The number of women with leadership roles in research studies published in major medical journals has increased significantly over the past three decades, but women remain under-represented among medical science investigators. In the July 20 New England Journal of Medicine (NEJM), a group from the Massachusetts General Hospital (MGH) reports that, among U.S. physician-researchers leading original studies published in some of the country's most prestigious medical journals, the proportion who are women increased almost fivefold from 1970 to 2004.
"We found that women have come a long way, but that there is still a long path ahead," says Reshma Jagsi, MD, DPhil, lead author of the study and formerly chief resident in the MGH Department of Radiation Oncology. "Although women are now entering the medical profession at the same rate as men, my colleagues and I had a sense that few of the studies and editorials in journals we read were authored by women, which might be discouraging to young women physicians and students. When we realized that no one had looked over time at the percentage of authors who were women, we decided to do it ourselves." Jagsi has now joined the faculty of the University of Michigan Medical School.
The MGH team analyzed the number of women with the key roles of lead or senior author in papers published in six leading U.S. medical journals: NEJM, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, Annals of Surgery, Journal of Pediatrics, and Obstetrics and Gynecology. They reviewed all original research reports published in 1970, 1980, 1990, 2000 and 2004 to determine the gender as well as the academic degrees and institutional affiliations of the lead and senior authors, restricting their analysis to authors holding MD degrees from U.S. institutions. They also reviewed editorials written by invited experts in NEJM and JAMA.
The results showed significant gains over the study period, with the proportion of lead authors who were women reaching 29 percent in 2004, compared with 6 percent in 1970; and the proportion of senior authors who were women reaching 19 percent in 2004, versus 4 percent in 1970. The researchers noted, however, that the rate of increase may be reaching a plateau, with an apparent slowdown from 2000 to 2004. In the specialty publications, the greatest increases were seen in the pediatrics and obstetrics/gynecology journals while the smallest increase was found in the surgical journal, trends that echo the representation of women in those fields.
Similar increases were seen in the proportion of invited editorials written by women. In 1980 no invited JAMA editorials were written by U.S. women physicians, while almost 19 percent of the U.S. physician authors of JAMA editorials published in 2004 were women. Only 1.5 percent of the U.S. physician authors of 1970 NEJM editorials were women, a proportion that rose to 20 percent in 2000 but dropped to 11 percent in 2004.
Among possible factors underlying the remaining "gender gap" in research publication, the authors cite the limited number of female senior faculty available to act as senior authors or to write invited editorials, along with competing demands - professional and personal - on their time. Another potential complication is that the years during which young researchers traditionally are most productive - their mid-30s - are also the years of greatest child-rearing activity.
"The difficulty of maintaining research productivity during the child-rearing years is a significant obstacle to career advancement for women in medical research," says Nancy Tarbell, MD, director of the MGH Office of Women's Careers and a co-author of the NEJM paper. "The MGH recognized this issue several years ago with the creation of the Office of Women's Careers, which provides considerable support and resources for our women faculty members.
"One of our most successful programs is the Claflin Distinguished Scholar Awards, which provide significant two-year grants to women junior faculty members launching independent research careers," she adds. "The grants have served as seed funding leading to subsequent support from outside organizations that has far exceeded the hospital's financial outlay." Tarbell is C.C. Wang Professor of Radiation Oncology at Harvard Medical School.
The senior author of the NEJM report is Elaine Hylek, MD, MPH, now at Boston University School of Medicine (BUSM). Additional co-authors are Elizabeth Guancial, MD, Cynthia Cooper Worobey, MD, and Yuchiao Chang, PhD, of MGH; Rebecca Starr, MBA, MSW, of the MGH Office of Women's Careers, and Lori Henault, MPH of BUSM.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of nearly $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, transplantation biology and photomedicine. MGH and Brigham and Women's Hospital are founding members of Partners HealthCare HealthCare System, a Boston-based integrated health care delivery system.