Increased female political representation associated with lower county-level uninsured and preventable hospitalizations rates in the United States, 2013-2018.

OBJECTIVE: Although women comprise 50% of the population, females remain underrepresented in government. Inequitable female political representation, a form of structural sexism, may impact population health. Previous studies focused primarily on individual health behaviors and low- or middle-income countries. To date, no study has examined the association between female political representation and healthcare access and utilization, immediately policy-amenable outcomes, in the United States. STUDY DESIGN: This was a repeated cross-sectional study. METHODS: This study uses 2013-2018 county-level data from the County Rankings. I performed multilevel analyses to determine the relationships between state-level female representation (% female state legislators) and two outcomes-the percentage of county-level population under age 65 years without health insurance (primary outcome) and the county-level preventable hospitalization rates (secondary outcome of interest). Potential confounders included county-level and state-level characteristics such as the unemployment rate. I also examined whether associations differed by political party control of the state legislature. RESULTS: In the fully adjusted model, one standard deviation difference in female political representation was associated with a decrease of 0.22 percentage points in county-level uninsured (95% confidence interval = -0.32, -0.12). The association between female political representation and preventable hospitalization rate differed according to state political party in control, with a decrease found only among counties in democratic/split controlled states (-80.51, 95% confidence interval = -149.65, -11.38). CONCLUSIONS: The results suggest that policy intervention addressing the underrepresentation of women in government may help increase the proportion of uninsured and, under certain circumstances, decrease county-level unnecessary hospitalizations. However, further research is needed to better understand the role of political party control in modifying noted associations.

Differences in Practice Patterns and Payments for Female and Male Dermatologists: A Canadian Population-Based Study Over 3 Decades.

BACKGROUND: Canada's fee-for-service physician reimbursement system, where a set rate is provided for each service, suggests that a physician sex pay gap should not exist. However, recent evidence has questioned this presumption. OBJECTIVES: To characterize trends in demographics and billing, overall and by sex, for dermatologists compared to other medical and surgical specialty groups in Ontario, Canada. METHODS: Using population-based data, analysis of physician billing and clinical activity from Ontario, Canada, over 27 years (1992-2018) was performed. Multilevel regression models were used to examine unadjusted and adjusted differences in payments between females and males over time, while controlling for age, distinct patients seen, patient visits, and full-time equivalent. RESULTS: A total of 22 389 physicians were included in the analyses, including 381 dermatologists. The proportion of female dermatologists increased from 32% in 1992 to 46% in 2018. Dermatologists' median Ontario Health Insurance Plan (OHIP) payments were $415 340 (IQR: 285 630-566 580) in 1992 compared to $296 750 (IQR: 164 480-493 180) in 2018. Male dermatologists' OHIP payments were 20% more than their female counterparts across the entire study period. After adjusting for practice volumes, there was no significant pay gap amongst female and male dermatologists (P = .42); however, the sex pay gap remained significant for the other specialty groups (P < .001). From 1992 to 2018, dermatologists on average saw 19% fewer distinct patients per year and 15% fewer visits per patient. CONCLUSIONS: The overall sex pay gap within medical dermatology can be attributed to differences in practice patterns, whereas the sex pay gap remained significant in the other specialty groups.

Investing in the future: a call for strategies to empower and expand representation of women in neurosurgery worldwide.

As progress is gradually being made toward increased representation and retention of women in neurosurgery, the neurosurgical community should elevate effective efforts that may be driving positive change. Here, the authors describe explicit efforts by the neurosurgery community to empower and expand representation of women in neurosurgery, among which they identified four themes: 1) formal mentorship channels; 2) scholarships and awards; 3) training and exposure opportunities; and 4) infrastructural approaches. Ultimately, a data-driven approach is needed to improve representation and empowerment of women in neurosurgery and to best direct the neurosurgical community's efforts across the globe.

An Analysis of the Relationship Between Female Faculty and Female Resident Representation in Neurosurgery Residency Programs.

BACKGROUND: Promoting minorities within medical specialties has been postulated to be crucial to patient care and recruitment of diverse candidates. This concept has been suspected but not formally studied in the minority of women faculty and trainees in neurosurgery. We aimed to quantitatively investigate the postulated correlation relative to female representation in neurosurgery. METHODS: Data obtained from accredited neurosurgery residency programs were reviewed. Data describing the percentage of female residents and 6 demographic and 14 program-specific variables were collected. All program websites were reviewed to assess percentages of female faculty and visible commitment to diversity in applicants, evident through communicated policies, statements, or initiatives. Included programs were defined as "low" or "high" percentage of female residents or faculty relative to the grouped median value for both categories; groups were assessed for significant differences. Percentages of female faculty and residents and program-communicated diversity initiatives were investigated for significant correlation. RESULTS: Female faculty and diversity data were available at 117 program sites; 81 programs reported female resident percentages. Analysis revealed a significant positive correlation between female faculty and female resident percentages. Programs with higher female resident percentages had higher levels of diversity in terms of race and ethnicity. No significant correlation was found between the percentage of female faculty or residents and a communicated diversity initiative. CONCLUSIONS: This study of current female representation in neurosurgery revealed a previously undocumented positive correlation between percentages of female faculty and female trainees. These data suggest a modifiable barrier to female entry into neurosurgical residency programs.

Gender Inequality Improvement in Medical School Admissions in Japan.

Purpose: To investigate the effects of gender discrimination in Japan's medical school admission process and to assess whether the situation has improved since the disclosure of such discrimination in 2018. Materials and Methods: A cross-sectional study was conducted using secondary data from the Ministry of Education, Culture, Sports, Science, and Technology. The proportions of male and female applicants vis-à-vis all successful candidates admitted from 2016 to 2021 were analyzed; four medical schools were found to be systematically guilty of discriminatory admission practices. Acceptance rate ratios (ARRs) were estimated, and difference-in-differences (DID) analysis was used to examine the differences in ARRs between the two groups-the 4 and 75 medical schools that were and were not reported, respectively-in the predisclosure (2016-2018) and postdisclosure (2019-2021) periods. Results: Female applicants were subjected to discriminatory admission practices at the four reported medical schools in the predisclosure period. However, postdisclosure, those four medical schools had higher female than male acceptance rates in all 3 years. DID analysis revealed a statistically significant estimated average treatment effect on the treated of 0.25148 (95% confidence interval [0.00455-0.49840]), indicating a 0.25-point increase in ARRs relative to the other 75 medical schools. Conclusions: Discriminatory practices against female applicants have decreased since the disclosure in 2018, with the acceptance rate of female students exceeding that of male students for the first time in 2021. In response to these findings, we propose recommendations to further promote gender equality in medicine.

Gender Disparity in Academic Trauma Surgery: The Current State of Affairs.

INTRODUCTION: Despite the increasing number of female surgeons in general surgery programs, women are still inadequately represented in leadership positions. This study aims to investigate the magnitude of gender bias in university-based trauma surgery fellowship programs and leadership positions in the United States of America. MATERIAL AND METHODS: FRIEDA was used to identify trauma surgery programs. A thorough website review of each program obtained further information on faculty members, including their name, age, gender, and faculty rank. Trauma surgeons with an MD or DO qualification and a faculty rank of Professor, Associate Professor, or Assistant Professor were selected for inclusion in this study. SCOPUS was used to assess the H-index and the number of publications and citations of surgeons. RESULTS: The total number of programs included was 136, consisting of 715 faculty members. Less than a quarter (n = 166; 23.2%) comprised females and less than one-fifth (n = 30; 19%) of female surgeons were Professors. The difference in the research productivity of male and female trauma surgeons was statistically significant (P < .05), with the average H-index being 10 vs 7.5, respectively, amongst the top 50 surgeons of both genders. Based on a multiple regression analysis, academic rank was significantly associated (P < .05), and gender was not significantly associated (P > .05) with H-index. CONCLUSION: Gender disparity exists in the field of trauma surgery, as noted in senior faculty ranks and leadership positions. Female-inclusive state policies, appropriate mentorship, and supportive institutions can help to bridge this gap.

Regional distribution in female representation in US otolaryngology faculty.

Objectives: To quantify the current proportion of women in otolaryngology at different levels of professorship and determine whether these proportions differ by US region. Methods: Academic rank and gender at all ACGME-accredited otolaryngology programs in the United States were determined from departmental websites, Doximity, and LinkedIn from November 2021 to March 2022. Individuals were then further organized using US Census Bureau-designated regions. Results: Among the 2682 faculty positions at 124 ACGME-accredited programs, women held 706 (26.3%) of these positions. Female representation was highest at the assistant professorship level, with women holding 286 (37.2%) positions out of a total 769. At the associate professorship level, women held 141 (27.6%) of the 511 total positions. The largest gender disparity is seen at the full professorship level; only 69 (13.6%) positions out of 508 were held by women. Out of every region and rank, only assistant professorship in the West had no significant difference in percentages of men and women (p = .710). Female representation of professors in the Northeast was significantly lower than that of our reference group (the South; ß = -10.9, p = .020). Conclusions: Otolaryngology has exhibited great progress in increasing female representation, with assistant professorship in the West reaching gender parity. However, the gender gap at other faculty levels still leaves much to be desired, particularly in senior ranks. The lack of otolaryngologists at senior ranks is detrimental to mentorship of junior faculty, residents, and medical students. Renewed efforts should be made to decrease the gender disparity in the South, Northeast, and particularly at the professorship level.

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.

Women in trauma and orthopaedics: are we losing them at the first hurdle?

INTRODUCTION: Diversity in the healthcare workforce is associated with improved performance and patient-reported outcomes. Gender disparity in Trauma and Orthopaedics (T&O) is well recognised. The aim of this study was to compare factors that influence career choice in T&O between male and female final-year students. Furthermore, the trend of representation of women in T&O over the last decade was also compared with other surgical specialities. METHODS: An online survey of final-year students who attended nationally advertised T&O courses over a 2-year period was conducted. Data from NHS digital was obtained to assess gender diversity in T&O compared with other surgical specialities. RESULTS: A total of 414 students from 13 UK medical schools completed the questionnaire. Compared with male students (34.2%), a significantly higher proportion of women (65.8%) decided against a career in T&O, p<0.001. Factors that dissuaded a significantly higher percentage of women included gender bias, technical aspects of surgery, unsociable hours, on-call commitments, inadequate undergraduate training and interest in another specialty (p<0.05). Motivating factors for choosing a career in T&O were similar between both sexes. T&O was the surgical specialty with the lowest proportion of women at both consultant and trainee level over the last decade. CONCLUSION: T&O remains an unpopular career choice among women. To enhance recruitment of women in T&O, future strategies should be directed toward medical students. Universities, orthopaedic departments and societies must work collaboratively to embed culture change, improve the delivery of the undergraduate curriculum, and facilitate students' exposure to operating theatres and female role models.

Primum Non Discernere: Glass Ceilings and Female Representation at the European Association of Urology and European Society for Paediatric Urology Annual Meetings, 2012-2022.

Background: The term glass ceiling coined by Loden in 1978 is commonly used to describe difficulties faced by minorities and women when trying to move into senior roles. Objective: To analyse trends and patterns for female representation at the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) annual general meetings over the past decade. Design setting and participants: We used objective data on female representation in the roles of chairs, moderators, and lecture speakers at the EAU and ESPU meetings from 2012 to 2022. Outcome measurements and statistical analysis: We evaluated gender based representation in paediatric urology sessions at the EAU and ESPU meetings, collecting data on the overall number of sessions, lectures, symposiums, abstract/poster sessions, and courses, and analysed the male/female ratio. Data were derived from printed and digital programmes for the relevant meetings. Results and limitations: During the period from 2012 to 2022, the percentage female representation varied from 0% (2012) to a maximum of 35% (2022) at EUA paediatric urology sessions, and from 13.5% (2014) to a maximum of 32% (2022) at ESPU meetings. Both associations show clear progression towards equality. Conclusions: Female representation at EAU and ESPU meetings has risen over the years, reaching 35% and 32%, respectively, in 2022, which is in line with the number of female members. We hope that this motivates a move towards the equality objectives for 2030. A clear and fundamental societal change is needed, with fair and more consistent institutional policies and framework commitments in the areas of science, medicine, and global health. Gender equality and diversity taskforces are essential to achieve these goals. Patient summary: We analysed the male/female ratio for participants in annual meetings held by the European Association of Urology and the European Society for Paediatric Urology. From a low level in 2012, the ratio increased to over 30% in 2022, in line with the female membership of the societies. Focus on fair and consistent policies is needed to ensure that women are well represented in medicine.

Trends in female representation in gastroenterology fellowships in the United States.

Background: Women have historically been underrepresented in gastroenterology (GI). Currently they compose only a small percentage of practicing GI physicians in the United States. Despite the rise in women graduating medical school, the percentage of current female GI fellows has remained low in recent years. In this study, we sought to examine the trends of female representation in GI over the past 10 years, to further elucidate the disparity, and to illustrate if any major changes have occurred. The findings were compared to those for other specialties to shed light on the relationship between them. Methods: This retrospective study used data on the gender of residents obtained through the Accreditation Council for Graduate Medical Education Data Resource Books from 2009-2019. Chi-square statistical testing was used to compare representation percentages across groups. Significance was determined at the P<0.05 level, while P<0.01 was also reported. Results: Over a 10-year period from 2009-2019, an average of 33.6% of GI fellowship positions were filled by women, an increase of only 3.3% since 2009. Chi-square analysis of proportions across groups demonstrated a significantly lower percentage of female representation in GI in comparison to other specialties. Conclusions: Despite an increase in the number of women entering and graduating from medical school within the last decade, the number of female gastroenterologists remains a poor reflection of it. GI continues to have a significantly lower female representation than other specialties over the last decade.

Gender-Related Trends in Publication Authorship: A 10-Year Analysis of a Brazilian Surgical Journal.

There is a gender gap in the representation of women in the authorship of surgical literature worldwide. In Brazil, data on the gender distribution of the authorship of articles are scarce; and hence, there is a lack of awareness about the contemporary situation of women surgeons within the academic surgery in the country. In light of this, we conducted this study with an aim to describe and evaluate the authorship trends in a Brazilian surgical journal over a period of 10 years (2010-2019). We included 4,301 authors from 792 articles extracted from 60 editions of this journal. We analyzed the female representation as authors in general, first and last authors, and the female surgeons' representation as first and last authors for 568 original articles. We found that, in general, women represented 27.8% of all authors. Regarding original articles, women surgeons represented 8.4% and 6.1% of first and last authors, respectively. The linear regression analysis demonstrated that there was an increase over the years in women authorship. However, despite this increase over the years, a gender gap still persists in terms of women's representation as authors in the Brazilian surgical literature.

Female Representation in Otolaryngology Leadership Roles.

OBJECTIVES/HYPOTHESIS: Characterization of leadership within otolaryngology is key to evaluating trends and promoting program advancement. This study evaluates representation of women in otolaryngology holding residency and fellowship directorships, or chair positions, comparing sex differences in academic rank, years in practice, and scholarly activity. STUDY DESIGN: Cross sectional analysis. METHODS: A comprehensive list of otolaryngology residency and fellowship directors from Accreditation Council for Graduate Medical Education-accredited programs in 2017 to 2018 was compiled. Academic rank and years in practice were determined from departmental websites, with online search tools used as secondary resources. The h-index was utilized as a measure of research productivity. Regression analysis was performed to analyze these variables. RESULTS: Among the 306 directorships, women held 57 (18.6%) of these positions, 27 (26.5%) residency and 30 (14.7%) fellowship directorships. Of the 99 chair positions, five (5.1%) were held by women. The majority (53.6%) of male directors were full professors, whereas only 26.3% of females were full professors (P = .04). Mean years in practice for female directors (13.9 ± 6.8) was less than that of male directors (20.3 ± 9.4, P < .0001). Similarly, mean h-index for female directors (11 ± 7.2) was lower than for males (17.5 ± 12.5, P = .0001). After controlling for academic rank and years of practice in a multivariable regression, the h-index remained lower for women than for men (P = .03). CONCLUSIONS: Women are disproportionately underrepresented in positions of residency and fellowship directorships, and chair positions, consistent with other specialties. Women in leadership had lower academic ranks, fewer years of practice, and lower h-indices than their male counterparts. This may represent a shift in academic otolaryngology as female otolaryngologists seek early involvement in leadership. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1664-1669, 2020.

Trends in female leadership at high-profile otolaryngology journals, 1997-2017.

OBJECTIVES: To determine the proportion and relative advancement of women in leadership positions at high-impact otolaryngology journals. METHODS: Nine clinical otolaryngology journals were selected based on high impact factor and subspecialty representation (journal impact factor, 2016: 1.16-2.95). The proportion of women editorial board members associate and/or section editors, and/or editor-in-chief was measured from 1997 to 2017. Comparisons were made to the proportion of women otolaryngology faculty at U.S. medical schools in 2017. RESULTS: From 1997 to 2017, female editorial board membership increased from 7.2% (range: 0.0%-12.8%) to 17.7% (range: 10.9%-38.9%) (P = 0.0001). In 2017, the proportion of female editorial board members was significantly less than the proportion of female academic otolaryngology faculty (17.7% vs. 27.7%, P = 0.0001), and there was threefold variation between journals. From 1997 to 2017, the proportion of female associate and/or section editors increased from 9.3% (range: 0.0-27.3) to 20.9% (range: 5.3% to 45.5%) (P = 0.09). In 2017, the proportion of female associate and/or section editors was not significantly different than the proportion of female associate or full professor academic otolaryngology faculty (20.9% vs. 19.5%, P = 0.73), but there was ninefold variation between journals. CONCLUSION: Women were underrepresented on eight of nine otolaryngology editorial boards but appropriately represented at the associate and/or section editorship level. There was remarkable variation in representation at individual journals, which may provide future opportunities to examine best practices. Disparity exists in leadership at the most senior level of these high-profile otolaryngology journals: none had women editor-in-chiefs. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2031-2035, 2019.