Geographic Comparison of Women in Academic Obstetrics and Gynecology Department-Based Leadership Roles

Abstract

Objective To describe and compare geographic representation of women in obstetrics and gynecology department-based leadership roles across American College of Obstetricians and Gynecologists' districts (ACOG districts) and U.S. Census Bureau regions while accounting for the proportion of women practicing in each area. Methods We conducted a cross-sectional observational study. In order to more meaningfully quantify representation of women as leaders in ACOG districts and U.S. Census Bureau regions, we calculated representation ratios—the proportion of department-based leaders who were women divided by the proportion of obstetrician–gynecologists who were women. A ratio of 1.0 indicates proportionate representation and <1.0 indicates under-representation. We calculated 95% confidence intervals to compare representation of women in leadership roles across geographic areas. The gender of major department-based leaders (chair, vice chair, division director) and educational leaders (fellowship, residency, associate residency, medical student clerkship director) was determined from websites. Results The proportion of department chairs who were women was highest in the West and lowest in the South Census Bureau regions. Representation ratios for women in major department-based leadership roles demonstrated under-representation relative to the practicing base nationally and in all four regions. While women were under-represented in major department-based leadership throughout the country, there was significantly higher women's representation in major department-based leadership roles in the West (ratio: 0.82; 95% CI: 0.68-0.99) compared to the Northeast (ratio: 0.50; 95% CI: 0.42-0.59) and South (ratio: 0.45; 95% CI: 0.36-0.57). Similarly, in the division director role, the West (ratio 0.85; 95% CI: 0.68-1.1) had significantly higher representation of women compared to the Northeast (ratio 0.50; 95% CI: 0.40-0.62). Nationally, women were under-represented as fellowship directors, proportionately represented as residency program directors, and over-represented as medical student clerkship directors. Conclusion Representation ratios of women in major department-based leadership roles, which account for the proportion of women practicing in each geographic area, suggest that women were more likely to advance to the department-based leadership roles of chair, vice chair, or division director in the Western United States.

Reflection of Trainee Class Gender Proportion in the Leadership of Minimally Invasive Gynecologic Surgery Fellowships

“…Although none of the ratios reached a point of proportionate representation of graduated fellows, the proportion of women in both the PD and APD roles has increased substantially between the 2009 -2010 and 2020 -2021 academic years. The representation ratio of 0.57 is consistent with the national average for women fellowship leaders in OB/GYN subspecialties as compared to women in practice as demonstrated by Ricciotti, et al 7 Of note, holding the current number of programs and leadership positions constant, it would require 26 leadership positions to be vacated by men and filled by women in order to achieve a representation ratio of 1.0 for all leadership combined. As FMIGS does not impose any limit on the amount of time a person may hold any leadership position it would be difficult to estimate how many opportunities for advancement have been, or will be, created.…”

Female representation in orthopedic surgery: where do we stand in Belgium ?

“…Comparing to other specialties, men are in minority in OB/GYN but why is the "problem" different ? Despite a clear feminization of gynecologists, there would be proportionally more men in higher hierarchical positions 16 . The gender issue is different in gynecology-obstetrics as the patient population is exclusively female, whereas in orthopedic surgery, it is mixed.…”

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“…As it has been shown that women remain underrepresented in departmental leadership roles and have a proclivity toward success in certain regions of the United States, these are factors that could have a potential impact on the representation of invited speakers at the SMFM and should be investigated in subsequent analyses. 15,16…”