Lack of Women on Anesthesiology Editorial Boards: Value Lost
Julie Williamson DO, Nina Deutsch MD, Jamie McElrath Schwartz MD
I asked Drs. Julie Williamson, Nina Deutsch, and Jamie McElrath Schwartz, leaders in SPA’s Women’s Empowerment Leadership Initiative program, to review today’s original article and its associated editorial. Julie is a Clinical Associate Professor, Stanford School of Medicine, Nina is an Associate Professor, George Washington School of Medicine and Health Sciences (and former president of SPA), and Jamie is an Assistant Professor, Johns Hopkins School of Medicine. To be frank, I wasn’t really shocked by these papers. I think pissed off would be a better sentiment and description. I think many of you probably share my sentiments. As always, please feel free to share your thoughts and I’ll post in a reader’s response. Myron Yaster MD
Original Article:
McMullen K, Kraus MB, Kosiorek H, Harbell MW. Representation of Women as Editors in Anesthesiology Journals. Anesth Analg. 2022 May 1;134(5):956-963. PMID: 35073283
Associated Editorial:
Dunn LK, Wong CA. Enough Talk, the Time Is Now for Gender Parity of Anesthesiology Journals' Editorial Boards. Anesth Analg. 2022 May 1;134(5):952-955. PMID: 35427268
Reducing the historic and ongoing impact of bias, policies, structures, and norms is imperative to address healthcare outcome disparities. Today’s PAAD article shows that concept is present in healthcare infrastructure as well as the bedside.
Harbell and colleagues reviewed the membership of the top 20 anesthesia journal editorial boards and compared the percentage of women on the boards to that of practicing anesthesiologists.
No journal had a woman as Editor in Chief, or as an Assistant, Associate or Deputy Editor in Chief. Women made up only 18% of editorial board members in contrast to the 36% of academic anesthesiology faculty who identify as women.1 Further, only 1 woman has ever served as the Editor in Chief of a major journal in the field: Professor Jennifer Hunter for the British Journal of Anaesthesia from 1997 to 2006.2
In the accompanying editorial Laura Dunn and Cynthia Wong point out that the discrepancy is not a pipeline problem.2 They are correct. In 2019, for the first time ever, women made up the majority of medical students.3 Anesthesiology is one of the top 10 fields for number of women in training, and over a third of academic anesthesiologists are women.2 But in academic anesthesiology women comprise only 22% of Professors and 34% of Associate Professors. Across all specialties, the number of women department chairs is 20% versus 80% male, and in anesthesiology there is a 5.6:1 male-to-female ratio of chairs.4
Women should have greater representation on editorial boards not because it is ‘the right thing to do’ but because there is substantial and diverse evidence that having women in leadership positions has vast positive impact on organizations and outcomes. In 360 evaluations, women are rated more highly than men in nearly all leadership categories.5 Companies with three or more women in top management score significantly better on evaluations of favorable organizational characteristics and have superior financial performance than those with less or no women in leadership.6 States and countries with women heads of state had higher survival during the COVID-19 crisis.7 Having greater representation of women on editorial boards of top anesthesiology journals will improve our specialty and science, and by extension, patient care.
There is an adage that “every system is perfectly designed to get the outcomes it gets”. Dunn and Wong assert that recognition of this ongoing under-representation is not enough to overcome it and that our systems are designed to maintain inequity. We echo their call for action. They propose that all editorial board members be educated regarding the value of equity and inclusion, that editorial positions and selection criteria be made public, formal application processes be followed and that under-represented applicants be encouraged to apply.2 High impact journals have significant power to impact scholarship, academics and equity through intentional policies that guide action. The 2019 Lancet Women Initiative (#LancetWomen) is an example of a successful multifaceted approach that was directed toward women, diversity, and underrepresented minorities.8
Programs like the Women’s Empowerment Leadership Initiative (WELI) within the Society for Pediatric Anesthesia have been developed to address the women leadership gap in our field. WELI’s mission is to provide highly productive, diverse women pediatric anesthesiologists with the tools to achieve equity and career advancement.9 The program’s success in mentoring and career advancement for women may serve as a model for future programs to address not just the gender gap but also the significant differences for underrepresented minorities.
Underrepresentation of women and lack of diversity on anesthesiology journal editorial boards diminishes the core values of academics and the impact of the science. It is a regrettable loss for all of us and our field. We can do better!
References
1. McMullen K, Kraus MB, Kosiorek H, Harbell MW. Representation of Women as Editors in Anesthesiology Journals. Anesth Analg. 2022 May 1;134(5):956-963. PMID: 35073283
2. Dunn LK, Wong CA. Enough Talk, the Time Is Now for Gender Parity of Anesthesiology Journals' Editorial Boards. Anesth Analg. 2022 May 1;134(5):952-955. PMID: 35427268
3. Report on Residents. Association of American Medical Colleges. Accessed May 2, 2022
4. 2021 U.S. Medical School Faculty. Faculty Roster: United States Medical Colleges. Association of American Medical Colleges. Accessed May 2, 2022. https://www.aamc.org/data-reports/faculty-institutions/interactive-data/data-reports/faculty-institutions/interactive-data/2021-us-medical-school-faculty
5. Zenger J, Folkman J. Research: Women score higher than men in most leadership skills. Harvard Business Review. June 25, 2019. Accessed April 10, 2021. https://hbr.org/2019/06/research-women-score-higher-than-men-in-most-leadership-skills
6. Women Matter: gender diversity, a corporate performance driver. Mckinsey and Company. 2007 https://www.mckinsey.com/business-functions/people-and-organizational-performance/our-insights/gender-diversity-a-corporate-performance-driver# Accessed May 5, 2022.
7. Garikipati S, Kambhampati U. Leading the Fight Against the Pandemic: Does Gender ‘Really’ Matter? June 3, 2020. Accessed May 14, 2022.
http://dx.doi.org/10.2139/ssrn.3617953
8. Advancing women in science, medicine and global health. The Lancet. 2019 Feb 9; 10171: 493-610.
McElrath Schwartz J, Markowitz SD, Yanofsky SD, Tackett S, Berenstain LK, Schwartz LI, Flick R, Heitmiller E, Fiadjoe J, Lee HH, Honkanen A, Malviya S, Cladis FP, Lee JK, Deutsch N. Empowering Women as Leaders in Pediatric Anesthesiology: Methodology, Lessons and Early Outcomes of a National Initiative. Anesth Analg. 2021 Dec 1;133(6):1497-1509.