Pushing Propofol and Gender Equity-Female Authorship in Anesthesia Publications.

Abstract

Purpose: While women and men have graduated from medical school in similar proportions since 2009, some specialties, such as anesthesia, have lagged behind in equal gender representation. This difference is especially evident when it comes to academic leadership roles. 1,2 As promotion in academic medicine is influenced by scholarly activities including research and publication, it is important to understand if a lack of women’s authorship in anesthesia publications is contributing to this gender gap. 3,4 This paper aims to assess how women’s authorship trends have changed in the last 15 years. Method: The 3 highest-impact journals in anesthesia were identified using InCites Journal Citation Reports. These were the Journal of Clinical Anesthesia, British Journal of Anesthesia, and Anesthesiology. Data was collected from articles published in 2005, 2010, 2015, and 2020. For each article, number of total authors, women authors, male authors, authors of unknown gender, and the presence or absence of a woman first and/or last author were recorded. A total of 750 articles were included in the study. Results: There was a statistically significant increase in the total number of women authors listed over the 15-year period with 21.9% women authors in 2005 and 32.5% in 2020. This was true in all 3 journals when stratified. Women’s first authorship increased from 18.8% of articles in 2005 to 29.2% in 2020. When stratified by journal, increase in women first authors was only significant for Anesthesiology. Women’s last authorship rose from 9.2% in 2005 to 20.1% in 2020. Increase in women last authors was only significant in The British Journal of Anaesthesiology. There was a statistically significant relationship between women senior authors and articles with 50% or more women authors. Only 14.7% of articles with male senior authors had 50% or more women authors compared with 53.2% of publications with women senior authors. This trend remained significant when stratified by year. Discussion: This analysis shows that women are slowly gaining representation in academic publications in the top journals in anesthesia. In the last 15 years, there has been an upward trend not only in the number and proportion of women authors but also in women last and first authors. While this is encouraging news for the progress of gender equity in academic medicine and anesthesia, a closer look at the numbers shows there is more work to be done. As of 2020, women still only represented ~30% of total and first authors and ~20% of last authors in the journals surveyed. This disparity remains important as senior authorship in particular can be important in advancing in academic leadership. 3,4 As recently as 2016, just 7.4% of women in anesthesiology were full professors compared with 17.3% of their male counterparts and only 14% of anesthesiology department chairs were women. 1 Significance: These data present a starting point for further investigation into contributing issues to the gender disparities seen within anesthesia. For example, the difference in number of articles with 50% or more women authors with men versus women senior authors should be considered. This may point to a lack of mentorship from women playing a role in the gender gap. Additionally, not all journals showed a significant increase in women’s first and last authorship when stratified. Although this may be due to lower statistical power from a decreased sample size, the editorial evaluation process for article acceptance presents as a potential source of gender bias. These among other issues must be identified and addressed to continue the forward progress in gender equity in anesthesia.