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ECONOMICS, EDUCATION, AND POLICY

The Status of Women in Academic Anesthesiology: A Progress Report

From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Address correspondence to Cynthia A. Wong, MD, Department of Anesthesiology, 251 E. Huron St., F5-704, Chicago, IL 60611. Address e-mail to c-wong2{at}northwestern.edu.

Abstract

BACKGROUND: The number of women in medicine has increased steadily in the last half century. In this study, we reassessed the status of women in academic anesthesiology departments in the United States in 2006.

METHODS: Medical student, resident, and faculty rank gender data were obtained from the Association of American Medical Colleges. Data regarding the make-up and gender of anesthesia subspecialty society leadership, the editorial boards of Anesthesia & Analgesia and Anesthesiology, the awardees of anesthesia research grants, American Board of Anesthesiology examiners, and department chairs were obtained from websites, organization management personnel, and the Wood Library-Museum of Anesthesiology. Anesthesiology data were compared with composite data from medical school departments in other clinical specialties and to data from previous years, beginning in 1985.

RESULTS: The percentage of medical school graduates, anesthesiology residents, and anesthesiology faculty members who are women has increased since 1985; however, the rate of increase in the percentage of women is significantly faster for medical school graduates compared with anesthesiology residents (P < 0.001) and faculty (P < 0.05). The percentage of women anesthesiology faculty members who were full professors in 2006 was 6.5% compared with 17.7% of men faculty (P < 0.001) and is not significantly different than in 1986 (P = 0.27). Fourteen percent of full anesthesiology professors were women and this does not differ from all clinical specialties combined (15%). Women comprised 12.7% of academic anesthesiology chairs and 10% of all medical school department chairs in 2006, significantly higher compared with 1993 (P < 0.05). Currently, 8% and 11% of editors and associate editors of Anesthesiology and Anesthesia & Analgesia are women, respectively. Eighteen percent of American Board of Anesthesiology oral board examiners in 2007 were women compared with 8% in 1985 (P < 0.05). The percentage of time in which women have served as anesthesiology society leaders was significantly greater during 1997–2006 compared with 1987–1996 (P < 0.001). The proportion of competitive research grants awarded to women has not changed over several decades.

CONCLUSIONS: The status of women in academic anesthesiology in the first decade of the millennium has, by some measures, advanced compared with 20 yr ago. However, by other measures, there has been no change. The task ahead is to identify factors that discourage qualified women medical students, residents, and junior faculty members from pursuing careers in academic anesthesiology and advancing in academic rank.

The number of women in medicine has increased steadily in the last half century. Today women represent nearly 50% of American medical school graduates and 32% of all medical school faculty members.1 The number of women in academic medicine is one important measure of diversity in the medical workforce. In 1986, Wilkinson and Linde, two early mentors of the authors of this article, summarized the status of women in academic anesthesiology in a special article.2 They compared faculty rank data available from the Association of American Medical Colleges (AAMC) for women and men in academic anesthesiology departments in the United States. Compared with medical school faculties in other clinical departments, women ages 50–65 yr were heavily represented at the assistant professor level, and therefore, under-represented in the associate and full professor ranks. They emphasized that the healthy development of the specialty required the active increase in the members of women in academic anesthesiology. The purpose of the current study was to reassess the status of women in academic anesthesiology departments in the United States in 2006 using medical school, residency, and faculty rank data from the AAMC. In addition, the status of women was assessed by examining the gender of anesthesiologists in leadership positions in anesthesiology academic and subspecialty societies, the American Society of Anesthesiology (ASA), and anesthesiology journal editorial boards, as well as anesthesiology research grant awardees and oral board examiners for the American Board of Anesthesiology.

METHODS

Data were obtained from several data bases maintained by the AAMC, either directly from the AAMC or its website (sources of data are listed in Appendix 1), or from articles published by the American Medical Association.3–8 These data include information on the gender of graduates of American medical schools and specialty graduate medical education programs, as well as data describing the distribution of faculty rank by gender and clinical department. In addition, the American Board of Anesthesiology, and academic or subspecialty anesthesiology society websites were searched for lists of past presidents, or leaders. Society management personnel or the literature9 were queried if the information was not available or missing. The editorial offices of the journals Anesthesia & Analgesia and Anesthesiology, and the Wood Library-Museum of Anesthesiology and the International Anesthesia Research Society (IARS) provided lists of past editorial board members of the two journals. Department chair gender was abstracted from membership lists from the Society of Academic Anesthesiology Chairs. The names of individuals awarded research grants by the Foundation for Anesthesia Education and Research (FAER) and IARS were obtained from the organizations’ websites. The percentage of women oral board examiners was provided by the American Board of Anesthesiology.

Gender was abstracted from lists of names by inspecting first names. If gender was not apparent from simple inspection of the name, the Internet was queried for a picture of the individual. If a picture was not found, several baby name websites were queried as to the gender usually associated with the name. Finally, colleagues who knew the individual personally were asked directly to identify the individual's gender.

Data for the specialty of anesthesiology were compared with composite values from medical school departments in other clinical specialties (18 specialties) during similar epochs. In addition, data were compared across epochs within the specialty of anesthesiology. The slopes and intercept of the percentage of medical school graduates, anesthesiology residents, and anesthesiology faculty members who are women, as well as in all clinical departments as a function of time (years) were compared using ANCOVA. The number of women and men professors, oral board examiners, research awardees, department chairs, and distribution of faculty ranks were compared by constructing contingency tables between men and women and year of data collection using a ² statistic or the Fisher's exact test. Exact P values were determined for the ² test using the Monte Carlo method with 10,000 samples and confidence limits of 99%. Statistical analyses were performed using SPSS version 15.0.1, Chicago, IL. P < 0.05 was used to reject the null hypothesis.

RESULTS

The percentage of medical school graduates, anesthesiology residents, and anesthesiology faculty members who are women has increased in the past two decades (Fig. 1). In 1985, 23.7% of anesthesiology faculty members and 19.0% of all clinical specialty faculty members were women. By 2006, these numbers had increased to 27.7% and 29.6%, respectively. The rate of increase in the percentage of women medical school graduates per year 0.95 (95% CI: 0.91–0.99) is more than the rate of increase in women in anesthesiology residencies 0.56 (95% CI: 0.38–0.72) (P < 0.001). These increases have outpaced the rate of increase in women anesthesiology faculty members during this same period 0.34 (95% CI: 0.26–0.42) (P < 0.05).

View larger version (14K): [in this window] [in a new window]   Figure 1. Percentage of medical school graduate, anesthesiology residents, and anesthesiology faculty members who are women, from 1970 to 2006. The rate of increase in the percentage of women medical school graduates per year is more than the rate of increase in women in anesthesiology residencies (P < 0.001) and in women anesthesiology faculty members during this same period (P < 0.05).

In 2006, the percentage of women anesthesiology faculty members who were full professors was 6.5% compared with 17.7% of men faculty (P < 0.001) (Fig. 2). The percentage of women who are full professors in anesthesiology is less than that for all clinical specialties combined (6.5% vs 9.5%; difference –3.0%: 95% CI of difference –2.0% to –4.4%). The percentage of women anesthesiology faculty members who were full professors is not significantly different in 2006 compared with 1985 (P = 0.27).

View larger version (13K): [in this window] [in a new window]   Figure 2. Percentage of women anesthesiology faculty members and women faculty members from all clinical specialties who were professors from 1985 to 2006 (closed symbols); and percentage of men anesthesiology faculty members and men faculty members from all clinical specialties who were professors (open symbols). In 2006, the percentage of women anesthesiology faculty members who had attained the rank of full professors was less compared with men (P < 0.001) and the percentage of anesthesiology men and women at this rank was less than the corresponding rates in all clinical specialties combined (P < 0.001).

The distribution of anesthesiology faculty members by academic rank for both men and women is shown in Figure 3. There was a significant difference in the distribution of men and women between 1985 and 2005, but not between 1995 and 2005. In 2006, 14% of full anesthesiology professors were women and this was not different from the percentage of women full professors in all clinical specialties combined (15%) (Fig. 4). The yearly rate of increase in the percentage of women at the full professor rank in anesthesiology is 0.32 (95% CI: 0.12–0.52) and this is not different from the rate of increase of women in all clinical specialties combined (0.39; 95% CI: 0.35–0.43) (P = 0.36). However, during this same period, the rate of increase in the percentage of women at all ranks in anesthesiology (0.34; 95% CI: 0.26–0.42) was less than that for women in all clinical departments combined (0.65; 95% CI: 0.56–0.74) (P < 0 0.001).

View larger version (20K): [in this window] [in a new window]   Figure 3. The number and distribution of anesthesiology women and men faculty members by rank in 1985, 1995, and 2005. There is a significant difference in the distribution between 1985 and 2005 (P < 0.05).

View larger version (13K): [in this window] [in a new window]   Figure 4. Percentage of full professors who are women in anesthesiology and in all clinical specialties combined (circles) and the percentage of members of all faculty ranks who are women in anesthesiology and in all clinical specialties combined (triangles) from 1985 to 2006. The rate of increase in the percentage of women at the full professor rank in anesthesiology was not different from the rate of increase of women in all clinical specialties (P = 0.36). The rate of increase in the percentage of women at all ranks in anesthesiology was less than that for women in all clinical departments (P < 0.01).

The percentage of women chairs of academic departments is shown in Figure 5. Women represented 12.7% of academic anesthesiology chairs and 10% of all medical school department chairs in 2006. The percentage of women chairs was significantly greater in 2007 compared with 1993 (P < 0.05).

View larger version (9K): [in this window] [in a new window]   Figure 5. The percentage of chairs of academic anesthesiology departments who are women from 1993 to 2007. The percentage of women chairs was significantly higher in 2007 compared with 1993 (P < 0.05).

A woman has not served as Editor-in-Chief of Anesthesia & Analgesia (first published in 1922) or Anesthesiology (first published in 1940). Women first became members of the Anesthesia & Analgesia and Anesthesiology editorial or associate editorial boards in 1980 and 1987, respectively. Currently, 2 of 10 editors and 1 of 28 associate editors of Anesthesiology are women (8%). Two of 19 editors and 3 of 28 associate editors of Anesthesia & Analgesia are women (11%), and 2 of 18 section editors are women (Table 1).

The gender of the presidents of anesthesiology societies since 1985 is shown in Figure 6. The percentage of time in which women served as society leaders was significantly greater between 1997 and 2006 compared with 1987 and 1996 (P < 0.001). Gender of chairs of key ASA academic committees (Section on Research and Education, Committee on Research, Section on the Annual Meeting), the Vice President for Scientific Affairs, and the Rovenstine lecturer are shown in Figure 7. One woman has served as president of the ASA (1991) since 1935. Five women have served on the Board of Trustees of the IARS in its 85 yr history: the first woman was appointed in the mid 1980s, and four additional women have served on the Board since then. Two have served as chair.

View larger version (10K): [in this window] [in a new window]   Figure 6. Gender of presidents of anesthesiology societies from 1975 to 2007. Each "step" indicates when a woman served as president. AAPD = Association of Anesthesiology Program Directors; ASA = American Society of Anesthesiologists; ASCCA = American Society of Critical Care Anesthesiologists; ASRA = American Society of Regional Anesthesia and Pain Medicine; AUA = Association of University Anesthesiologists; ISAP = International Society of Anesthesia Pharmacology; SAAC = Society of Academic Anesthesiology Chairs; SAMBA = Society of Ambulatory Anesthesia; SCA = Society of Cardiovascular Anesthesiologists; SCCM = Society of Critical Care Medicine; SEA = Society of Education in Anesthesia; SNACC = Society for Neurosurgical Anesthesia and Critical Care; SOAP = Society for Obstetric Anesthesia and Perinatology; SPA = Society of Pediatric Anesthesia.

View larger version (7K): [in this window] [in a new window]   Figure 7. Gender of chairs of ASA academic committees, Vice President for Scientific Affairs, and Rovenstine Lecturer, 1982 to 2007. Gaps in line indicate missing data.

Two of 62 past directors of the American Board of Anesthesiology (since 1938) have been women and 2 of the current 12 members of the Board of Directors are women. In 2007, 18% of all oral board examiners were women, compared with 8% in 1985 (Fig. 8) (P < 0.05). Twenty-five percent of junior examiners compared with 13% of senior examiners are women.

View larger version (13K): [in this window] [in a new window]   Figure 8. The percentage of American Board of Anesthesiology oral board examiners who are women, 1985 to 2007. There is a significant difference between the percentage of total examiners (open diamonds) who were women in 1985 compared with women in 2007 (P < 0.05).

The number of women and men awarded competitive research grants from the FAER and IARS are shown in Table 2. There were no differences in the proportion of women awarded grants in earlier compared with later epochs (1985–2007).

Of the 789 current members of the Association of University Anesthesiologists (AUA), 11.7% are women.

DISCUSSION

Diversity in the medical profession is a critical component of our health care system and gender diversity in the academic workplace is an important component of maintaining and growing diversity. We took a "snapshot" of gender diversity in academic anesthesiology in 2006–2007, using several measures of diversity, and analyzed trends for the past two decades. There is good news and bad news. Women essentially achieved parity with men in terms of matriculation into medical school in 2002.1 The percentage of women faculty members of anesthesiology departments is increasing, albeit at a much slower rate than that at which women have entered medicine in the past 20 yr. The number of women department chairs has increased by over 100% in the past decade, and is on par with the overall percentage of medical school department chairs. Encouragingly, approximately 25% of research grants from the FAER and IARS have been awarded to women in the last decade, and this approximates the percentage of women faculty members. Finally, women have been elected leaders of anesthesiology societies, and held leadership positions on academic ASA committees more often in the past decade compared with the preceding decade.

There is, however, cause for concern. There has only been one woman president in the entire 72 yr history of the ASA, 15-yr ago. The rate of increase in the percentage of women faculty members is slower than that for medical school graduates and anesthesiology residents. An analysis of women in all academic specialties identified this same trend.10 The authors suggested that the slower rate of growth in women faculty members compared with medical students can be explained by the slower turnover rate of academic faculty members compared to medical students. They estimated that, at the current rate of change, women will achieve parity with men on academic faculties sometime between 2025 and 2030. However, anesthesiology residents turn over at the same rate as medical students and it is worrisome that the rate of increase in the percentage of women anesthesiology residents is slower than the increase in medical school graduates and other clinical specialties. Finally, it is of additional concern that the rate of increase in the percentage of women anesthesiology faculty members lags behind the increase in medical school departments in other clinical specialties. Rose et al. suggested that the lack of role models may be one reason women medical students fail to choose anesthesiology as a specialty.11 Although the lack of role models may be one reason for the disparity between anesthesiology and other specialties, it is not likely to be the only explanation. All specialties were at one time male dominated, but some have achieved parity at a much faster rate than anesthesiology.

The percentage of women faculty members in all specialties who attain the rank of full professor lags well behind that of men,12 and this state of affairs is certainly true for anesthesiology. Another measure of academic success in the field of anesthesiology is election to the AUA. Criteria for election are based on academic contributions to the field. The percentage of women members of the AUA similarly lags behind the percentage of women faculty members. Both women and men in anesthesiology lag behind their peers in other specialties in attaining the rank of full professor. The dearth of physician scientists in the academic ranks of anesthesiology departments has received recent attention on several fronts.13,14 In addition, the lack of change in the distribution of women in faculty ranks in the past decade is a cause for concern. Many more women medical students were graduated in the 1970s and 1980s compared with previous decades, more joined academic faculties, and more of these women should have moved into the ranks of associate and full professors by 2006.

The pool from which the American Board of Anesthesiology oral examiners, as well as journal editors, are chosen is likely the pool of academic anesthesiologists who are associate or full professors, although the American Board of Anesthesiology does strive to include private practitioners in the ranks of oral board examiners. The percentage of women editorial board members in the United States’ two major anesthesiology journals (Anesthesiology 8%, Anesthesia & Analgesia 11%) is at the low end of the spectrum compared with other journals, and low compared with the percentage of associate and full anesthesiology professors who are women (21%). The number of women who are editorial board members of 12 general medicine and specialty journals ranged from 5.6% to 36.4% in a 1999 analysis (average 17%)15 and ranged from 11% to 47% in a 2003 analysis of six major general medicine journals.16 In 1999, the percentage of women editors had attained parity with the percentage of women in the specialty in 4 of 10 specialty journals.15 In a review of the gender of the leadership of specialty boards and editorial boards, anesthesiology was identified as 1 of 6 specialties (total 21) in which women were significantly under-represented in comparison to the total number of women in the specialty.17 Encouragingly, the percentage of American Board of Anesthesiology oral board junior examiners (25%) is larger than the percentage of associate and full professors who are women.

The gender disparity at the upper ranks of academia is not confined to medicine. In a 2006 report from the National Academy of Sciences, the Committee on Maximizing the Potential of Women in Academic Science and Engineering concluded that women scientists and engineers face barriers to success in every field, and that finding the causes for these barriers and eliminating them will improve workplace environments for all employees, while simultaneously strengthening the competitiveness of America in the world.18 Barriers differ by field and career stage. The reasons for gender disparities in academic promotion have not been well studied.19 There does not appear to be a difference in the preparation of men and women for academic careers. However, women are less likely to have external grant funding and produce fewer publications than men.20 One editorialist concluded, therefore, that factor(s) negatively influencing the academic productivity of junior faculty women relative to men must be at play.19 One factor frequently mentioned as contributing to failure to advance up the academic ladder is inadequate mentoring. Although senior men can certainly mentor junior women, the shortage of senior women academicians likely exacerbates the mentoring problem.21 Finally, there is no denying that women have different family responsibilities than men. In a survey of National Institute of Health postdoctoral fellows, the largest differences between men and women fell into two categories: family responsibilities and self-confidence.22 Advancement in academic medicine requires travel and time away from home, among other commitments. Decisions to participate or not participate in these types of activities may be influenced by family responsibilities and, therefore, gender, and may contribute to academic inequality between women and men. Whether barriers to advancement are the same for anesthesiology faculty members compared with those in other disciplines is not known. All who have studied the subject, however, have acknowledged that the lack of women in leadership positions in academic institutions and societies is a waste of talent and money23 and endangers the United States research base and economy.18

In their report of 1986, Wilkinson and Linde asked a series of questions in their concluding paragraph.2 These questions concerned why women did not get involved in research and publications, and why they held fewer administrative positions. They further asked, "Are they [women] denied the means to advancement, such as sponsorship, research facilities, male mentor relationships, time out of the clinic, and secretarial help? Are they isolated from mainstream academic endeavors? Or do they not have ambition, curiosity, competitive spirit ...?" Twenty years later many of these questions largely remain unanswered, although the answer most certainly does not lie in sweeping generalizations about ambition and competitive spirit. The first conclusion of the Committee on Maximizing the Potential of Women in Academic Science and Engineering was that there is no evidence for significant biologic differences between men and women in performing science and mathematics and that the problem is not the pipeline.18 The barriers likely "lie in unintentional biases and outmoded institutional structures that hinder the access and advancement of women."18

In conclusion, the status of women in academic anesthesiology in the first decade of the millennium has, by some measures, advanced compared with that of women 20 yr ago. However, by other measures, there is still much work to be done in order for women to attain parity with men in our specialty. The task ahead is to identify factors that discourage qualified women medical students from pursuing careers in anesthesiology, factors that discourage qualified women residents from pursuing careers in academic anesthesiology, and finally, factors that negatively affect the chances of promotion for qualified junior women anesthesiology faculty.

Footnotes

Accepted for publication February 13, 2008.

Dr. Cynthia A. Wong, Section Editor for Obstetric Anesthesiology, was recused from all editorial decisions related to this manuscript.

Reprints will not be available from the author.

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