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After years of growth, female first authorship in top medical journals has stalled

Female first authorship in high-impact medical journals increased “significantly” over the 2 decades preceding 2014, according to a paper published earlier this month in The BMJ. This is the “good news,” writes Kathryn Rexrode of Harvard Medical School in an editorial (subscription required) in the same issue, because publishing original research in prominent journals is “the currency of success for promotion in academic medicine.” This progress, however, seems to have “plateaued in recent years and has declined in some journals,” note the article’s authors, led by epidemiologist Giovanni Filardo of Baylor Scott & White Health in Dallas, Texas. “These results, along with the significant differences seen between journals, suggest that underrepresentation of research by women in high impact journals is still an important concern,” they write. The plateauing or drop in female first authorship since 2009 may, they suggest, arise from “the subtle and unconscious gender bias that persists in the scientific community.”

Increasing the prominence of women and minority groups currently under-represented in medicine and research brings new perspectives that expand the scope of research and practice.

–Kathryn Rexrode

The article identifies a trend whose importance extends beyond abstract notions of equity, Rexrode adds. “The progress of women attaining first and senior authorship of original research publications … will directly translate into equity of academic advancement for women in the future.” To those who “may ask whether we truly need diversity in authorship,” she explains that this trend has important scientific and clinical implications. “Increasing the prominence of women and minority groups currently under-represented in medicine and research brings new perspectives that expand the scope of research and practice. It is no coincidence that women are more likely than men to conduct research on women’s health or gender disparities.”

Determining the first author’s gender for 3758 articles published in six top medical journals between 1994 and 2014, Filardo and co-authors found that “female first authorship increased significantly from 27% in 1994 to 37% in 2014,” with some variation between the individual journals. In The New England Journal of Medicine, for example, female first authorship decreased over the study period. “[I]t also seemed to decline in recent years in The BMJ,” the authors write, but even so, “The BMJ had the highest total proportion of female first authors.”

The authors also note the “intriguing” fact that the four journals that had “female editors-in-chief for all or most of the 2009-14 period had the highest unadjusted rates of female first authorship”—45%, 44%, 42%, and 36%—while the remaining two journals “had considerably lower rates” of 20% and 35%. Beyond the editors-in-chief are the journals’ full editorial boards, “in which women remain vastly underrepresented,” the authors note, which could be another factor affecting publication of articles with female first authors. The paper’s authors cite research showing “that male editors are more likely to assign manuscripts to male reviewers and that reviewers are more likely to recommend rejection” of papers authored by members of the opposite sex.

Women may also be likelier to submit their articles to some journals rather than others, the authors suggest. “[S]imilar to the pattern that has been found in grant applications for public research funds, whereby women tend to have similar success rates but lower application rates, female first authors may be less likely to submit their manuscripts to the top ranked journals.”