American Journal of Roentgenology (AJR)

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AJR January 2019

Saba Moghimi
University of Toronto

Kiran Khurshid
Faisal Khosa
Vancouver General Hospital

“Gender Differences in Leadership Positions Among Academic Nuclear Medicine Specialists in Canada and the United States”

While the number of female medical students has risen, women nuclear medicine specialists remain underrepresented in academic and leadership positions in the United States and Canada, according to an article in the January 2019 issue of the American Journal of Roentgenology (AJR).

Using the Fellowship and Residency Electronic Interactive Database (FREIDA) and Canadian Resident Matching Service (CaRMS), the authors created a database of faculty members in nuclear medicine. For assessment of academic performance, the h-index, number of publications, number of citations, and years of active research were extracted using Scopus.

The academic ranks of 237 faculty members were used for analysis; of this group, 16.95% of associate professors were female. Women were less frequently represented in higher academic ranks, and women were also less frequently represented in leadership ranks (13.6% female vs 86.4% male). The h-index was comparable across genders.

The results showed that women were consistently underrepresented in academia, with fewer women in senior positions than in junior faculty track positions. This distribution may be suggestive of a trend toward more equal representation of genders as more women take on faculty positions and work toward senior positions.

The gender gap seen in the field of radiology is an important issue because it may reflect a lost chance to access intellectual capital among female physicians. The article noted strategies for overcoming gender discrepancy among radiologists, including addressing the misperception that there is no patient contact in the field of radiology. Although radiologists have less patient contact than some other specialties, there are still opportunities to have meaningful therapeutic relationships in some subspecialties within radiology, such as during procedures or when communicating results. Of note is that nuclear medicine, unlike interventional radiology, does not provide as many opportunities for patient interaction. Nevertheless, providing a good overview of the scope of practice and amount of patient interaction within the landscape of radiology subspecialties is of great importance.

In this Q&A, coauthors Saba Moghimi, Kiran Khurshid, and Faisal Khosa discuss the ideas behind the study and the outlook for further research.

What is the background for this study? How did you and your co-authors come up with the idea?

Our team, under the mentorship of Dr. Faisal Khosa at University of British Columbia, conducted a Bibliometric analysis of the Top 100 cited articles on leadership, and found a paucity of articles on disparity (racial, gender & financial) and succession planning. Identifying these gaps in the literature, our team set out to conduct studies to better understand gender distribution across sub-specialties in radiology.

This is an enormous undertaking in collaboration with experts in radiology and advocates for equity, diversity and inclusion across North America. Our work on gender disparity has been made possible through collaboration with many colleagues including Drs. Carolyn Meltzer (Emory University); Mauricio Castillo (University of North Carolina School of Medicine); Katarzyna J. Macura (Johns Hopkins University); Laura Bancroft (University of Central Florida); Nupur Verma (University of Florida College of Medicine); Hansel Otero and Ammie White (Children’s Hospital of Philadelphia); Alexander Norbash (University of California San Diego); Sravanthi Reddy (University of Southern California); Sarah B. White (Medical College of Wisconsin Froedtert Memorial Lutheran Hospital.); Meridith J. Englander (Albany Medical Center Hospital); Gloria M. Salazar (Massachusetts General Hospital); Mai-Lan Ho (Mayo Clinic); Pina C. Sanelli (Donald and Barbara Zucker School of Medicine); Ruth Carlos (University of Michigan Health System); and Frank Rybicki (University of Ottawa and The Ottawa Hospital Research Institute).

Our team is currently mentoring over 100 students from groups, which are underrepresented in medicine and has published manuscripts on gender distribution across different subspecialties of academic radiology including the most recent work focused on Nuclear Medicine [1-9].

What should readers take away from your article?

The results of this study highlight the differences in gender representation among nuclear medicine specialists. We studied academic ranks among 237 faculty members, 58 (24.4%) of whom were women.

The gender distribution varied across academic ranks. At the assistant professor, associate professor, and professor levels 36.4%, 16.95%, and 12.68% were women, respectively. Another finding was that women represented only 13.6% of departmental leadership roles.

We used h-index as a measure for research productivity to assess scientific contributions across the specialists. In our study, 50 male assistant professors and 24 female assistant professors had a median h-index of 6 and 5, respectively. At the associate professor level faculty, 42 male and 9 females had a median h-index of 9 and 10, respectively. At the professor level, 56 male and 7 females had a median h-index of 21.5 and 21, respectively. These results indicate that both men and women showed comparable academic metrics.

A multitude of factors may play a role in the gender differences observed. Gaining an understanding of the underlying reasons is an important milestone in the pursuit of equity diversity and inclusion.

What recommendations do you have for future research as a result of this article?

There is a need to better understand why women are under-represented in higher academic ranks. The next important step is to investigate the root cause of the difference in gender representation, in higher academic ranks, and identify new strategies to promote diversity in leadership and academia.

Previous studies conducted by our team have also shown that women are under-represented in higher academic ranks across other sub-specialties of radiology and its professional societies.

Our group, in collaboration with experts across North America, continue to conduct studies to gain a better understanding of gender distribution in radiology and other subspecialties of academic medicine. These studies will help us understand patterns that may be unique to each subspecialty versus more broadly seen differences. Comparing the scope of practice between various academic medical and surgical subspecialties may shed light on some of the root causes of the differences in gender representation. The combined results of this research and mentoring of students from UIM groups has the potential to generate momentum for diversity, equity and inclusion in academics, and eventually in the society at large.

Is there anything else you would like to add?

The importance of increasing diversity in health care is compelling. In 2004, the Institute of Medicine (IOM) specifically addressed this need in the health care workforce, citing shifting population demographics and the importance of ethnic/racial diversity among health care professionals [8]. The report suggested that a more diverse workforce allows for improved access to care for minorities, permits better communication with patients, and facilitates patient centered care with respect to health care decision-making. These assertions are strongly supported by other studies showing better communication and participatory decision making with providers and patients of the same race/ethnicity or gender [9].

Another component to ensure equality in health care is to improve the ‘‘cultural competence’’ of physicians, through education to aid understanding of different health beliefs and patient perspectives and incorporating this understanding into delivering patient care. The presence of cultural competence has been shown to result in better health outcomes for the patient and the health system, while providing fair and equitable healthcare regardless of race, ethnicity, gender, or culture [10].

Different strategies have been identified in the past as a means of promoting gender diversity. One of these strategies may be to overcome the misperception that there is no patient contact in radiology. Although, radiologists have less patient-contact compared to some other specialties, there are still opportunities to have meaningful therapeutic relationship, such as during procedures or when communicating results. Providing a good overview of the scope of practice and amount of patient interaction within the landscape of radiology subspecialties is of great importance. Providing early exposure to radiology during medical school education may be another effective strategy to inspire more female students because previous research has shown that female medical students have less pre-clinical radiology [11].

Overcoming the lack of gender diversity among various sub-specialties in radiology is an important pursuit. Different strategies at individual and institutional levels can be devised to address the gender gap, which may include mentorship and female associations to connect junior faculty with senior mentors.

Efforts geared towards promoting diversity can have a lasting and meaningful impact by increasing role models in order to inspire the upcoming generations of women pursuing a career in radiology.


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