Redefining the Gender Gap in Urology Authorship: An 18-Year Publication Analysis

Abstract

Background

Academic authorship is a critical productivity metric used for academic promotion.

Objective

To characterize temporal changes in female representation in academic authorship in ten primary urology journals as the complement of female urologists is increasing.

Design, setting, and participants:

Publication records were retrieved from 2002 to 2020 for the ten urology journals with the highest impact factor. The names of all authors were gathered and gender was inferred using first names.

Outcome measurements and statistical analysis

Trends in first and last/senior authorship by gender were evaluated overall, within journals, and by geographic region.

Results

A total of 59,375 articles were analyzed, of which 94.1% had gender information for the first author and 94.2% had gender information for the last author. The percentage of overall female authors increased positively from 17.2% (95% highest density interval [HDI] 12.9–21.4%) in 2002 to 27.2% (HDI 21.7–33.6%; p < 0.01) in 2020. Overall female first authorship increased from 15.2% (95% HDI 11.0–19.5%) to 28.5% (95% HDI 21.8–35.6%; p < 0.01). There was also significant growth for female senior authors from 10.4% (95% HDI 7.6–13.5%) to 18.6% (95% HDI 13.6–23.8%; p < 0.01). Assessment of journal-specific changes revealed that Neurourology and Urodynamics (12.6%, 95% HDI 9.9–15.1%) and The Journal of Sexual Medicine (16.2%, 95% HDI 13.6–19.0%) had significantly higher growth in female authorship when compared to Journal of Endourology (7.2%, 95% HDI 5.5–8.7%) and Urologic Oncology (4.5%, 95% HDI 2.0–6.8%; p < 0.05).

Conclusions

Although overall female authorship increased between 2002 and 2020, women remain underrepresented in urology authorship. The percentage of females in senior (last) author positions is less than the percentage of females in first author positions. Journal-specific differences can probably be attributed to gender-based differences in subspecialized fields.

Patient summary

In this study, we characterized the underrepresentation of women as authors in urology journals and analyzed the change in female authorship for ten academic urology journals over the course of 18 years. Although the proportion of female authors has increased over that time, the percentage of females in senior authorship roles is less than the percentage of females in first author positions.

Introduction

The enactment of Title IX, a law prohibiting sex-based discrimination in education programs that receive federal funding, has contributed substantially to the rapid rise in women’s enrollment in US medical schools [1]. Owing to the steadily increasing proportion of female students, the majority of medical students across the USA are now women (50.5%) [2]. Although women are becoming equally represented in the practice of medicine, they are less likely to remain in academic medicine [3]. Fewer women than expected reach the position of associate professor, full professor, or department chair, with no change over the past 35 years [4].

Publications in medical journals represent a critical productivity metric necessary for promotion [5]. For women in science, barriers to authorship and publishing are widely observed. Articles with women as the first or last author are cited less frequently, and women are less likely to serve as journal reviewers, and even less likely to serve as editors of major academic journals [6], [7], [8]. Together, these disparities translate to greater challenges in the promotion of women to associate and full professor roles, and subsequently to difficulty in the recruitment and retention of women to academic medicine [9].

In the field of urology, female authorship in academic journals has yet to be evaluated in a study robust enough to evaluate the breadth of urologic subspecialties or provide an international analysis; previous analysis was limited to two journals (Urology and Journal of Urology) and only included articles from American institutions at eight time points [10]. Thus, a full assessment of the state of female authorship is warranted.

In this study, our objectives were to analyze 18 years of data from ten urology and urology subspecialty journals to characterize changes in the proportion of female first authors, senior authors, and overall female authorship over time. Secondary objectives were to assess between-journal differences in the rates of female authorship as well as worldwide geographic variation. We hypothesized that overall female authorship would increase from 2002 to 2020.