Representation of female vascular surgeons in national clinical trial leadership: analysis of trends over 20 years

Abstract

Female vascular surgeons constitute 15% of the workforce. Despite an increased pipeline of female vascular surgeons, representation in leadership positions nationally has not maintained pace. We hypothesized that female vascular surgeons are underrepresented as leaders of clinical trials in the United States for several vascular conditions germane to our specialty. Clinical trials registered in the United States were reviewed using the ClinicalTrials.gov website for several index vascular conditions: abdominal aortic aneurysm, carotid artery disease, hemodialysis access, venous thrombectomy and stenting, and peripheral arterial disease. The specialty and presenting gender of national and site principal investigators were recorded. The gender distribution was compared for trials led by vascular surgeons and nonvascular surgeon physicians. A subgroup analysis was performed for solo and group investigators, intervention types, sponsorship sources, and professional affiliation. Temporal trends were examined to evaluate the relationship between the duration of board certification and clinical trial leadership involvement. For all conditions, female vascular surgeons represent 10.3% and 7.8% of national and site principal investigators, respectively. A significantly lower proportion of female investigators were included in national vascular surgeon-led trials compared with nonvascular surgeon-led trials (10.3% vs 19.9%; P = .006). However, site investigators had a lower, but similar, proportion of women in both groups (7.8% vs 7.9%; P = .89). A significantly lower proportion of female vascular surgeons led clinical trials focused on interventions vs noninterventions (6% vs 11%; P = .02). There was a trend toward fewer female vascular surgeons conducting industry-sponsored trials for group (8% vs 11%; P = .3) and solo (5% vs 12%; P = .1) investigator-led trials. A similar proportion of female investigators had both academic and nonacademic affiliations (15% vs 16%; P = .83). Of 109 individual vascular surgeon investigators who were board certified between 1983 and 2003, 6 were women (5.5%) compared with 24 women (28.6%) of 84 investigators who had received board certification between 2004 and 2023. Finally, female vascular surgeon investigators started leading clinical trials sooner after board certification compared with male investigators (mean, 5.5 years vs 10.9 years; P = .0009). The representation of female leaders in vascular clinical trials lags behind that of male leaders, although this trend has improved over time. However, a percentage of women in vascular surgery are successful in leading clinical trials early in their career, suggesting the importance of strong sponsorship and allyship. Furthermore, it is a call to action to our leaders and our industry partners to “lift the curtain” on the pathway to clinical trial leadership.