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COVID-19 Medical Papers Have Fewer Women First Authors Than Expected

COVID-19 Medical Papers Have Fewer Women First Authors Than Expected

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This article is composed of the ‘introduction’ and ‘discussion’ parts of a paper published on eLife on June 15, 2020.

During the COVID-19 pandemic, many governments have shuttered schools and implemented social distancing requirements that limit options for childcare, while simultaneously requiring researchers to work from home (Minello, 2020).

Robust evidence suggests that women in academic medicine shoulder more of the burden of domestic labour within their households than do men. One study of an elite sample of NIH-funded physician-researchers showed that women spent 8.5 hr more per week on parenting and domestic tasks than their men peers (Jolly et al., 2014). Recent research also suggests that women in academia take on more domestic responsibilities than men, even in dual-career academic couples (Derrick et al., 2019). Therefore, the recent restrictions in access to childcare might reasonably be expected to have disproportionate impact on women in academic medicine, as compared to men (Viglione, 2020).

The impact of new professional service demands that now compete with time for scholarly productivity in academic medicine, including work to increase the use of virtual platforms for teaching and clinical care, may also disproportionately impact women medical researchers, who are disproportionately represented on clinician-educator tracks (Mayer et al., 2014).

Here, we focus on the published medical research literature, where it may be possible to provide an early evaluation of whether the gender gap in academic productivity is widening. The medical literature now includes a substantial number of articles directly relating to COVID-19, mostly generated rapidly after the broader social restrictions came into being, in most US states, in March 2020. We identified 15,839 articles on COVID-19 published between 1January 1, 2020, and June 5, 2020, including 1,893 articles that had a first author and/or last author with an affiliation in the US. Here we report the results of an analysis that compared the proportion of women scientists in various author positions in this sample and a sample of 85,373 papers published in the same journals in 2019 (with first and/or last authors with a US affiliation; see Materials and methods for details).

Prior research has raised concerns about women’s underrepresentation among authors of medical research, including both original research and commentaries (Clark et al., 2017Hart and Perlis, 2019Jagsi et al., 2006Larson et al., 2019Silver et al., 2018). Our study suggests that the COVID-19 pandemic might have amplified this gender gap in the medical literature. Specifically, we find that women constitute a lower share of first authors of articles on COVID-19, as compared to the proportion of women among first authors of all articles published in the same journals the previous year. However, our analysis also indicates that the first-author gender gap in COVID-19 research might have decreased during the past month of the pandemic. Our findings are consistent with a contemporaneous study of pre-prints (Vincent-Lamarre et al., 2020), which also found women to be under-represented.

Journal specialty
2019 papers COVID-19 papers
N
Proportion of women
N
Proportion of women
First author Full group Last author First author Full group Last author
Dermatology 1811 0.44 0.42 0.37 72 0.46 0.41 0.31
Emergency medicine 1283 0.32 0.3 0.22 54 0.31 0.25 0.13
High impact general medicine 7142 0.41 0.42 0.39 194 0.31 0.37 0.35
Infectious diseases 1404 0.45 0.42 0.34 44 0.2 0.32 0.34
Internal medicine 19,980 0.36 0.33 0.25 484 0.33 0.32 0.24
Other basic sciences 6975 0.42 0.38 0.29 135 0.33 0.34 0.28
Other clinical sciences 21,869 0.4 0.37 0.31 429 0.38 0.38 0.35
Otolaryngology 1063 0.32 0.29 0.21 106 0.28 0.29 0.24
Pathology 869 0.46 0.43 0.32 66 0.27 0.37 0.3
Public health 11,015 0.47 0.41 0.35 99 0.33 0.41 0.37
Radiology 2262 0.37 0.33 0.27 60 0.25 0.28 0.17
Surgery 9700 0.21 0.2 0.13 186 0.26 0.22 0.16

Our findings are also consistent with the idea that restricted access to child-care and increased work-related service demands might have taken the greatest toll on early-career women, particularly early on when the disruptions were most unexpected, although our observational data cannot conclusively support causal claims. As more robust evidence becomes available, mechanisms which disadvantage specific ethnic, age and gender groups should be monitored and inform policies that promote equity (Donald, 2020).

Some have argued that the authorship gender gap in academic medicine is best explained by a slow pipeline and the historical exclusion of women from medical school enrolment (Association of American Medical Colleges, 2019). However, as time has passed, and women have reached parity in the United States and even begun to constitute the majority of the medical student body in many other countries, their persistently low participation as authors has raised concerns about bias in unblinded peer review processes and unequal opportunities prior to manuscript submission (Jagsi et al., 2014Silver, 2019).Studies have demonstrated differences in the language used by men and women to describe their research findings (Lerchenmueller et al., 2019), and evidence from the field of economics suggests that women’s writing may be held to higher standards (Hengel, 2017).

In any case, the current study suggest that if authorship of COVID-19-related papers is a bellwether, women’s participation in the medical research literature may now be facing even greater challenges than before the pandemic (Kissler et al., 2020).

This study is limited to a relatively small sample produced early in the course of the pandemic and misses information on important covariates. A key limitation is that we have not been able to adjust for variations in COVID-19 related research activities across medical research specialties. Since women’s representation as authors varies across specialties (Andersen et al., 2019), this may introduce a bias. We have attempted to mitigate this bias by including scientific journal as random effect parameter in the regression models, hereby adjusting for variations in COVID-19 related research activities across publication outlets.

Moreover, descriptive analysis that breaks down our results by journal specialty does not suggest that those journal specialties that might dominate research related to COVID had low proportions of women among authors in 2019. Indeed, many such specialties, including infectious disease and public health, qualitatively appear to have a markedly lower proportion of women among authors in the 2020 COVID-related dataset than in the 2019 dataset within those fields. Nevertheless, future research might refine our analysis by using Medical Subject Headings (MeSH) to infer the research specialty of each paper (Andersen et al., 2019). The US National Library of Medicine usually assign MeSH terms to medical papers within 3–6 months after publication.

Although we were reliably able to determine gender for the vast majority of the first and last authors and a large majority of all authors, bias is possible due to omission of those whose gender could not be determined. There is no difference in the percentage of matched names between the treatment and control groups.

Despite limitations, this early look suggests that the previously documented gender gap in academic medical publishing may warrant renewed attention (Jagsi et al., 2006), and that ongoing research on this subject is necessary as more data become available. The need for greater equity and diversity is most evident in times of crisis. Abundant literature reveals the importance of diverse teams for solving complex problems like those related to COVID-19 (Mayer et al., 2014Nielsen et al., 2017aNielsen et al., 2018Phillips, 2014Woolley et al., 2010).

If societal constraints limit the talent pool who may contribute to research informing the crisis response, the consequences will be profound indeed. Policies to support the full inclusion of diverse scholars and transformation of norms for dividing labor appear to be urgent priorities. Policies that merit consideration include providing more teaching support for female faculty or relieving them of teaching duties, supporting child-care costs and identifying child-care options, extending the tenure-clock for the duration of the lockdown, or adjusting the criteria used to assess and select candidates for research funding and tenured positions.

Jens Peter Andersen is in the Danish Centre for Studies in Research and Research Policy, department of political science, Aarhus University, Aarhus. Mathias Wullum Nielsen is in the department of sociology, University of Copenhagen, Copenhagen. Nicole L. Simone is in the department of radiation oncology, Sidney Kimmel Cancer Centre, Thomas Jefferson University, Philadelphia. Resa E. Lewiss is in the department of emergency medicine, Thomas Jefferson University, Philadelphia. Reshma Jagsi is in the department of radiation oncology, University of Michigan, Ann Arbor.

This article was originally published on eLife and has been republished here under a Creative Commons Attribution license. References and additional resources are available on the source page.

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