Gender and leadership: Continued progress in academic dermatology

To the Editor: In 2020, 51% of active physicians in dermatology in the United States were women, making dermatology one of the most equally-represented fields in medicine.1Association AM Active Physicians by Sex and Specialty, 2019. Association of American Medical Colleges, 2019Google Scholar Over the last quarter-century, women have comprised the majority of dermatology residents. Looking at gender and leadership in 2016, only 24% of academic dermatology chairs were women.2Nambudiri V.E. Shi C.R. Vleugels R.A. Olbricht S.M. Academic dermatology leadership in the United States -- addressing the gender gap.Int J Womens Dermatol. 2018; 4: 236-237Crossref PubMed Scopus (9) Google Scholar Regarding fellowships, there were significantly fewer female program directors for micrographic surgery and dermatopathology fellowships.3Shi C.R. Olbricht S. Vleugels R.A. Nambudiri V.E. Sex and leadership in academic dermatology: a nationwide survey.J Am Acad Dermatol. 2017; 77: 782-784Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar These statistics suggested that, despite nearly equal representation at earlier career stages, there was work to be done for women to ascend the pipeline to higher leadership roles. Studies have shown that women with women mentors tend to attain promotions earlier and are more likely to publish scientific work.4Aagaard E.M. Hauer K.E. A cross-sectional descriptive study of mentoring relationships formed by medical students.J Gen Intern Med. 2003; 18: 298-302Crossref PubMed Scopus (92) Google Scholar,5Levinson W. Kaufman K. Clark B. Tolle S.W. Mentors and role models for women in academic medicine.West J Med. 1991; 154: 423-426PubMed Google Scholar We sought to assess and update the current state of women in academic dermatology by performing a cross-sectional analysis of US academic dermatology programs. We performed a cross-sectional analysis of all active dermatologists participating in certified US dermatology residency programs. Academic dermatologists were identified using the Accreditation Council for Graduate Medical Education website. Accredited US dermatology residency programs were cross referenced with the Residency Navigator Directory on Doximity and faculty listings from program websites. Faculty without training in dermatology were excluded from the analysis. Data were compiled into an encompassing database. Statistical analysis involved 2-sample proportion tests, Wilcoxon’s signed rank tests, and Wilcoxon rank sum tests. Significance was assessed at the alpha = 0.05 level and all P values were 2-sided. All statistical analyses were performed using Stata software for Mac, Version 17.0 (StataCorp. 2021. Stata Statistical Software: Release 17). Table I demonstrates the characteristics of practicing dermatologists at academic dermatology programs in the United States and US territories as of 2021. Among academic dermatology programs in the country, significantly more men are department chairs and full professors compared to women. There was a roughly equal distribution between women and men program directors. With regards to fellowships, a significantly higher proportion of men were Mohs fellowship directors, while a significantly higher proportion of women were pediatrics fellowship directors. The proportion of men and women in dermatopathology fellowship director roles was not significantly different. Fig 1 visually depicts the distribution of academic dermatology leadership positions among men and women in the United States and US territories.Table ICharacteristics academic dermatologists in the United States and US territories in 2021 by departmentMalen (%)Femalen (%)P valuePosition Chair63 (61%)41 (39%).03 PD69 (48%)74 (52%).63 APD16 (31%)36 (69%).01 ProfessorFull4.2 ± 2.83.7 ± 4.2.08∗Wilcoxon’s signed rank test.Associate2.0 ± 1.52.8 ± 2.1.01∗Wilcoxon’s signed rank test.Assistant2.9 ± 2.34.3 ± 2.8<.01∗Wilcoxon’s signed rank test.Clinical1.6 ± 1.21.8 ± 1.4.48∗Wilcoxon’s signed rank test.Associate clinical2.1 ± 1.52.3 ± 2.0.75∗Wilcoxon’s signed rank test.Assistant clinical3.1 ± 2.53.4 ± 3.2.22∗Wilcoxon’s signed rank test.Degrees Chair2.2 ± 0.382.3 ± 0.45.33†Wilcoxon rank sum test. PD2.1 ± 0.392.1 ± 0.25.32†Wilcoxon rank sum test.Publications Chair40.0 ± 24.041.2 ± 22.9.82†Wilcoxon rank sum test. PD26.8 ± 18.031.8 ± 18.3.14†Wilcoxon rank sum test. APD13.8 ± 6.613.1 ± 10.6.57†Wilcoxon rank sum test.Fellowships Mohs microsurgery38 (67%)19 (33%).01 Pediatrics0 (0%)9 (100%)<.01 Dermatopathology30 (59%)21 (41%).21Continuous variable presented as mean ± SD statistical testing was performed with two-sample proportion tests for categorical variables and Wilcoxon sign-rank tests or Wilcoxon rank-sum tests for continuous variables. Significance was assessed at the alpha = 0.05 level.APD, Associate program director; PD, program director.∗ Wilcoxon’s signed rank test.† Wilcoxon rank sum test. Open table in a new tab Continuous variable presented as mean ± SD statistical testing was performed with two-sample proportion tests for categorical variables and Wilcoxon sign-rank tests or Wilcoxon rank-sum tests for continuous variables. Significance was assessed at the alpha = 0.05 level. APD, Associate program director; PD, program director. Our results indicate that there are no significant differences between men and women departmental leaders with regards to number of degrees or publications. These results suggest that the gap between men and women dermatologists in leadership positions is smaller than the last time it was studied. This should be taken as a sign of progress, though more work needs to be done. Given the study-design, tracking faculty is a challenge since online websites only provide a snapshot in time. The authors attempted to mitigate this limitation by querying robust and multiple sources. As we continue to bridge gaps in our field, it is important to continue advocating for women to hold leadership roles in dermatology and provide mentors to aspiring female dermatologists in academic medicine. None disclosed.