Disclosures: Arora reports no relevant financial disclosures.
July 29, 2021
4 min read

Gender disparity in journal citations perpetuates academic advancement gap

Disclosures: Arora reports no relevant financial disclosures.
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Recently published data showed that articles written by women in academic medicine had fewer journal citations regardless of authorship seniority, a disparity the authors noted may have extensive consequences for promotion and advancement.

That cross-sectional study of 5,554 articles published in Annals of Internal Medicine, BMJ, JAMA, JAMA Internal Medicine and The New England Journal of Medicine — conducted by Paula Chatterjee, MD, MPH, and Rachel M. Werner, MD, PhD, both of Perelman School of Medicine at the University of Pennsylvania — showed 35.6% of the articles had women as primary authors and 25.8% as senior authors. Those articles with women primary or senior authors had been cited significantly fewer times than those authored by men (median, 33 citations vs. 59 citations; P < .001).

Quote from Vineet M. Arora, MD, MAPP

Citations as ‘currency of promotion’

In an editorial accompanying the study in JAMA Network Open, Vineet M. Arora, MD, MAPP, Herbert T. Abelson professor of medicine, Dean for Medical Education at the University of Chicago Pritzker School of Medicine, and Helen R. Burstin, MD, MPH, executive vice president and CEO of Council of Medical Specialty Societies, wrote that although women are increasingly published in prestigious journals, advancement can be limited without peer recognition.

“One thing to keep in mind is that less than 25% of professors in academic medicine are women, despite equal numbers of men and women coming into medical school,” Arora told Healio in an interview.

This means there are fewer female mentors available who might be in a senior authorship position, Arora said, adding that this then leads to a continued course of male physicians taking on that role, even as a guest author.

“A big currency of promotion is based on impact and a big part of impact is whether you move the field and who is looking at your work, citations being one metric used,” Arora said. “As you go up the chain in academic medicine, what people will look at is if you’ve had a senior authorship position in a paper. So, if women are less likely to have those senior authorship positions, or their work is not as likely to be recognized when they do hold those positions, that’s going to bias them at the time of promotion.”

Impact of COVID-19

Arora said that although this is not a new problem, it has become consistently worse during the COVID-19 pandemic.

“The pandemic has unmasked many inequities, but especially for women and other people who may be underrepresented in medicine,” she said. “What has happened is that we’ve seen many of those people who are in junior positions redeployed to the front line or have had to go back to the drawing board to redesign a course.

“A lot of physicians in heavy clinical roles have had to do whatever they can to plug holes and keep medical centers moving forward,” she continued. “That means less time for their scholarly work. Although clinical work is valued to an organization, if you haven’t had time to share your work during the pandemic, you’re going to be at a disadvantage at the time of promotion compared with these other academic outputs, such as papers and grants.”

Additionally, the pandemic put pressure on women in medicine because many tend to be the primary caregivers for children — who remained home during school and day care closings — as well as for seniors who may need assistance.

Closing the gap

As far as next steps, Arora addressed what both women and male allies can do to help diminish this gap in academic acknowledgement.

“For women, it’s important for leaders and those in the workforce to band together and create a support network and to understand that you’re not alone,” she said. “I’ve talked to women who have said, ‘It’s been a year and I’ve published nothing.’ Before you make a rash decision to leave academic medicine or feel defeated about your academic career, it’s important to reach out. Let people know you’re suffering and need help.”

She also emphasized to keep in mind every accomplishment made recently, including reworking courses for virtual attendance, developing telehealth avenues and handling COVID-19-related health care needs.

“I’ve been a big proponent of documenting that value,” Arora said. “Although it may not turn into a citation or a grant, it’s still important to document on your CV what you did during the pandemic that might have disrupted your academic trajectory.”

She also recommended seeking novel opportunities in academic medicine, including writing editorials or becoming part of a research writing team to spread the work out or an advocacy organization to write op-eds.

Finally, Arora noted that the disparity in citations carries over to social media, which is a perfect opportunity for allies to help elevate women’s work on such a far-reaching platform.

“We’ve seen data that have shown that women physicians in social media, even though they have the same professional aspirations, are less likely to get external talks or research collaborations using social media than men are,” Arora said. “It’s important to highlight that bias. Those in power need to understand this so that we can dismantle the structures in place that lead to such inequities.”


For more information:

Vineet M. Arora, MD, MAPP, can be reached at varora@medicine.bsd.uchicago.edu.