exact test analysis. Multivariate logistic regression models were used to adjust odds ratios for years of postresidency experience.

To measure the impact of female leadership on faculty representation and positional distribution, listed programs were divided into two groups: having a male chair (n = 92) or a female chair (n = 7). The proportion of women in each program was measured and compared by leadership gender using the t test. An overall comparison of the distribution of academic rank for female faculty in each of these leadership groups was made using the Pearson chi-square test. This study was determined to be exempt from review by the University of Pittsburgh Institutional Review Board. All analyses were completed through SAS University Edition 9.04.01 (SAS Institute, Inc., Cary, N.C.).23

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RESULTS

Initial search of Accreditation Council for Graduate Medical Education independent and integrated plastic surgery training programs yielded 140 training programs representing 100 unique institutions. Using the aforementioned search criteria, 930 academic plastic surgeons were identified on corresponding faculty websites and included in the study.

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Demographics of Academic Plastic Surgeons

Demographic and workplace characteristics of male and female academic plastic surgeons included in the study are listed in Table 1. Women represented 19.7 percent of all academic plastic surgeons, were significantly younger than their male colleagues (female academic plastic surgeons, 44.6 years; male academic plastic surgeons, 51.63 years; p < 0.0001), and graduated more recently (2009 versus 2004; p < 0.0001). Among female academic plastic surgeons, 26.6 percent were nonwhite, whereas only 24.3 percent of male academic plastic surgeons were nonwhite (p = not significant). Within the nonwhite group of female academic plastic surgeons, 63.2 percent were described as Asian, 8.2 percent were described as black, and 28.6 percent were described as Hispanic. Institutions in the United States Southern census region had the lowest representation of female academic plastic surgeons (17.4 percent), followed by the Northeast census region (20.1 percent), the Western census region (21.1 percent), and the Midwest census region (21.3 percent) (p = not significant). Women and men in academia worked in programs with comparable faculty size (female academic plastic surgeons, 15.5; male academic plastic surgeons, 15.5; p = not significant) who served a similar population size (female academic plastic surgeons, 120,000 people; male academic plastic surgeons, 120,000 people; p = not significant).

Table 1. - Characteristics of Academic Plastic Surgeons in the United States
Characteristic Women (%) Men (%) p
No. of patients 184 746
Mean age ± SD, yr 44.6 ± 7.8 51.6 ± 11.8 <0.0001
Race 0.76*
 White 135 (73.4) 565 (75.7)
 Nonwhite 49 (26.6) 181 (24.3)
Residency graduation year <0.0001
 Median 2009 2004
 IQR ±8 ±17
Region 0.67
 Northeast 43 (20.1) 171 (79.9)
 South 49 (17.4) 233 (82.6)
 Midwest 60 (21.3) 222 (78.7)
 West 32 (21.1) 120 (78.9)
Mean program size ± SD 15.5 ± 11.5 15.3 ± 11.3 0.87
Mean city size ± SD 1.2E5 ± 1.7E5 1.2E5 ± 1.7E5 0.89
IQR, interquartile range; E5, ×10
5.
*
Pearson χ2 analysis was performed to test differences in proportion.
Wilcoxon rank sum analysis was performed for differences in nonparametric data.

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Qualifications of Women in Academic Plastic Surgery

The distribution of qualifications for academic plastic surgeons, by gender, is listed in Table 2. Women in academic plastic surgery were significantly more likely than men to have received integrated residency training (OR, 2.72; 95 percent CI, 1.87 to 3.96). There were no gender differences in the rates of advanced degree attainment, clinical fellowship attainment, research fellowship attainment, or the total number of fellowships completed. Overall, 9.2 percent of female academics completed an additional advanced degree, 66.9 percent completed a clinical fellowship, and 15.2 percent completed a research fellowship. Among clinical fellowship subtypes, female academic plastic surgeons were significantly less likely to have had hand fellowship training (OR, 0.64; 95 percent CI, 0.43 to 0.97), whereas other fellowships did not exhibit significant gender disparities.

Table 2. - Qualifications Held by Academic Plastic Surgeons
Qualification Men (%) Women (%) OR* 95% CI p
Residency training type
 Integrated 108 (14.48) 57 (30.9) 2.72 1.87–3.96 <0.0001
 Independent 642 (83.7) 121 (65.8) 0.37 0.25–0.53
Additional advanced degree 101 (13.5) 17 (9.2) 0.65 0.38–1.12 0.12
 D.D.S. 18 (2.4) 1 (0.5) 0.22 0.03–1.67 0.15
 D.M.D. 12 (1.7) 0 (0) 1.02 1.01–1.03 0.08
 M.B.A. 12 (1.7) 0 (0) 1.02 1.01–1.03 0.08
 M.H.S. 1 (0.1) 1 (0.5) 4.07 0.25–65.4 0.09
 M.P.H. 9 (1.2) 6 (3.3) 2.76 0.97–7.86 0.09
 M.S. 23 (3.1) 3 (2.2) 0.69 0.24–2.05 0.51
 Ph.D. 32 (4.3) 7 (3.8) 0.88 0.38–2.03 0.77
Clinical fellowship training 244 (67.3) 61 (66.9) 0.98 0.65–1.38 0.91
 Aesthetic 33 (4.4) 11 (5.9) 1.37 0.68–2.77 0.37
 Body contouring 2 (0.27) 2 (1.1) 4.09 0.57–29.2 0.18
 Burn 25 (3.4) 4 (2.2) 0.64 0.22–1.86 0.41
 Craniofacial 164 (21.9) 41 (22.3) 1.02 0.69–1.49 0.93
 Hand 189 (25.3) 33 (17.9) 0.64 0.43–0.97 0.035
 Microsurgery 139 (18.6) 36 (19.6) 1.06 0.71–1.59 0.77
 Wound care 3 (0.4) 0 (0) 1 0.99–1.01 >0.999
 Other 24 (3.2) 5 (2.7) 0.84 0.32–2.23 0.73
 Research 105 (14.1) 28 (15.2) 1.09 0.69–1.72 0.69
D
.D.S., Doctor of Dental Surgery; D.M.D., Doctor of Dental Medicine; M.B.A., Master of Business Administration; M.H.S., Master of Health Science; M.P.H., Master of Public Health; M.S., Master of Science; Ph.D., Doctor of Philosophy.
*
Male reference.
Fisher’s exact test used for analysis of qualifications not meeting Pearson χ2 assumptions.

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Female Academic Rank and Leadership Positions

Measuring academic rank and leadership roles (Table 3), women represent 27.1 percent of all assistant professors, 19.5 percent of associate professors, and 6.1 percent of full professors. When compared to men, women were significantly more likely to be assistant professors (OR, 2.19; 95 percent CI, 1.58 to 3.05), less likely to be full professors (OR, 0.20; 95 percent CI, 0.11 to 0.35), and less likely to be chairs/chiefs (OR, 0.28; 95 percent CI, 0.13 to 0.61). Although not statistically significant, women were also less likely to be residency directors (women, 13.5 percent; men, 86.5 percent; p = not significant) or fellowship directors (women, 13.8 percent; men, 86.2 percent; p = not significant). A review of current and past leadership within major plastic surgery societies (i.e., American Society of Plastic Surgeons, Plastic Surgery Research Council, and American Association of Plastic Surgeons) demonstrates that none has had more than three female presidents during their history, leading to a limited overall presence of women in society leadership (Table 4).

Table 3. - Academic Rank and Leadership Positions
Position Women (%) Men (%) OR* 95% CI p
Assistant professor 106 (57.6) 285 (38.2) 2.19 1.58–3.05 <0.0001
Associate professor 39 (19.5) 161 (80.5) 0.98 0.66–1.45 0.91
Full professor 14 (6.1) 217 (93.9) 0.2 0.11–0.35 <0.0001
Residency director 14 (13.5) 90 (86.5) 0.6 0.33–1.08 0.08
Fellowship director 9 (13.8) 56 (86.2) 0.63 0.31–1.31 0.21
Chair 7 (7.1) 92 (92.9) 0.28 0.13–0.61 0.0015
*
Male reference.

Table 4. - National Leadership Positions
Society Female Leaders (%) Male Leaders (%)
AAPS 1 (1) 79 (99)
ASPS 2 (3) 75 (97)
PSRC 3 (7) 42 (93)
Overall 6 (3) 196 (97)
A
APS, American Association of Plastic Surgeons (1921 to 2018); ASPS, American Society of Plastic Surgeons (1932 to 2018); PSRC, Plastic Surgery Research Council (1955 to 2017).

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Experience in Academic Plastic Surgery

When assessed as an overall cohort (Fig. 1), the majority (58.2 percent) of current female academic plastic surgeons have 10 or fewer years of postresidency experience, compared to 37.9 percent of all male academic plastic surgeons. Figure 1 highlights the disproportionately large grouping of female academic plastic surgeons at the junior level, and highlights the more homogenous presence of male surgeons possessing a wider range of postresidency experience. Women employed in the assistant professor position had, on average, fewer years of postresidency experience than men (female academic plastic surgeons, 6 years; male academic plastic surgeons, 7 years; p < 0.0001), whereas women employed in the associate professor (female academic plastic surgeons, 13 years; male academic plastic surgeons, 12.5 years; p = not significant) and full professor (female academic plastic surgeons, 26 years; male academic plastic surgeons, 26 years; p = not significant) positions had comparable postresidency experience, as shown in Table 5. The average number of years of postresidency experience for men in the chair position was 24 years, and although 27.1 percent of men met or exceeded 24 years of postresidency experience, a mere 8.2 percent of women met or exceeded 24 years of postresidency experience, demonstrating an underrepresentation of female candidates with years of postresidency experience characteristic of the chair position (Fig. 2). Even fewer women met the male 26-year average of postresidency experience for the full professor position; although 24.1 percent of men met or exceeded this postresidency years of experience, a mere 7.4 percent of women met or exceeded it. Again, this demonstrated an underrepresentation of female candidates with years of postresidency experience typical for senior positions and emphasized the importance of controlling for cohort experience differences. After adjusting for differences in years of postresidency experience using multivariate logistic regression (Table 6), only gender differences at the full professor position remained significant (OR, 0.34; 95 percent CI, 0.16 to 0.17), indicating that gender inequality, independent from experience, is prominent at the full professor level and that current differences in cohort experience are a significant contributor to the observed positional disparities at the assistant professor and chair positions.

Table 5. - Median Years of Postresidency Experience, by Position
Position Women (IQR) Men (IQR) p
Assistant professor 6 (5) 7 (8) <0.0001
Associate professor 13 (8) 12.5 (8.5) 0.28
Full professor 26 (19) 26 (14) 0.99
Residency director 14.5 (11) 18 (16) 0.3
Fellowship director 9.5 (9) 14.5 (9.5) 0.07
Chair 22 (14) 24 (13) 0.95
I
QR, interquartile range.

Table 6. - Leadership Differences in Institution Diversity and Faculty Advancement
Position Programs with Female Chair (%) Programs with Male Chair (%) % Change with Female Chair p
No. of programs 7 92
Average female faculty, per institution 3.71 (32.5) 1.76 (18.2) 14.3 0.016
Academic rank 0.0041*
 Female assistant professor 11 (50) 95 (69.3) −19.3
 Female associate professor 5 (22.7) 24 (24.8) −2.1
 Female full professor 6 (27.3) 8 (5.8) 21.5
*
Comparison of overall distribution of academic rank by Pearson χ2 analysis.

Fig. 1.

Fig. 1.

Fig. 2.

Fig. 2.

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Effects of Diversity in Leadership

When programs were grouped based on the gender of the chair (Table 7), it was found that programs led by a female chair (n = 7) employed significantly more female faculty than programs led by a male chair (n = 92) (female chair, 32.5 percent female faculty; male chair, 18.2 percent female faculty; p = 0.016). In programs with a female chair, compared to programs with a male chair, there were 19.3 percent fewer women in the assistant professor position and 21.4 percent more women in the full professor position. Overall, a significant difference was also found in the distribution of faculty positions for female faculty based on the gender of the program chair (change in distribution of female faculty with female chair: assistant professor, −19.3 percent; associate professor, −2.1 percent; full professor, 21.5 percent; p = 0.0041).

Table 7. - Position Gender Differences with Adjustment for Years of Experience
Position Unadjusted Adjusted for Years of Experience
OR* 95% CI p OR* 95% CI p
Assistant professor 2.19 1.58–3.05 <0.0001 1.21 0.77–1.92 0.41
Associate professor 0.98 0.66–1.45 0.91 1.11 0.69–1.77 0.67
Full professor 0.2 0.11–0.35 <0.0001 0.34 0.16–0.73 0.006
Residency director 0.6 0.33–1.08 0.08 0.73 0.36–1.49 0.39
Fellowship director 0.63 0.31–1.31 0.21 0.81 0.36–1.78 0.59
Chair 0.28 0.13–0.61 0.0015 0.56 0.24–1.29 0.18
*
Male reference.
Full professor was the only position to retain significant gender difference after adjustment for years of experience.

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DISCUSSION

Current gender disparities in surgery have been widely publicized in the academic literature.24–26 Academic plastic surgery faces many of the same discriminatory practices.1–3 Previous work has shown that these women face distinct challenges in entry, advancement, and promotion to leadership positions that have hindered proportional representation in the field.3–5,7,10,14,27 This study found that similar disparities still exist, but that representation is likely to improve. During the 10-year period from 2005 to 2015, female representation in plastic surgery residency programs climbed from 21 percent to 35 percent.28 Since 2014, the overall representation of women in academic plastic surgery has increased 6 percent.13 During a similar period, the proportion of women in the assistant professor position decreased 15 percent, whereas the proportion of women in the more senior associate and full professor positions increased 12 percent and 1 percent, respectively.13

Gains in experience, a commonly documented disparity between men and women in academic plastic surgery, may explain some of the recent advancements.29,30 The accumulation of clinical experience, publication volume, and prestige toward positional promotion is characterized as a “pipeline” for promotion. Disparities in this pipeline have long been implicated in the underrepresentation of women at key career stages.25,28,31 Although sources of female attrition, or “leaks,” during this process have been well documented, the time required to advance from one position to the next has never before been measured. As demonstrated by the female cohort peaks in Figure 2, it may appear that the emphasis toward inclusion initiated by the Implementation Committee of the American Association of Medical Colleges and the American Society of Plastic Surgeons within the past 10 to 15 years are only now beginning to increase female representation at the most junior academic positions.15,32 A further one to two decades of time is likely required for this current cohort of rising female academics to achieve the length of postresidency training typically required of candidates for the most senior academic and leadership positions. Given the known benefits of female leaders in mentorship, role modeling, and now faculty diversity and advancement, a delay of this length may be considered prohibitive.5,6

This study found that notable gender inequalities still exist at the most senior academic and leadership positions. Disparities at these senior levels are longstanding and pervade almost every field of medicine.28,32,33 As shown in Table 4, no major plastic surgery society has had more than three female leaders during their history. A lack of effective female mentorship has been described by women of many different backgrounds as one of the key causes of this imbalance.10,34–36 Programs put into place to increase same-sex mentorship have motivated greater field entry, professional development, and career planning among female faculty.37,38 During the 14-year period following implementation of the Women in Medicine and Health Sciences mentoring program, the University of California Davis School of Medicine reported increases in the number and percentage of female faculty and department chairs and decreases in female faculty departure.39 Social media, an increasingly important tool for many physicians, has also been shown to be useful in connecting female physicians beyond the boundaries of a single institution or region.40 Ultimately, establishing networks of motivated female mentors is essential for developing greater representation in the field.

For women, the climb from a junior academic position to a senior academic or leadership position is a process that requires many years of experience and training. This study demonstrated that plastic surgery program directors had an average of 22 years of postresidency experience in the field. During the career advancement process, women face increasing burdens at home, training deficits, and job dissatisfaction that often hinder their advancement and cause attrition from the field.41–43 Leadership development programs, such as the Hedwig van Ameringen Executive Leadership in Academic Medicine program for women, create forums for women to address inequalities and improve self-efficacy attitudes toward leadership.44 These programs have been shown to be very effective at providing women with management skills and advancing their role within the institution.45 Expanding leadership training resources to provide early exposure for junior female faculty has the potential to increase field retention and reduce the overall time-to-leadership lag.

Finally, if women are to advance in numbers equal to men, biases against hiring and promoting women must be addressed. These biases have been well described in other fields and medical specialties, often occurring as implicit, or “unconscious” bias.26,46,47 This is the first study to definitively confirm that experience-independent inequalities exist at the full professor position and that leadership gender corresponds with both institutional diversity and female faculty position in academic plastic surgery. Well-documented prejudices against women because of pregnancy concerns and a perceived lack of confidence or “leadership” qualities may have played a role in these inequalities.8,14,48 It is also possible that institutions with a more negative culture toward women did worse promoting female advancement and leadership. Several suggestions have been put forth to tackle these issues, including increased transparency in decision-making and the establishment of a diverse advisory committee for hiring and advancement.49–51 Reorganizing departmental reviews to have a more defined structure and provide clearer expectations of faculty has also been successfully implemented to improve faculty diversity.2,52 Although we may be decades away from establishing equal representation of women at the chair position, efforts to reduce implicit bias and improve decisional objectivity can have more immediate effects on the hiring and advancement of female academic plastic surgeons.

This study has several notable limitations. First, this study relied on public-use information listed on institution and networking websites. It is probable that segments of the information listed on these resources were not up-to-date and did not reflect all of the current positions or qualifications of the included subjects. Efforts were made to check online information against existing faculty lists, Accreditation Council for Graduate Medical Education residency director listings, and San Francisco Match fellowship director listings, but these resources did not cover the full range of included variables. Study comparisons were conducted through cross-sectional analysis because of the limited availability of historic faculty data. Data indicating the extent of current clinical practice for listed academic plastic surgeons had similar, limited availability. Determinations of race for the study were made at the discretion of data collectors and may not have reflected self-identified race. Furthermore, faculty position data were not available for 68 individuals (7.3 percent), and residency graduation data were not available for 273 individuals (29.4 percent). Missing data for residency graduation disproportionately affected older plastic surgeons—who have been shown to have decreased use of social media and networking websites. Despite these limitations, this study had better collection rates for academic rank than similar studies in the field.13,53

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CONCLUSIONS

Gender diversity in academic plastic surgery remains a significant issue but may see improvement as the disproportionately high number of junior female academics advance in their careers and access senior positions. However, leadership disparities affecting the inclusion and promotion of women in academia continue to exist. Policies to diversify leadership education, improve implicit bias training, and expand female mentorship networks can help reduce, but not eliminate, discrimination and incorporate more women into the field. Overall, reducing gender disparities in academic plastic surgery creates a community that is not only more representative of its patient population but also better equipped to recruit and train a new generation of rising plastic surgeons.

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