Gender Representation Among Physician Authors of Practice Guidelines Developed, Endorsed, or Affirmed by the American Academy of Neurology

Abstract

Background and ObjectivesTo assess American Academy of Neurology (AAN)–recommended Practice Guidelines (PGs) for equity in gender representation among physician authors.MethodsThis cross-sectional study included AAN-recommended PG publications from January 1, 2015, to December 31, 2020. Author degrees and gender were identified by 2 reviewers using the publication and/or online searches. Gender was determined from pronouns or photographs. Gender representation was compared with Association of American Medical Colleges (AAMC) data on academic neurologists. Data were analyzed usingZtests of 2 proportions and descriptive statistics.ResultsAAMC benchmarks report academic women neurologists represented 35% of the specialty in 2015, 38% in 2018, and 39% in 2020. We identified 68 unique PG publications with 709 physician authors, 31% (223) women, 68% (484) men, and 0.3% (2) gender could not be identified. Representation of women physicians was low among PG authors across all benchmarks, significantly so for 2018 and 2020 (p< 0.01). Among physician first authors, women were significantly underrepresented across all benchmarks (18% [12/65],p< 0.01). Representation of women physicians was lower when men physicians were first authors vs women physicians (31% [161/524] vs 43% [50/118],p= 0.02). Among subspecialties with 10+ PGs, women physician authorship was highest in child neurology (48% [57/120]) and lowest in stroke and vascular neurology (16% [18/113]).DiscussionWe found that women physicians were underrepresented as authors of AAN–recommended PGs. This suggests a missed opportunity for neurology because PGs that include expertise from women physicians may improve care and translation into practice. In addition, women physicians lose out on professional development from authorship. Further research is needed to understand causality and address gaps.

Author Diversity on Clinical Practice Guideline Committees

“…The issue of women physicians being particularly underrepresented on CPGs is consistent with the published literature. 2,3,[20][21][22][23][24][25][26][27][28][29][30] Even when there is an upward trend in the inclusion of women experts, this may not represent equitable inclusion across the specialty or disease topic. For example, a study evaluating the gender representation for CPGs published by the National Comprehensive Cancer Network found that the proportion of women on panels increased from 2013 to 2019 by 1.6% per year, and this rate was roughly equivalent to 1.0% per year previously observed among oncology trainees and full-time female hematology/ oncology faculty.…”

Author Response: Gender Representation Among Physician Authors of Practice Guidelines Developed, Endorsed, or Affirmed by the American Academy of Neurology

“…We want to thank the group of American Academy of Neurology (AAN) practice guideline (PG) leaders for their attention to our study, 1 but we find their complaints related to our work to be unfounded.…”

Gender Representation Among Physician Authors of Practice Guidelines Developed, Endorsed, or Affirmed by the American Academy of Neurology

“…In the Research Article previously titled “Gender Representation Among Physician Authors of American Academy of Neurology Clinical Practice Guidelines” by Ross et al, 1 several changes were made after online-first publication of the accepted manuscript before final publication. The article title was revised, along with the titles of Figures 1, 2, 3, and 4.…”