Underrepresentation of women in academic medicine is strongly linked to differences in men’s and women’s scholarship and has been shown to substantially reduce the overall quality of research. An authorship “gender gap” exists in most medical specialties, but differences in research article authorship have only been recently suggested in anesthesiology. We analyzed authorship of US research articles published in Anesthesiology and Anesthesia and Analgesia (journals that publish two-thirds of all anesthesiology-related articles) from 1967 to 2017 to test the hypothesis that publication of anesthesiology research articles by women authors has progressively increased over time along with greater involvement in first, last, and corresponding author roles. Research articles appearing in Anesthesiology and Anesthesia and Analgesia in 1967, 1977, 1987, 1997, 2007, and 2017 were identified. The corresponding author was used to determine the country of origin of each article; only articles originating from the US were included in the analysis. Each author’s gender was determined by inspection of the first name and verified using the author’s institutional website or an internet search if necessary. First, last, and corresponding authors as well as co-authors were noted for each article. Federal grant support was also identified if present. Gender was identified in 98.2% of authors. A total of 1350 research articles with 6165 authors (1319 female; 21.4%) originated from the US. The percentage of women authors increased in a time-dependent manner in Anesthesiology from 6.2% in 1967 to 31.3% in 2017. The proportion of women who were first, last, and corresponding authors increased from 5.1%, 8.9%, and 2.5%, respectively, in 1967 to 37.0%, 22.2%, and 25.9% in 2017, respectively. The number of women co-authors per article also increased over time. Similar results were observed in Anesthesia and Analgesia. The percentage of articles that included at least one woman rose progressively over time in both journals (e.g., Anesthesiology, 12.6% in 1967 versus 90.7% in 2017). Articles published in Anesthesiology were more likely to be supported by a federal grant than those in Anesthesia and Analgesia. The percentage of women first authors of US research articles in Anesthesiology and Anesthesia and Analgesia increased from 1967 to 2017 and approaches the proportion who currently hold academic appointments. Women’s last and corresponding authorship also increased during the past 50 years, but women continue to be relatively underrepresented in these roles.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
The data in this manuscript can be obtained from the corresponding author upon request.
Ahmed, A. A., Egleston, B., Holliday, E., Eastwick, G., Takita, C., & Jagsi, R. (2014). Gender trends in radiation oncology in the United States: A 30-year analysis. International Journal of Radiation Oncology Biology Physics, 88, 33–38.
Amering, M., Schrank, B., & Sibitz, I. (2011). The gender gap in high-impact psychiatry journals. Academic Medicine, 86, 946–952.
Amrein, K., Langmann, A., Fahrleitner-Pammer, A., Pieber, T. R., & Zollner-Schwetz, I. (2011). Women underrepresented on editorial boards of 60 major medical journals. Gender Medicine, 8, 378–387.
Asghar, M., Usman, M. S., Aibani, R., Ansari, H. T., Siddiqi, T. J., Fatima, K., et al. (2018). Sex differences in authorship of academic cardiology literature over the last 2 decades. Journal of the American College of Cardiology, 72, 681–685.
Baerlocher, M. O., Newton, M., Gautam, T., Tomlinson, G., & Detsky, A. S. (2007). The meaning of author order in medical research. Journal of Investigative Medicine, 55, 174–180.
Beasley, B. W., Simon, S. D., & Wright, S. M. (2006). A time to be promoted. The prospective study of promotion in academia. Journal of General Internal Medicine, 21, 123–129.
Bergeron, J. L., Wilken, R., Miller, M. E., Shapiro, N. L., & Bhattacharyya, N. (2012). Measurable progress in female authorship in otolaryngology. Otolaryngology—Head and Neck Surgery, 147, 40–43.
Bhattacharyya, N., & Shapiro, N. L. (2000). Increased female authorship in otolaryngology over the past three decades. Laryngoscope, 110(3 Pt 1), 358–361.
Blumenthal, D. M., Olenski, A. R., Yeh, R. W., DeFaria, Yeh D., Sarma, A., Stefanescu Schmidt, A. C., et al. (2017). Sex difference in faculty rank among academic cardiologists in the United States. Circulation, 135, 506–517.
Campbell, L. G., Mehtani, S., Dozier, M. E., & Rinehart, J. (2013). Gender-heterogeneous working groups produce higher quality science. PLoS ONE, 8, e79147.
Carr, P. L., Gunn, C. M., Kaplan, S. A., Raj, A., & Freund, K. M. (2015). Inadequate progress for women in academic medicine: Findings from the National Faculty Study. Journal of Women’s Health (Larchmt), 24, 190–199.
Carr, P. L., Gunn, C., Raj, A., Kaplan, S., & Freund, K. M. (2017). Recruitment, promotion, and retention of women in academic medicine: How institutions are addressing gender disparities. Womens Health Issues., 27, 374–381.
Dickersin, K., Fredman, L., Flegal, K. M., Scott, J. D., & Crawley, B. (1998). Is there sex bias in choosing editors? Epidemiology journals as an example. JAMA, 280, 260–264.
Dickersin, K., Fredman, L., Flegal, K. M., Scott, J., & Crawley, B. (2010). Female editorship is an important indicator of gender imbalance. Journal of the Royal Society of Medicine, 103, 5.
Duch, J., Zeng, X. H., Sales-Pardo, M., Radicchi, F., Otis, S., Woodruff, T. K., et al. (2012). The possible role of resource requirements and academic career-choice risk on gender differences in publication rate and impact. PLoS ONE, 7, e51332.
Evans, M. (2004). Healthcare’s minority report. Sullivan Commission, IOM try to make patient, hospital staff makeup more reflective of the nation’s ever-changing population. Modern Healthcare, 34, 6–7.
Fahy, B. G., Culley, D. J., Sun, H., Dainer, R., Lutkoski, B. P., & Lien, C. A. (2018). Gender distribution of the American Board of Anesthesiology Diplomates, Examiners, and Directors (1985–2015). Anesthesia and Analgesia, 127, 564–568.
Feramisco, J. D., Leitenberger, J. J., Redfern, S. I., Bian, A., Xie, X.-J., & Resneck, J. S. (2009). A gender gap in the dermatology literature? Cross-sectional analysis of manuscript authorship trends in dermatology journals during 3 decades. Journal of the American Academy of Dermatology, 60, 63–69.
Filardo, G., de Graca, B., Sass, D. M., Pollock, B. D., Smith, E. B., & Martinez, M. A. (2016). Trends and comparison of female first authorship in high impact medical journals: Observational study (1994–2014). British Medical Journal, 352, i847.
Flexman, A. M., Parmar, A., & Lorello, G. R. (2019). Representation of female authors in the Canadian Journal of Anesthesia: A retrospective analysis of articles between 1954 and 2017. Canadian Journal of Anaesthesia, 66, 495–502.
Galley, H. F., & Colvin, L. A. (2013). Next on the agenda: Gender. British Journal of Anaesthesia, 111, 139–142.
Hall, A. K., Mills, S. L., & Lund, P. K. (2017). Clinical-investigator training and the need to pilot new approaches to recruiting and retaining this workforce. Academic Medicine, 92, 1382–1389.
Hamel, M. B., Ingelfinger, J. R., Phimister, E., & Solomon, C. G. (2006). Women in academic medicine—Progress and challenges. New England Journal of Medicine, 355, 310–312.
http://www.brimr.org/NIH_Awards/2017/NIH_Awards_2017.htm. Accessed December 7, 2018.
Jagsi, R., Guancial, E. A., Cooper Worobey, C., Henault, L. E., Chang, Y., Starr, R., et al. (2006). The “gender gap” in authorship of academic medical literature-a 35-year perspective. New England Journal of Medicine, 355, 281–287.
Jena, A. B., Olenski, A. R., & Blumenthal, D. M. (2016). Sex differences in physician salary in US public medical schools. JAMA Internal Medicine, 176, 1294–1304.
Klingensmith, M. E., & Anderson, K. D. (2006). Educational scholarship as a route to academic promotion: A depiction of surgical education scholars. American Journal of Surgery, 191, 533–537.
Knight, P. R., & Wartlier, D. C. (2006). Anesthesiology residency programs for physician scientists. Anesthesiology, 104, 1–4.
Kurichi, J. E., Kelz, R. R., & Sonnad, S. S. (2005). Women authors of surgical research. Archives of Surgery, 140, 1074–1077.
Li, S. F., Latib, N., Kwong, A., Zinzuwadia, S., & Cowan, E. (2007). Gender trends in emergency medicine publications. Academic Emergency Medicine, 14, 1194–1196.
Liang, T., Zhang, C., Khara, R., & Harris, A. C. (2015). Assessing the gap in female authorship in radiology: trends over the past two decades. Journal of the American College of Radiology, 12, 735–741.
Long, M. T., Leszczynski, A., Thompson, K. D., Wasan, S. K., & Calderwood, A. H. (2015). Female authorship in major academic gastroenterology journals: A look over 20 years. Gastrointestinal Endoscopy, 81, 1440–1447.
Lorello, G. R., Parmar, A., & Flexman, A. M. (2019). Representation of women on the editorial board of the Canadian Journal of Anesthesia: A retrospective analysis from 1954 to 2018. Canadian Journal of Anesthesia (in press).
Mazumdar, M., Messinger, S., Finkelstein, D. M., Goldberg, J. D., Lindsell, C. J., Morton, S. C., et al. (2015). Evaluating academic scientists collaborating in team-based research: A proposed framework. Academic Medicine, 90, 1032–1038.
Miller, J., Chuba, E., Deiner, S., DeMaria, S., & Katz, D. (2019). Trends in authorship in anesthesiology journals. Anesthesia & Analgesia (in press).
Mimouni, M., Zayit-Soudry, S., Segal, O., Barak, Y., Nemet, A. Y., Shulman, S., et al. (2016). Trends in authorship of articles in major ophthalmology journals by gender, 2002–2014. Ophthalmology, 123, 1824–1828.
Nonnemaker, L. (2000). Women physicians in academic medicine: new insights from cohort studies. New England Journal of Medicine, 342, 399–405.
O’Connor, E. E., Chen, P., Weston, B., Anderson, R., Zeffiro, T., Ahmed, A., et al. (2018). Gender trends in academic radiology publications in the United States revisited. Academic Radiology, 25, 1062–1069.
Okike, K., Liu, B., Lin, Y. B., Torpey, J. L., Kocher, M. S., Mehlman, C. T., et al. (2012). The orthopedic gender gap: trends in authorship and editorial board representation over the past 4 decades. American Journal of Orthopedics, 41, 304–310.
Pagel, P. S. (2016). Demographics and scholarly productivity of American Board of Anesthesiology volunteers: Results of an internet-based bibliometric analysis. Journal of Cardiothoracic and Vascular Anesthesia, 30, 1396–1403.
Pagel, P. S., Freed, J. K., & Lien, C. A. (2019). Gender differences in authorship in the Journal of Cardiothoracic and Vascular Anesthesia: A 28-year analysis of publications originating from the United States, 1990–2017. Journal of Cardiothoracic and Vascular Anesthesia, 33, 593–599.
Pagel, P. S., & Hudetz, J. A. (2012). Recent trends in publication of basic science and clinical research by United States investigators in anesthesia journals. BMC Anesthesiology, 12, 5.
Pagel, P. S., & Hudetz, J. A. (2015). Scholarly productivity and National Institutes of Health funding of Foundation for Anesthesia Education and Research grant recipients: Insights from a bibliometric analysis. Anesthesiology, 123, 683–691.
Pati, S., Reum, J., Conant, E., Tuton, L. W., Scott, P., Abbuhl, S., et al. (2013). Tradition meets innovation: transforming academic medical culture at the University of Pennsylvania’s Perelman School of Medicine. Academic Medicine, 88, 461–464.
Physician Specialty Data Report. (2008). Association of American Medical Colleges, Washington, D.C.; Table 3.
Physician Specialty Data Report. (2016). Association of American Medical Colleges, Washington, D.C.; Table 1.3.
Piper, C. L., Scheel, J. R., Lee, C. I., & Forman, H. P. (2016). Gender trends in radiology authorship: A 35-year analysis. American Journal of Roentgenology, 206, 3–7.
Reed, D. A., Enders, F., Lindor, R., McClees, M., & Lindor, K. D. (2011). Gender differences in academic productivity and leadership appointments of physicians throughout academic careers. Academic Medicine, 86, 43–47.
Schimanski, L. A., & Alperin, J. P. (2018). The evaluation of scholarship in academic promotion and tenure processes. F1000Research, 7, 1605.
Schwinn, D. A., & Balser, J. R. (2006). Anesthesiology physician scientists in academic medicine: A wake-up call. Anesthesiology, 104, 170–178.
Shah, D. N., Huang, J., Ying, G.-S., Pietrobon, R., & O’Brien, J. M. (2013). Trends in female representation in published ophthalmology literature, 2000–2009. Digital Journal of Ophthalmology, 19, 50–55.
Shapiro, D. W., Wenger, N. S., & Shapiro, M. F. (1994). The contributions of authors to mulitauthored biomedical research papers. JAMA, 271, 438–442.
Sidhu, R., Rajashekhar, P., Lavin, V. L., Parry, J., Attwood, J., Holdcroft, A., et al. (2009). The gender imbalance in academic medicine: A study of female authorship in the United Kingdom. Journal of the Royal Society of Medicine, 102, 337–342.
Szokol, J. W., Murphy, G. S., Avram, M. J., Nitsun, M., Wynnychenko, T. M., & Vender, J. S. (2003). Declining proportion of publications by American authors in major anesthesiology journals. Anesthesia and Analgesia, 96, 513–517.
Taira, B. R., Jahnes, K., Singer, A. J., & McLarty, A. J. (2008). Does reported funding differ by gender in the surgical literature? Annals of Surgery, 247, 1069–1073.
Thomas, P. A., Diener-West, M., Canto, M. I., Martin, D. R., Post, W. S., & Streiff, M. B. (2004). Results of an academic promotion and career path survey of faculty at the Johns Hopkins University School of Medicine. Academic Medicine, 79, 258–264.
Toledo, P., Duce, L., Adams, J., Ross, V. H., Thompson, K. M., & Wong, C. A. (2017). Diversity in the American Society of Anesthesiologists leadership. Anesthesia and Analgesia, 124, 1611–1616.
Tscharntke, T., Hochberg, M. E., Rand, T. A., Resh, V. H., & Krauss, J. (2007). Author sequence and credit for contributions in multiauthored publications. PLoS Biology, 5, e18.
Warner, M. A. (2006). Who better than anesthesiologists? The 44th Rovenstein lecture. Anesthesiology, 104, 1094–1101.
Wenger, N. K. (2008). Women in leadership positions in the medical academic enterprise: what are the next steps? Archives of Internal Medicine, 168, 449–450.
Wright, A. L., Schwindt, L. A., Bassford, T. L., Reyna, V. F., Shisslak, C. M., St Germain, P. A., et al. (2003). Gender differences in academic advancement: Patterns, causes, and potential solutions in one US college of medicine. Academic Medicine, 78, 500–508.
Yedidia, M. J., & Bickel, J. (2001). Why aren’t there more women leaders in academic medicine? The views of clinical department chairs. Academic Medicine, 76, 453–465.
Zhuge, Y., Kaufman, J., Simeone, D. M., Chen, H., & Velaquez, O. C. (2011). Is there still a glass ceiling for women in academic surgery? Annals of Surgery, 253, 637–643.
This work was supported entirely by departmental funds (salary support).
Conflict of interest
The authors have no competing interests.
Institutional Review Board approval was not required because this work is based on publicly-available data through internet sources and because human subjects are not involved.
Consent for publication
The authors have read the manuscript, agree with its contents, and consent to its submission for publication.
About this article
Cite this article
Pagel, P.S., Freed, J.K. & Lien, C.A. A 50-year analysis of gender differences in United States authorship of original research articles in two major anesthesiology journals. Scientometrics 121, 371–386 (2019). https://doi.org/10.1007/s11192-019-03192-y
- Gender equality
- Anesthesia and Analgesia
- Rank and tenure
- Women in academic medicine