Don't Hold Your Breath—The Rise of Women on Journal Editorial Boards

Abstract

THE FIRST issue of the Journal of Cardiothoracic and Vascular Anesthesia appeared in 1987. That same year Aretha Franklin became the first woman inducted into the Rock and Roll Hall of Fame, Margaret Thatcher was elected as Prime Minister of the United Kingdom for the third time, and first-year female residents in Obstetrics and Gynecology outnumbered men for the first time. Fast forward to 2019, and even though women now account for about half of all medical school graduates, significant disparities still exist across most aspects of their professional career development and advancement. For literally decades, studies have confirmed a disproportion in the gender composition of journal editorial boards across a large number of specialties. Despite an upward trend in the number of women holding a seat at the table, the rate of increase has been slow, and the proportions generally are not reflective of the representation of women in their respective specialties. Few studies have examined the editorial board composition of anesthesiology journals (Table 1),1Morton M.J. Sonnad S.S. Women on professional society and journal editorial boards.J Nat Med Assoc. 2007; 99: 764-771PubMed Google Scholar, 2Amrein K. Langmann A. Fahrleitner-Pammer A. et al.Women underrepresented on editorial boards of 60 major medical journals.Gender Med. 2011; 8: 378-387Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar, 3Lorello G.R. Parmar A. Flexman A.M. Representation of women on the editorial board of the Canadian Journal of Anesthesia: A retrospective analysis from 1954 to 2018.Can J Anesth. 2019; 66: 989-990Crossref PubMed Scopus (22) Google Scholar, 4Miller J. Chuba E. Deiner S. et al.Trends in authorship in anesthesiology journals.Anesth Analg. 2019; 129: 306-310Crossref PubMed Scopus (59) Google Scholar, 5Pagel P.S. Freed J.K. Lien C.A. Gender composition and trends of Journal of Cardiothoracic and Vascular Anesthesia editorial board membership: A 33-year analysis, 1987-2019.J Cardiothoracic Vasc Anesth. 2019; 33: 3229-3234Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar and to date, none has specifically addressed the subspecialty of cardiothoracic anesthesia.Table 1Representation of Women on Anesthesiology Journal Editorial BoardsCitationJournal(s) ExaminedTimeline% Female Editorial Board MembersMorton et al.1Morton M.J. Sonnad S.S. Women on professional society and journal editorial boards.J Nat Med Assoc. 2007; 99: 764-771PubMed Google ScholarAnesthesiologyAnesthesia & AnalgesiaMarch 200410.9%4.8%Amrein et al.2Amrein K. Langmann A. Fahrleitner-Pammer A. et al.Women underrepresented on editorial boards of 60 major medical journals.Gender Med. 2011; 8: 378-387Abstract Full Text Full Text PDF PubMed Scopus (198) Google ScholarAnesthesiologyPain British Journal of AnaesthesiaEuropean Journal of PainAnesthesia & Analgesia201011.6%23.9%9.4%24.2%6.9%(overall 15%)Lorello et al.3Lorello G.R. Parmar A. Flexman A.M. Representation of women on the editorial board of the Canadian Journal of Anesthesia: A retrospective analysis from 1954 to 2018.Can J Anesth. 2019; 66: 989-990Crossref PubMed Scopus (22) Google ScholarCanadian Journal of Anesthesia1954–20181996*Year that first woman joined the editorial board.–2018201420172019†Data from 2019 described anecdotally in study but not part of analysis.6%11%0%19%25%†Data from 2019 described anecdotally in study but not part of analysis.Miller et al.4Miller J. Chuba E. Deiner S. et al.Trends in authorship in anesthesiology journals.Anesth Analg. 2019; 129: 306-310Crossref PubMed Scopus (59) Google ScholarAnesthesiologyAnesthesia & Analgesia(combined)20022007‡Unable to extract actual percentages from published graphic representation of trends for 2007 and 2012; however, the trend was upward after 2007.2012‡Unable to extract actual percentages from published graphic representation of trends for 2007 and 2012; however, the trend was upward after 2007.20179.5%––15.5%Pagel et al.5Pagel P.S. Freed J.K. Lien C.A. Gender composition and trends of Journal of Cardiothoracic and Vascular Anesthesia editorial board membership: A 33-year analysis, 1987-2019.J Cardiothoracic Vasc Anesth. 2019; 33: 3229-3234Abstract Full Text Full Text PDF PubMed Scopus (20) Google ScholarJournal of Cardiothoracic and Vascular Anesthesia1987–19951996–20032004–20112012–20192.9%7.2%9.8%16.2% Year that first woman joined the editorial board.† Data from 2019 described anecdotally in study but not part of analysis.‡ Unable to extract actual percentages from published graphic representation of trends for 2007 and 2012; however, the trend was upward after 2007. Open table in a new tab In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Pagel et al. followed-up on their recent publication on gender trends in authorship and publishing in the journal6Pagel P.S. Freed J.K. Lien C.A. Gender differences in authorship in the Journal of Cardiothoracic and Vascular Anesthesia: A 28-year analysis of publications originating from the United States, 1990-2017.J Cardiothorac Vasc Anesth. 2019; 33: 593-599Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar with a study on the journal's editorial board composition over a 33-year timespan, from the journal's inception in 1987 to the present.5Pagel P.S. Freed J.K. Lien C.A. Gender composition and trends of Journal of Cardiothoracic and Vascular Anesthesia editorial board membership: A 33-year analysis, 1987-2019.J Cardiothoracic Vasc Anesth. 2019; 33: 3229-3234Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The study period was divided into quartiles (1987–1995, 1996–2003, 2004–2011, and 2012–2019), and among the 2,787 members who could be positively identified by gender, 11.1% were women (310/2,787). Further breakdown yielded that women represented the following: 13.0% associate and section editors (54/414) and 10.9% general editors (256/2,353). An upward trend in female board membership was noted at each quartile, with an overall increase from 2.5% to 15.8%, mostly because of an increase in general editors. As has been reported across numerous medical and surgical specialty/subspecialty journals, women also are underrepresented on the journal's editorial board relative to practicing female academic cardiothoracic anesthesiologists in the United States. Along similar lines, Pagel et al. noted gender gaps between first and senior authorship and board composition when data from their original study were correlated.6Pagel P.S. Freed J.K. Lien C.A. Gender differences in authorship in the Journal of Cardiothoracic and Vascular Anesthesia: A 28-year analysis of publications originating from the United States, 1990-2017.J Cardiothorac Vasc Anesth. 2019; 33: 593-599Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar How women in the other anesthesiology subspecialties fare is unknown at this point. The few studies that included editorial board membership data for both Anesthesiology and Anesthesia & Analgesia showed a wide gender gap between the 2 journals, with Anesthesiology being more favorable toward women. Both journals include members from various subspecialties, and published studies have examined only overall numbers without any breakdown. If one considers that adult cardiothoracic anesthesia is a predominantly male-dominated subspecialty, the number of women serving on the Journal of Cardiothoracic and Vascular Anesthesia board may be somewhat better compared with that of Anesthesiology and Anesthesia & Analgesia, although this has yet to be determined. It would be interesting to examine the breakdown of women on the latter journal's board relative to the subspecialties. For instance, are women better represented in the obstetric and pediatric anesthesia sections? Women in medicine have faced unique challenges since the achievement of equal representation in medical school. One would have hoped that the natural progression would be for them to find their place professionally across the spectrum of medical specialties, including research opportunities, grants and awards, academic advancement, speaking opportunities at society conferences, compensation, editorial board membership, and leadership opportunities. Based on what we already know, parity is nowhere in sight, so don't hold your breath, and despite things “getting better,” the pace has been sluggish and trends have not kept up with the changing demographic. The interrelationship among academic position, scholarly output, and leadership roles still contributes to the likelihood of being on an editorial board. The invitation or nomination to serve on a journal's editorial board can be based on a number of factors, including academic rank, number of peer reviewed publications, and research expertise.7Kennedy B.L. Lin Y. Dickstein L.J. Women on the editorial boards of major journals.Acad Med. 2001; 76: 849-851Crossref PubMed Scopus (58) Google Scholar Serving on an editorial board is an honor, but it also is a springboard to further career advancement for many. Benefits of being on a board include the development of relationships with other peers, formation of new professional networks, advancement of scholarship, and recognition as an expert in one's specialty. Gender disparities in the composition of journal editorial boards were brought to our attention in the 2008 study by Jagsi et al., which examined the gender composition of editors-in-chief and editorial board members from 16 high-impact medical journals from 1970–2005.8Jagsi R. Tarbell N.J. Henault L.E. et al.The representation of women on the editorial boards of major medical journals: A 35-year perspective.Arch Intern Med. 2008; 168: 544-548Crossref PubMed Scopus (93) Google Scholar The authors found that gender distribution increased from 1.4% in 1970 to 16.0% in 2005, with an overall 11.5% representation during the study period. Even though the trend was positive, is this really good enough? How should we define the appropriate proportion of women occupying editorial board seats? A common theme across studies is that there has been a small uptick in female editorial board membership, but that it is not representative of the overall proportion of faculty members in the various specialties, including radiology,9Piper C.L. Scheel J.R. Lee C.I. et al.Representation of women on radiology journal editorial boards: A 40-year analysis.Acad Radiol. 2018; 25: 1640-1645Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar anesthesiology,1Morton M.J. Sonnad S.S. Women on professional society and journal editorial boards.J Nat Med Assoc. 2007; 99: 764-771PubMed Google Scholar emergency medicine,10Miro O. Burillo-Putze G. Plunkett P.K. et al.Female representation on emergency medicine editorial teams.Emerg Med. 2010; 17: 84-88Google Scholar and dermatology.11Gollins C.E. Shipman A.R. Murrell D.F. A study of the number of female editors-in-chief of dermatology journals.Int J Womens Dermatol. 2017; 3: 185-188Crossref PubMed Scopus (19) Google Scholar Even in the traditionally female-dominated areas of pediatrics and obstetrics and gynecology, the proportion of female board members has been significantly less than the proportion of women in these specialties.1Morton M.J. Sonnad S.S. Women on professional society and journal editorial boards.J Nat Med Assoc. 2007; 99: 764-771PubMed Google Scholar, 7Kennedy B.L. Lin Y. Dickstein L.J. Women on the editorial boards of major journals.Acad Med. 2001; 76: 849-851Crossref PubMed Scopus (58) Google Scholar The presence of a female editor-in-chief, a rarity in itself, was not correlated with higher percentages of female editorial board members in a few studies that examined this relationship.2Amrein K. Langmann A. Fahrleitner-Pammer A. et al.Women underrepresented on editorial boards of 60 major medical journals.Gender Med. 2011; 8: 378-387Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar, 8Jagsi R. Tarbell N.J. Henault L.E. et al.The representation of women on the editorial boards of major medical journals: A 35-year perspective.Arch Intern Med. 2008; 168: 544-548Crossref PubMed Scopus (93) Google Scholar The question of requisite qualifications and selection criteria for women to be appointed to society journal editorial boards was posed in a brief communication penned by a female cardiovascular surgeon from Japan, a country where the gender disparities are exceedingly high.12Tomizawa Y. What are the qualifications and selection criteria for women to be appointed to society journal editorial boards?.Gen Thorac Cardiovasc Surg. 2014; 62: 131-132Google Scholar For instance, in 2012 the first woman was appointed to the editorial board of an English journal by the Japanese Association for Thoracic Surgery, making it the first female appointment as editor of an English journal among all surgical member societies of the Japanese Association of Medical Science. This author recommended that editor appointments should be based on unbiased and objective selection criteria. Disparities in advancement across multiple categories have left women lagging behind their male peers for a number of reasons, including the following: opportunity; implicit and explicit biases; discrimination; disproportionate child parenting and household responsibilities; delays in early career advancement; lack of support at departmental, institutional, and professional society levels; career path choices within academic practice; lack of mentorship and female role models; rigid organizational structures; and the pipeline phenomenon.13Jolly S. Griffith K.A. DeCastro R. et al.Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers.Ann Intern Med. 2014; 160: 344-353Crossref PubMed Google Scholar, 14Dickersin K. Fredman L. Flegal K.M. et al.Is there a sex bias in choosing editors? Epidemiology journals as an example.JAMA. 1998; 280: 260-264Crossref PubMed Scopus (64) Google Scholar, 15Robinson S. Lecky F. Mason S. Editorial boards: Where are all the women?.Eur J Emerg Med. 2010; 17: 61-62Google Scholar The disparities in editorial board membership are not unique to US publications, as illustrated in a geographic glimpse of the largest international radiologic societies that included 6 journals (January 2018 issues) with an impact factor ≥1 in which 19.13% of editorial board members were women.16Abdellatif W. Shao M. Jalal S. et al.Novel geographic thematic study of the largest radiology societies globally: How is gender structure biased within editorial boards?.Am J Roentgenol. 2019; 213: 2-7Crossref PubMed Scopus (33) Google Scholar Female board members in the higher academic echelons were less represented than their male counterparts and less likely to hold departmental leadership titles. Subcategorization of all editorial board positions showed that men predominated in all listed associate editor positions (100% for cardiac imaging) with the exception of (not surprisingly) breast imaging associate editor (63.64% female). This same trend also has been observed in the STEM (science, technology, engineering, and math) disciplines; social sciences; and business.14Dickersin K. Fredman L. Flegal K.M. et al.Is there a sex bias in choosing editors? Epidemiology journals as an example.JAMA. 1998; 280: 260-264Crossref PubMed Scopus (64) Google Scholar, 17Cho A.H. Johnson S.A. Schuman C.E. et al.Women are underrepresented on the editorial boards of journals in environmental biology and natural resource management.Peer J. 2017; 2: e542Google Scholar All the studies to date have had similar limitations, including: being limited to specific journals in one or more specialties; many studies examined fixed time points (eg, one specific month's issue for the year) or incremental versus continuous time points; potential selection bias of journals sampled; same editors being counted during each period in multiyear studies (instead of providing an absolute total number of individual women); different numbers of board members among journals; and the lack of information concerning women who might have declined offers to join a board. So how do we tackle this problem, and why is this important? Women should be in a position to reach their full potential. There is no lack of talent among women in medicine; however, outdated institutional hierarchies have held many women back. Editorial board members play an important role in the dissemination of scientific information to the medical community. Women can bring gender-specific life experiences and perspectives to the board and address underrepresented aspects of women's health and gender-specific data analysis. They can generate new ideas and affect decisions made when the board convenes. Just as international representation on editorial boards is important, so, too, is gender diversity.18Carnes M. Morrissey C. Geller S.E. Women's health and women's leadership in academic medicine: Hitting the same glass ceiling?.J Womens Health (Larchmt). 2008; 17: 1453-1462Crossref PubMed Scopus (197) Google Scholar, 19Heidari S. Babor T.F. De Castro P. et al.Sex and gender equity in research: Rationale for the SAGER guidelines and recommended use.Res Integr Peer Rev. 2016; 1: 2Crossref PubMed Google Scholar After all, women are a significant part of a journal's readership. Some approaches and initiatives have been suggested to help tip the balance, including early career mentoring; ad hocreviewing opportunities to develop the requisite skills; support from higher institutional levels (eg, department chair, institutional faculty development programs); integration of family considerations in order to level the playing field; evaluating board turnover rates versus length of tenure of more senior members; review of qualification thresholds for board membership; and monitoring the process for editorial board appointments and nominations. We also need to take note of the advancement of women at regular intervals (not every 10 years!), set goals, and follow-up on outcomes. So has this just been all talk and no action? Not exactly. A number of organizations have been addressing this problem. In its 2007 executive summary entitled “Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering,” the National Academy of Sciences, National Academy of Engineering, and Institute of Medicine proposed a series of guidelines intended to ensure adequate representation of women in many areas, including editorial boards.20National Academy of Sciences, National Academy of Engineering, and Institute of MedicineBeyond bias and barriers: Fulfilling the potential of women in academic science and engineering. National Academies Press, Washington, DC2007Google Scholar The European Association of Science Editors, which was established in 2012, has a Gender Policy Committee, for which one of the stated missions is to “encourage gender balance among reviewers, on editorial boards, and in editorial offices.”21European Association of Science Editors. Gender policy committee. Available at: http://old.ease.org.uk/about-us/organisation-and-administration/gender-policy-committee. Accessed August 7, 2019.Google Scholar The journal The Lancet recognizes the underrepresentation of women as authors, reviewers, and in editorial positions across journals. In response to these inequities, The Lancet launched its #LancetWomen project in December 2017.22Clark J. Horton R. What is The Lancet doing about gender and diversity?.Lancet. 2019; 393: 508-510Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar, 23Boylan J. Dacre J. Gordon H. Addressing women's under-representation in medical leadership.Lancet. 2019; 393: e14Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 24Editors of the Lancet GroupThe Lancet Group's commitments to gender equity and diversity.Lancet. 2019; 394: 452-453Google Scholar Lancet specialty journals (18 in all) made a commitment to reach gender parity on their editorial advisory boards by 2020. Eight of these journals already have met this goal. A diversity pledge has been posted on the journal's website (https://www.thelancet.com/diversity). The Lancet Group also has made a commitment to end all-male panels; stated that their editors would not serve on panels that did not include women at public conferences; and that for hosted events, the goal is for participation of at least 50% female speakers. Founded in 1823, The Lancet is one of the oldest and most well-recognized medical journals in the world, with an impact factor of 59. It is comforting to see that a journal as prestigious as The Lancet is leading the way, and hopefully other journals will follow suit. The American Society of Anesthesiologists in recent years has given rise to the first female anesthesia society, Women in Anesthesiology, Inc., whose mission is to support women anesthesiologists both professionally and personally by focusing on “techniques and tools that will help women physicians advance in their careers while addressing the specific challenges women physicians may face” (www.womeninanesthesiology.org). The Society of Cardiovascular Anesthesiologists similarly has introduced a Women in Cardiothoracic Anesthesia Special Interest Group. Along parallel lines, the corporate world has been gaining ground and even has set benchmarks with a timeline. In the corporate arena, women have faced challenges similar to those of physicians, for which a longstanding gender gap has been noted on boards of directors. A “2020 Women on Boards Gender Diversity Index (GDI)” was developed in 2011, representing a yearly review of the gender diversity in boards of directors of companies on the Russell 3000 Index and Fortune 1000 list. The stated goal is for all corporations to exceed a 20% threshold of women on boards by 2020.252020 Women on Boards. Gender diversity index: 2018 progress of women corporate directors by company size, state, and industry sector. Available at: https://www.2020wob.com/sites/default/files/2020WOB_GDI_Report_2018_FINAL.pdf. Accessed August 7, 2019.Google Scholar In this report, gender diversity is not construed as a social issue but rather as a strategic imperative. Pagel et al. have offered further insight into the problem of gender imbalance on journal editorial boards and for the first time have brought cardiothoracic anesthesia into the discussion. It is likely that over past decades, large numbers of talented female cardiothoracic anesthesiologists were overlooked when opportunities for professional advancement should have been at their disposal. Others simply grew weary of trying to prove themselves amid historically biased institutional hierarchies and succumbed to the norms of the day. The good news is that this topic is gaining widespread attention, with respected organizations across various disciplines setting realistic goals with timelines. Women are not looking for special concessions—they simply want access to the same opportunities that have been routinely afforded to their male counterparts. Now that we are abundantly aware of the problem, it is time for action. The authors do not have any conflicts of interest to declare. Gender Composition and Trends of Journal of Cardiothoracic and Vascular Anesthesia Editorial Board Membership: A 33-Year Analysis, 1987-2019Journal of Cardiothoracic and Vascular AnesthesiaVol. 33Issue 12PreviewGender disparities in editorial board composition exist in the vast majority of specialties including anesthesiology. If a similar lack of gender parity exists in cardiothoracic anesthesiology is unknown. The authors examined the gender composition and trends of the Journal of Cardiothoracic and Vascular Anesthesia (JCVA) editorial board from the initial year of its publication (1987) to 2019. The authors tested the hypothesis that the proportion of women serving on the JCVA editorial board has steadily increased over the journal's history, but women are underrepresented compared with the percentage of those currently practicing academic cardiothoracic anesthesia in the United States (US). Full-Text PDF