Despite Progress, Emergency Medicine Still Dominated by Male Physicians

The Bottom Line

Despite the increasing number of women enrolled in medical school, women and individuals from racial and ethnic groups that are underrepresented in medicine (URiM) continue to have fewer roles in higher academic ranks and senior leadership positions.

Context

Recent studies have shown that women and URiM are less likely to be promoted or hold senior leadership positions in academic medicine, including departmental chairs, deans, chief medical officers and chief executive officers of hospital systems, than their male colleagues. These disparities are also reflected in emergency medicine. However, developing diversity in academic leadership is critical, not only to incorporate varied experiences and viewpoints, but also to increase innovation and provide excellent patient care. Hospitals and health care systems need to find additional strategies to address these inequities.

A new study from The American Journal of Emergency Medicine that included first author Judith Linden, MD, Senior Vice Chair of Emergency Medicine at Boston Medical Center—as well as researchers from other academic institutions—examined the temporal change in women and URiM composition with respect to leadership role and academic rank, over a six-year time span between 2015 and 2020.

Study Objective

To evaluate changes in leadership and academic promotion for women and URiM over time.

The Details

Researchers analyzed six years of data from a successive cross-sectional survey (2015–2020) collected from academic emergency departments (EDs) participating in the annual Academy of Administrators in Academic Emergency Medicine /Association of Academic Chairs of Emergency Medicine (AAAEM/AACEM) Benchmark Survey.

A physicians’ race and ethnicity were recorded as URiM based on the Association of American Medical Colleges (AAMC) definition as “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” White or Asian was coded as not URiM, while Black/African American, other races and Hispanic ethnicity were all recorded as URiM.

Physician leadership roles were divided into four main categories: no leadership role (primary position clinical only), operations leadership (overseeing clinical operations), education leadership (residency program/medical student education), research leadership (research director), and executive leadership (chair/vice chair).

Primary analyses focused on gender/racial differences in leadership roles and academic rank. Secondary analyses focused on disparities during the first 10 years of practice. Statistical modeling was conducted to address the primary aim of assessing differences in gender and racial representation in EM leadership roles and rank over time.

Findings

This study found continued disparities in leadership and promotion for women and URiMs in academic emergency medicine over a six-year time span. In total, there were 12,967 responses included (4,589 women, 8,378 men). Women had fewer median years as faculty (7 vs. 11). The researchers found women and URiM were less likely to hold a leadership role and had lower academic rank with no change over the study period.

More women were consistently in the early career cohort (within 10 years or less as faculty) in 2015 (75% vs. 61%) and in 2020 (75% vs. 63%). Men were significantly more likely to have any leadership role compared to women in 2015 (54% vs. 45%) and in 2020 (43% vs. 35%). Higher academic rank (associate/professor) was significantly more common among early career men than women in 2015 (21% vs. 13%) and in 2020 (23% vs. 17%).

In examining the effect of URiM status in leadership representation in 2015 and 2020, those who were identified as URiM were significantly more likely than non-URiM to have no leadership role (57% vs. 54%). Across survey years URiM identified faculty were less likely to be in executive roles (4% vs. 18%) and education leadership roles (13% vs. 15%).  Given the small number of URiM in this database, the authors were unable to perform an analysis to separate out Black women and men.

Pull Quote

“Additional research, effort, and resources are needed to identify and implement effective strategies early in the careers of underrepresented faculty to mitigate these persistent barriers to the retention and advancement of women and URiMs in academic emergency medicine.”