Career trajectories of MD-PhD physician scientists: The loss of women investigators.

Advances in biomedical research require a robust physician scientist workforce. Despite being equally successful at securing early career awards from the NIH as men, women MD-PhD physician scientists are less likely to serve as principal investigators on mid- and later careers awards. Here, we discuss the causes of gender disparities in academic medicine, the implications of losing highly trained women physician scientists, and the institutional and systemic changes needed to sustain this pool of talented investigators.

Discrimination against the female surgeon in the exercise of her profession.

OBJECTIVE: To describe the discrimination experienced by the general female surgeon. METHOD: Prospective, cross-sectional and descriptive study, with a survey of 30 questions, closed, anonymous, voluntary and confidential, distributed through a link in the WhatsApp chat in a closed group of female surgeons who are members of the Asociación Mexicana de Cirugía General. RESULTS: 146 female surgeons participated, with a response rate of 58.4%. The discrimination perceived by female surgeons in training was 86 (58.9%), and 28 (19.2%) when they are already surgeons by not allowing them to perform the same procedures as their peers. Regarding the patients, discrimination against female surgeons was 72 (49.3%). They do not call them doctors, but "ladies", in 126 (86.3%), and they are asked to perform nursing duties in 120 (82.2%). On the other hand, there is also discrimination against female surgeons by nursing staff in 87 (59.6%). CONCLUSIONS: Discrimination is common in the daily surgical practice of female surgeons in all three areas: peers, patients, and nursing staff. This is an initial work, where the quantification of discrimination in Mexico is carried out. Strategies must be implemented to avoid discrimination against female surgeons and be in an environment of equality.

OBJETIVO: Describir la discriminación que vive la cirujana general en México. MÉTODO: Estudio prospectivo, transversal y descriptivo, con una encuesta de 30 preguntas cerradas, de manera anónima, voluntaria y confidencial, distribuida a través de un enlace en el chat de WhatsApp en un grupo cerrado de cirujanas de todo el país que son miembros de la Asociación Mexicana de Cirugía General. RESULTADOS: Participaron 146 cirujanas, con un porcentaje de respuesta del 58.4%. La discriminación percibida por las cirujanas en formación fue de 86 (58.9%), frente a 28 (19.2%) cuando ya son cirujanas, al no permitirles realizar los mismos procedimientos que sus pares. La discriminación por parte de los pacientes fue de 72 (49.3%). No las llaman doctoras sino «señoritas¼ en 126 (86.3%) y les solicitan hacer funciones de enfermería en 120 (82.2%). También existe discriminación hacia las cirujanas por el personal de enfermería en 87 (59.6%). CONCLUSIONES: La discriminación hacia las cirujanas es frecuente en los tres ámbitos: pares, pacientes y personal de enfermería. Este es un trabajo inicial, donde se realiza la cuantificación de la discriminación en México. Se deberán implementar las estrategias para evitar la discriminación a las cirujanas y estar en un ambiente de igualdad.

Women in Orthopaedics: 10-Year Trends of Fellowship Match Rate and Subspecialty.

BACKGROUND: Orthopaedic surgery has consistently remained one of the least diverse specialties in medicine. There are limited data on the match rate by sex into orthopaedic fellowships. PURPOSE: The goals of this study were to determine (1) how the percentage of women applying to orthopaedic fellowships has changed from 2011 to 2021, (2) whether there was a correlation between sex and the likelihood of a successful fellowship match, and (3) which subspecialties tend to have a greater proportion of female applicants and fellows. METHODS: The San Francisco (SF) Match service was used to obtain US orthopaedic fellowship applicant data from 2010 to 2021. San Francisco Match has run the match for the orthopaedic fellowship match since 2010. International medical graduates' applications, incomplete applications, or withdrawn applications were excluded. The following variables were collected and assessed: sex, subspecialty choice (except for hand because they do not use SF Match services), and match outcome. The number of female applicants and matches was recorded by year and compared with the number of male applicants and matches. Chi-square analysis was used to analyze categorical variables. RESULTS: A total of 6969 applicants to all orthopaedic specialties within SF Match were included during the study period. Overall, 859 were female (12.3%), and 6110 were male (87.7%). The number of female applicants had an increasing trend over the 10-year period from 65 applicants in 2011 to 111 in 2021. The overall proportion of female applicants was between 10.1% and 14.4%. The annual match rate for female applicants was 90.7% to 100% during the study period while the match rate for male applicants was 93.7% to 97.3%. Regarding successful matches, pediatrics had the highest proportion of women (range: 30.2% to 46.2%), followed by foot and ankle (range: 9.8% to 26.4%). Spine (range: 3.2 to 10.9%) and adult reconstruction (range: 3.9% to 9%) had the least number of women among matched applicants. DISCUSSION: This study found that the number of female applicants to orthopaedic fellowships has increased over the past 10 years. The difference in fellowship match rates among male versus female applicants did not statistically differ during this 10-year period; however, the proportion of female fellows is not equally distributed among subspecialties, with a higher proportion of women matching into pediatrics and foot and ankle and lower proportion in reconstruction and spine. These data can provide a benchmark for department chairs and society leadership to ensure they are recruiting, interviewing, and selecting candidates who are representative of the current sex demographics of orthopaedic fellowship graduates.

Abdominal Transplant Surgeons: The Lack of Female Surgeons and People From Underrepresented Racial and Ethnic Minority Groups in Academic and Clinical Leadership.

OBJECTIVES: The demographic disparities among surgeons in academic leadership positions is well documented. We aimed to characterize the present demographic details of abdominal transplant surgeons who have achieved academic and clinical leadership positions. MATERIALS AND METHODS: We reviewed the 2022-2023 American Society of Transplant Surgeons membership registry to identify 1007 active abdominal transplant surgeons. Demographic details (academic and clinical titles) were collected and analyzed using the chi-square test, the Fisher exact test, and t tests. Multinomial logistic regressions were conducted. RESULTS: Female surgeons (P < .001) and surgeons from racial-ethnic minorities (P = .027) were more likely to be assistants or associates rather than full professors. White male surgeons were more likely to be full professors than were White female (P < .001), Asian female (P = .008), and Asian male surgeons (P = .005). There were no Black female surgeons who were full professors. The frequency of full professorship increased with surgeon age (P < .001). Male surgeons were more likely to hold no academic titles (P < .001). Female surgeons were less likely to be chief of transplant(P = .025), chief of livertransplant (P = .001), chief of pancreas transplant (P = .037), or chair of surgery (P = .087, significance at 10%). Chief of kidney transplant was the most common clinical position held by a surgeon from a racial or ethnic minority group. Female surgeons were more likely to hold no clinical titles (P = .001). CONCLUSIONS: The underrepresentation of women and people from racial and ethnic minority groups in academic and clinical leadership positions in the field of abdominal transplant surgery remains evident. White male physicians are more likely to obtain full professorship, and they comprise most of the clinical leadership positions overall. A continued push for representative leadership is needed.

Association between anaesthesia-surgery team sex diversity and major morbidity.

BACKGROUND: Team diversity is recognized not only as an equity issue but also a catalyst for improved performance through diversity in knowledge and practices. However, team diversity data in healthcare are limited and it is not known whether it may affect outcomes in surgery. This study examined the association between anaesthesia-surgery team sex diversity and postoperative outcomes. METHODS: This was a population-based retrospective cohort study of adults undergoing major inpatient procedures between 2009 and 2019. The exposure was the hospital percentage of female anaesthetists and surgeons in the year of surgery. The outcome was 90-day major morbidity. Restricted cubic splines were used to identify a clinically meaningful dichotomization of team sex diversity, with over 35% female anaesthetists and surgeons representing higher diversity. The association with outcomes was examined using multivariable logistic regression. RESULTS: Of 709 899 index operations performed at 88 hospitals, 90-day major morbidity occurred in 14.4%. The median proportion of female anaesthetists and surgeons was 28 (interquartile range 25-31)% per hospital per year. Care in hospitals with higher sex diversity (over 35% female) was associated with reduced odds of 90-day major morbidity (OR 0.97, 95% c.i. 0.95 to 0.99; P = 0.02) after adjustment. The magnitude of this association was greater for patients treated by female anaesthetists (OR 0.92, 0.88 to 0.97; P = 0.002) and female surgeons (OR 0.83, 0.76 to 0.90; P < 0.001). CONCLUSION: Care in hospitals with greater anaesthesia-surgery team sex diversity was associated with better postoperative outcomes. Care in a hospital reaching a critical mass with over 35% female anaesthetists and surgeons, representing higher team sex-diversity, was associated with a 3% lower odds of 90-day major morbidity.

Short-time mentoring - enhancing female medical students' intentions toward surgical careers.

BACKGROUND: Women pursuing a career in surgery or related disciplines are still in the minority, despite the fact that women compose at least half of the medical student population in most Western countries. Thus, recruiting and retaining female surgeons remains an important challenge to meet the need for surgeons and increase the quality of care. The participations were female medical students between their third and fifth academic year. In this study, we applied the well-established psychological theory of planned behavior (TPB) which suggests that the intention to perform a behavior (e.g. pursuing a career in surgery) is the most critical and immediate predictor of performing the behavior. We investigated whether a two-part short-mentoring seminar significantly increases students' intention to pursue a career in a surgical or related specialty after graduation. METHOD: The mentoring and role-model seminar was conducted at 2 days for 90 minutes by six inspiring female role models with a remarkable career in surgical or related disciplines. Participants (N = 57) filled in an online survey before (T0) and after the seminar (T1). A pre-post comparison of central TPB concept attitude towards the behavior, 2) occupational self-efficacy and 3) social norm) was conducted using a paired sampled t-test. A follow-up survey was administered 12 months later (T2). RESULTS: The mentoring seminar positively impacted female students' attitude towards a career in a surgical specialty. Female students reported a significantly increased positive attitude (p < .001) and significantly higher self-efficacy expectations (p < .001) towards a surgical career after participating in the mentoring seminar. Regarding their career intention after the seminar, female students declared a significantly higher intention to pursue a career in a surgical specialty after graduating (p < .001) and this effect seems to be sustainable after 1 year. CONCLUSION: For the first time we could show that short-mentoring and demonstrating role models in a seminar surrounding has a significant impact on female medical student decision´s to pursue a career in a surgery speciality. This concept may be a practical and efficient concept to refine the gender disparity in surgery and related disciplines.

Gender distribution of Top Doctors in otolaryngology-head and neck surgery.

INTRODUCTION: Our study seeks to understand the profiles of otolaryngologists selected by Castle Connolly's Top Doctor list and how this compares to the entire field of otolaryngology. METHODS: Top Doctor lists published in Castle Connolly affiliated magazines were analyzed for Otolaryngology, Otolaryngology/Facial Plastic Surgery, or Pediatric Otolaryngology physicians. Only lists published in 2021 or representing the 2021 Top Doctor lists were analyzed. Of the total 39 partnered magazines, 27 met our criteria. Information on the physician was analyzed from the Castle Connolly website and included: gender, education, faculty position, years as a Top Doctor, and certifications of each physician. RESULTS: 879 doctors, 742 (84%) men and 137 women (16%), were included in our analysis. 509 physicians completed a fellowship, 85 (62%) women and 424 (57%) men. The fellowship type varied significantly between gender (p = .002). 122 (14%) Top Doctors completed facial and plastic reconstructive surgery and 111 (91%) were men. Of the women Top Doctors completing a fellowship, 29 (34%) completed a fellowship in pediatric otolaryngology. A logistic regression found that men have an increased odds of being on the Top Doctors list for more years than females (OR: 1.36, p < .001). CONCLUSION: The percentage of women named as Top Doctors was less than the proportion of women in otolaryngology. This may be attributed to gender differences we found in fellowship type and certification. Further research into the role of otolaryngology subspecialties in selection of Top Doctors is needed to better understand gender differences.

Gender inequities in ENT: Insights from women speakers at American Head and Neck Society meetings.

BACKGROUND: Gender inequity exists across national speakers at American Head and Neck Society (AHNS) conferences. This qualitative study explores potential causes of this disparity by surveying women invited to speak at AHNS between 2007 and 2019 and examining advice, resources, and meaningful actions from "those who made it." METHODS: An internet search for contact information for the 131 female AHNS was performed. An electronic survey was distributed via email. Deidentified qualitative responses were coded by two independent researchers into themes. Themes characterize barriers that female head and neck (HN) surgeons face and describe ways to mitigate the impact of these for the next generation. RESULTS: Contact information for 73/131 female AHNS speakers was obtained via internet search. Email responses were received from 22/73 (30%). Of those, respondents specialized in otolaryngology (n = 17), medical oncology (n = 2), palliative care (n = 1), vascular surgery (n = 1), and thoracic surgical oncology (n = 1). All speakers worked in academic settings at varying stages of their career with 81.8% (18/22) of respondents fellowship-trained (primarily HN surgery). Concerns about gender disparity in ENT were grouped into the following themes: (1) recruiting women to ENT, (2) removing barriers to career advancement, (3) diversifying ENT's national presence, and (4) improving the broader culture of HN surgery. Respondents emphasized a need for diversifying leadership, early exposure to otolaryngology in medical school, and connecting students with female role models. Outstanding research, involvement at annual meetings, and committee membership were consistently deemed important for establishing a national presence in the field. Implicit bias, "boys clubs" culture, and burdensome childcare responsibilities were described as barriers to career advancement. CONCLUSIONS: While encouraging more women to enter otolaryngology residencies, increasing the number female role models and establishing strong mentoring networks may help to mitigate challenges. Meaningful progress requires the efforts of both male and female allies within the specialty. Simple solutions, such as educating on implicit bias, removing demographics from applications, and eliminating hidden penalties for maternity leave, may help improve diversity and mitigate barriers to career progression for underrepresented groups within ENT.

Being a Female Gastroenterologist in Turkey.

BACKGROUND/AIMS: Our aim is to examine the representation of woman gastroenterologists in both work and social life in Turkey and to elucidate the difficulties they encounter during their career pathways or while actively practicing their profession. MATERIALS AND METHODS: A self-structured survey consisting of 25 questions was sent via email to all 152 female gastroenterologists. Survey results were received from 140 participants. RESULTS: Sixty percent of the woman gastroenterologists had marriage-career conflicts, and 74% of them stated that they could not manage work-life balance with their children. Among these woman gastroenterologists, 46.6% of them reported that they had faced carrier-related barriers and challenges while applying for an academic rise or expecting a promotion in their job, 58.5% were exposed to gender mobbing, and 35.6% were subjected to verbal or physical violence. On the other hand, woman gastroenterologists are found to be underrepresented in endoscopic interventions where only one-third of the participants perform invasive endoscopic procedures, and the percentage of those who perform advanced endoscopy such as endoscopic submucosal dissection and endoscopic mucosal resection remains even less as 8.9%. The number of women in leadership positions during their careers is found to be low, and only 2 women were selected as the president of the society since 1959, the establishment time of the Turkish Society of Gastroenterology. CONCLUSION: More effort is needed to keep a fair gender balance in Turkish gastroenterology society and to increase the women's representation in therapeutic endoscopy options and also in leadership positions.

Excelencia en Neurocirugía: María Cristina García-Sancho, the First Latina Neurosurgeon in the World.

BACKGROUND: Neurosurgery is a specialty that has been dominated by males. Although there has been an increase in the number of women in the field, it is not yet close to being equal. Some noteworthy women who have carved the path for other women to follow in their footsteps include Drs. Sofía Ionescu and Diana Beck, the first and second female neurosurgeons worldwide, respectively. However, there are limited publications on Dr. María Cristina García-Sancho, the first Latina neurosurgeon. METHODS: The purpose of this review was to illuminate the neurosurgical community on the life of Dr. García-Sancho. A thorough literature was performed on medical and non-medical publications that were either authored by Dr. García-Sancho or mentioned her directly. RESULTS: Dr. García-Sancho earned her medical degree at the School of Medicine of the National Autonomous University of Mexico under the guidance of Dr. Clemente Robles, who founded Mexico's first neurosurgical department. Her training took her worldwide. CONCLUSIONS: Her expertise allowed her to pioneer a revolutionary advancement known as the one-step bilateral cordotomy. Her perseverance led her to becoming the head of the Department of Neurosurgery at the National Cancer Institute of Mexico and co-found the Mexican Society of Neurological Surgery, where she served on the board of directors. This review aims to advocate for an equitable environment in the field of neurosurgery with Dr. García-Sancho's story.

Gender, flexibility and workforce in the NHS: A qualitative study.

Data from the General Medical Council show that the number of female doctors registered to practise in the UK continues to grow at a faster rate than the number of male doctors. Our research critically discusses the impact of this gender-based shift, considering how models of medical training are still ill-suited to supporting equity and inclusivity within the workforce, with particular impacts for women despite this gender shift. Drawing on data from our research project Mapping underdoctored areas: the impact of medical training pathways on NHS workforce distribution and health inequalities, this paper explores the experiences of doctors working in the NHS, considering how policies around workforce and beyond have impacted people's willingness and ability to continue in their chosen career path. There is clear evidence that women are underrepresented in some specialties such as surgery, and at different career stages including in senior leadership roles, and our research focuses on the structural factors that contribute to reinforcing these under-representations. Medical education and training are known to be formative points in doctors' lives, with long-lasting impacts for NHS service provision. By understanding in detail how these pathways inadvertently shape where doctors live and work, we will be able to consider how best to change existing systems to provide patients with timely and appropriate access to healthcare. We take a cross-disciplinary theoretical approach, bringing historical, spatiotemporal and sociological insights to healthcare problems. Here, we draw on our first 50 interviews with practising doctors employed in the NHS in areas that struggle to recruit and retain doctors, and explore the gendered nature of career biographies. We also pay attention to the ways in which doctors carve their own career pathways out of, or despite of, personal and professional disruptions.

Advanced degrees, gender, and professional rank in surgery, disparities in academic medicine.

INTRODUCTION: Women comprise nearly half of all residents in training, yet there is a significant disparity of women in academic leadership. Surgical subspecialties are dominated by men in both percentages of physicians and leadership positions. We sought to examine the association of advanced non-medical degrees with academic rank and gender in academic surgery departments. METHODS: Faculty from 126 ACGME-accredited academic medical centers were analyzed to identify faculty gender as described in online biographical information, advanced non-medical degrees, academic rank, and additional leadership positions held. Descriptive statistics and logistic regression models were used for statistical analyses. RESULTS: 4536 surgeons were identified, 69.3% men, 27.3% female, and 3.3% unlisted. Female surgeons were more likely to hold advanced non-doctoral degrees than men (18.2% vs. 13.8%, p â€‹< â€‹0.002). Among those with advanced degrees, PhDs were held by 3.3% of women and 5.7% of men (p â€‹< â€‹0.001). Female surgeons were less likely to hold the rank of Professor than male surgeons (15.8% vs 30.3%, p â€‹< â€‹0.001), and more likely to hold the rank of Assistant Professor than male surgeons (51.9% vs 36.1%, p â€‹< â€‹0.001). This likelihood remained true when analyzing only surgeons with one or more advanced non-medical degrees. Men were more likely to be Chair of Surgery (3.0%), Division Chief (9.6%), and Research Chair (0.5%); compared to women (1.3%; 4.8%; 0.2%; p â€‹= â€‹0.001, <0.001, 0.21 respectively). CONCLUSIONS: There continues to be a significant male predominance in general surgery. Gender discrepancy is also seen in professional rank and academic title despite women holding more advanced degrees. Advanced degrees are currently considered academic qualifications, but this does not reflect surgical academic leadership roles or rank.

Gender representation in the Central Surgical Association: A call to action.

BACKGROUND: Organizations such as the Central Surgical Association are important for promulgating advances in general surgery, but diversity and inclusion profoundly affect what is presented and discussed. The objective of this study was to evaluate gender representation trends at the Central Surgical Association and its annual meetings over the past 13 years. METHODS: Publicly available Central Surgical Association meeting proceedings from 2010 to 2022 were reviewed for society leaders, new members, invited speakers and moderators, and contributors to scientific sessions (first authors, senior authors). Gender identity was assessed through professional online platforms. The 2017 and 2021 meetings were conjoined with the Midwest Surgical Association. Incomplete data were obtained from 2013 and 2020-2022. RESULTS: A total of 2,158 individuals were reviewed, 554 (25.7%) of which were women. The overall trend of the absolute proportion of women participation increased by 1.8% per year (R2 = 0.7, P < .01). For leadership roles, 42/205 (20%) were women, with a 2.4% per year increase (R2 = 0.45, P = .02). For speaker roles, 82/384 (21.4%) were women, with a 2.2% increase per year (R2 = 0.6, P < .01). For scientific contributions, 253 first (35.9%) and 136 (19.3%) senior authors of 704 were women, with 1.5% (R2 = 0.4, P = .02) and 1.3% (R2 = 0.4, P = .03) increase per year, respectively. CONCLUSION: There has been a positive trend in women's involvement at Central Surgical Association meetings for leaders, speakers, and scientific authors. Diversity allows variate experiences to contribute to surgical advancements; thus, measures by the Central Surgical Association to ensure adequate representation should continue.

Paving a Path to Gender Parity: Recent Trends in Participation of Women in an Academic Surgery Society (Society for Surgery of the Alimentary Tract).

INTRODUCTION: The proportion of women surgeons is increasing, although women in surgical leadership and research has not kept pace. The Society for Surgery of the Alimentary Tract (SSAT) pledged its commitment to diversity and inclusion in 2016. Our study sought to evaluate the temporal trend of gender representation in leadership, speakership, and research at SSAT. METHODS: Publicly available SSAT meeting programs from 2010 to 2022 were reviewed to assess gender proportions within leadership positions (officers and committee chairs); invited speakerships, multidisciplinary symposia, and committee panel session moderators and speakers; and contributions to scientific sessions (moderator, first author and senior author). Verified individual professional profiles were analyzed to categorize gender as woman, man, or unavailable. Descriptive and trend analyses using linear regression and chi-squared testing were performed. RESULTS: A total of 5506 individuals were reviewed; 1178 (21.4%) were identified as women and 4328 (78.6%) as men or did not have available data. The absolute proportion of total female participation increased by 1.05% per year (R2=0.82). There was a statistically significant difference in the total proportion of women participation before and after 2016 (18.5% vs. 27.1%, p<0.01). Increases in the proportion of women were demonstrated in leadership, invited speakerships, multidisciplinary symposia, committee panel sessions, research session moderators, and abstract first authors. The proportion of women senior authors remained stagnant. CONCLUSION: Though this upward trajectory in SSAT women participation is encouraging, current trends predict that gender parity will not be reached until 2044.