Sage Journals: Discover world-class research

Abstract

Objective: To understand the factors contributing to gender disparities in the research productivity of Canadian academic otolaryngologist-head and neck surgeons. Methods: Publicly available sources including departmental websites, SCOPUS, and the Royal College of Physicians and Surgeons of Canada were accessed between February and April 2022 to analyze gender differences in the academic productivity of otolaryngologist-head and neck surgeons across Canada. Gender differences in research productivity metrics, including h-index, i10-index, publication number, and number of first and senior authorships were assessed. Demographic data, including gender, institution, years in practice, and leadership roles were assessed for correlation with increased research productivity. Subgroup analyses were used to evaluate gender differences in productivity metrics, and univariable and multivariable regression analyses were used to evaluate predictors of research productivity. Results: Data were collected for 316 academic otolaryngologists (252 men, 64 women, P < .001). Men had significantly more years of publishing [mean (standard deviation, SD), 15.64 (9.45) vs 12.44 (8.28), P = .014], higher h-indices [12.22 (11.47) vs 7.33 (5.36), P < .001], i10-indices [22.61 (37.88) vs 8.17 (9.14), P > .001], publication numbers [46.63 (65.18) vs 19.59 (23.40), P < .001], and first [8.18 (9.95) vs 4.89 (6.18), P = .001] and senior authorships [12.98 (22.72) vs 3.83 (6.89), P < .001]. Gender differences were most pronounced in head and neck oncology, pediatrics, and the late career stage. Gender disparities in productivity were absent in the early career stage. Multivariate analysis identified only the number publications and number of senior author publications as being significantly influenced by gender. Conclusion: Canadian female otolaryngologist-head and neck surgeons appear to have equivalent research productivity to their male counterparts in the early career stage. This mirrors the recent findings in the United States, and demonstrates progress compared to earlier studies that found women to have lower research productivity in the early career stage.

Keywords

head and neck pediatrics rhinology otolaryngology otology laryngology

Introduction

Women in otolaryngology—head and neck surgery (OHNS)—face unique barriers to career advancement compared to their male colleagues. While the number of female OHNS residents is steadily rising, the proportion of female full-time academic OHNS staff is increasing much more slowly.^1,2 Across North America, women in academic OHNS have a slower rate of career advancement than their male counterparts, and are less likely to obtain the rank of full professor.^3-6 Similar findings have been described for the appointment of leadership positions (eg, chair, division head, program director), with only 11% of all Canadian academic leaders in OHNS being women in 2020.⁶ Likewise, in the United States, only 8% of all OHNS department chairs were women in 2021.⁷

Research productivity is 1 of the key metrics determining career advancement in academic medicine. The proportion of literature authored by female otolaryngologists is increasing over time.⁸ However, female first authorship is increasing more rapidly than female senior authorship.⁹ The increase in female OHNS authorship also appears to be predominantly in low-impact journals and remains unchanged in journals with higher impact factors.⁸ These findings are significant as both senior authorship and the impact factor of the publishing journal have a higher contribution to the measurement of an author’s research productivity, and therefore, career advancement.¹⁰ It appears that this is also dependent on career stage, with female early career otolaryngologists having lower productivity than later career counterparts, who may ultimately surpass male colleagues in research.¹¹ A recent study by Okafor et al,³ however, found that women in certain OHNS subspecialties are keeping pace with their male counterparts even in the early stages of their careers.

Several metrics have emerged as markers of a physician’s academic impact. The h-index was developed to evaluate the volume and relevance of researchers’ publications to help make objective decisions regarding career advancement.¹² The h-index is defined as the greatest number of an author’s publications that have h or more citations each.¹³ For example, to have an h-index of 20, an author must have published at least 20 articles with 20 citations each. In academic OHNS, higher h-index is correlated with higher rank and is thus a reliable method for appraising an academic otolaryngologist’s research productivity.¹⁴ The i10-index, introduced by Google Scholar, tracks the number of articles per author with 10 or more citations.¹⁵ These metrics are complimented by others, such as number of citations per article, which are not included in the calculation of h-index and also measure research impact.

The aim of the present study was to analyze gender-based differences in the research productivity of academic otolaryngologists in Canada using h-index, number of publications, and other metrics. The size of the community allows complete analysis nationally in all subspecialties and career stages and will add to the growing body of literature on the impact of gender on career advancement in academic OHNS.

Methods

Ethical Considerations

The present study was exempt from ethical review due to the public availability of the data.¹⁶

Data Collection

We accessed the websites of all academic otolaryngology departments across Canada to retrieve a list of academic otolaryngologists, their gender, academic rank, and subspecialty. We collected the data between February and April 2022 and assigned gender based on physicians’ names, photos, and stated pronouns. We categorized academic rank into assistant professor, associate professor, professor, and other (clinical instructor, clinical lecturer, lecturer). Adjunct professors and professors emeriti were excluded from this study. Subspecialties included general otolaryngology, pediatric otolaryngology, laryngology, otology, rhinology, head and neck oncology, sleep surgery, and facial plastics and reconstructive surgery (FPRS).

Using the publicly available Royal College of Physicians and Surgeons of Canada Directory,¹⁷ we retrieved residency graduation year for each faculty member. Based on a physician’s graduation year, we determined career stage as early (1-5 years), mid (6-15 years), and late (16+ years), as described in previous work.³

Using the abstract and citation database Scopus (www.scopus.com), we collected bibliometric data. Collected data included publication numbers, h-indices, i10-indices, number of citations per document, number of years publishing (ie, duration between an author’s first and most recent publication), number of years publishing prior to 2022 (ie, duration between an author’s first publication and 2022), number of first and senior authorships, and mean number of citations per document.

Statistical Analyses

Differences in academic productivity and academic rank/leadership positions were compared between genders using independent samples t-test for continuous data and chi-square test/Fisher’s exact test for categorical level data. We conducted subgroup analyses for gender differences in academic productivity by subspecialty, and gender differences in academic productivity by practice stage. Univariable and multivariable linear regression analyses were conducted to identify predictors of academic productivity. Gender, subspecialty, and career stage were entered into the linear regression models as independent variables with productivity metrics (ie, publication numbers, h-indices, i10-indices, number of citations per document, number of years publishing, number of first and senior authorships, and mean number of citations per document) as dependent variables. We conducted separate linear regression analyses for each productivity metric. Statistical significance was set a priori at P < .05.

Results

Study Population

A total of 330 academic OHNS faculty were initially identified in our search. Of these, 1 was excluded because they were not listed in the Royal College of Physicians and Surgeons of Canada Directory; 1 was excluded because their Scopus indices were merged with those of another author; 9 were excluded because their work was not indexed in Scopus; and 3 were excluded because gender could not be determined. After exclusions, 316 academic otolaryngology faculty were included in the final analyses. A total of 64 (20.3%) were women, and 252 (79.7%) were men (P < .001). Distribution of faculty across subspecialties by gender is displayed in Figure 1.

Figure 1.

Proportion of female and male OHNS faculty in each subspecialty in Canada. Male otolaryngologists make up a higher proportion of all subspecialties except laryngology, where female representation is higher [χ² (7) = 38.13, P < .001]. OHNS, otolaryngology-head and neck surgery.

Academic Rank and Leadership Roles

Male OHNS faculty were more likely to have higher academic rank than women (Figure 2) (χ² = 11.07, P = .011). Higher proportions of female OHNS faculty occupied the rank of assistant professor (45.3% of female vs 32.1% of male); and higher proportions of male OHNS faculty were ranked as full professors (19% of male vs 3.2% of female). The “other” category included clinical instructors, clinical lecturers, and lecturers. No significant difference was found between the proportions of male and female OHNS faculty at each career stage (χ² = 3.77, P = .152), with the majority in both groups in the late practice stage (47.6% of female vs 59.9% of male) (Table 1). There was no difference in the types of leadership roles (dean, program director, etc) held by men and women (χ² = 2.30, P = .129) (Table 2).

Figure 2.

Proportion of male and female OHNS faculty occupying each academic rank. There was a significant difference noted in proportion of female versus male otolaryngologists across these categories [χ² (3) = 11.07, P = .011]. Of those categorized as “other,” for female faculty this included 5.9% clinical instructor, 11.8% clinical lecturer, and 82.4% lecturer; and male faculty 15.8% clinical instructor, 12.3% clinical lecturer, and 71.9% lecturer. OHNS, otolaryngology-head and neck surgery.

Table 1.

Mean Academic Productivity Metrics for Male and Female Otolaryngologist - Head and Neck Surgeons (OTOHNS) by Practice Stage in Canada.

Variable	Male	Female	Mean difference (95% CI)	P value
Early (1-5 years)
Sample	21	5
Publications, mean (SD)	19.33 (19.60)	20.80 (24.91)	−1.75 (−23.46 to 19.96)	.887
h-index, mean (SD)	6.81 (4.45)	6.40 (4.39)	0.40 (−4.29 to 5.09)	.854
Years publishing, mean (SD)	8.10 (4.29)	8.00 (4.48)	0 (4.81 to −4.81)	.964
Citations, mean (SD)	275.52 (424.12)	286.40 (442.55)	−10.30 (−461.71 to 441.11)	.96
Citations/document, mean (SD)	13.81 (19.55)	10.39 (4.08)	3.57 (−15.34 to 22.51)	.705
First authorships, mean (SD)	6.71 (4.69)	9.60 (11.52)	−3.10 (−17.27 to 11.07)	.610
Senior authorships, mean (SD)	9.29 (29.13)	1.40 (1.52)	2.15 (−9.97 to 14.27)	0.557
Mid (6-15 years)
Sample	78	28
Publications, mean (SD)	39.85 (40.81)	22.57 (27.73)	14.86 (0.66 to 29.05)	.041
h-index, mean (SD)	11.21 (7.25)	8.07 (6.06)	2.63 (−0.47 to 5.74)	.044
Years publishing, mean (SD)	13.58 (5.75)	10.07 (6.67)	3.36 (0.65 to 6.07)	.009
Citations, mean (SD)	641.95 (866.04)	424.39 (547.88)	164.42 (−181.55 to 510.39)	.217
Citations/document, mean (SD)	16.55 (13.08)	17.68 (18.47)	−1.63 (−8.23 to 4.97)	.727
First authorships, mean (SD)	10.24 (11.10)	6.00 (7.00)	3.73 (−0.61 to 8.07)	.023
Senior authorships, mean (SD)	8.53 (12.54)	4.11 (6.80)	3.60 (−0.06 to 7.26)	.023
Late (16+ years)
Sample	148	30
Publications, mean (SD)	54.49 (77.98)	17.03 (19.14)	37.73 (23.33 to 52.12)	<.001
h-index, mean (SD)	13.64 (13.62)	6.90 (4.39)	6.80 (3.96 to 9.64)	<.001
Years publishing, mean (SD)	17.78 (10.79)	15.17 (9.34)	2.61 (−1.59 to 6.82)	.218
Citations, mean (SD)	1323.02 (2524.99)	275.20 (291.24)	1050.70 (627.82 to 1473.58)	<.001
Citations/document, mean (SD)	21.65 (14.78)	16.11 (9.18)	5.53 (1.39 to 9.66)	.01
First authorships, mean (SD)	7.22 (9.69)	3.17 (3.27)	4.14 (2.17 to 6.12)	<.001
Senior authorships	16.02 (25.61)	4.03 (7.64)	12.02 (7.03 to 17.01)	<.001

Gender differences in academic productivity metrics were most pronounced in the late career stage but were absent in the early career stage.

Abbreviations: CI, confidence interval; SD, standard deviation.

Bold indicates statistical significance.

Table 2.

Leadership Roles in Canadian OHNS.

Leadership role	Male, N (%)	Female, N (%)	Combined, N (%)	χ² Test
Advanced leadership role (Dean, Surgery, Department Chair)	4 (9.5)	0 (0)	4 (8.2)	χ² (5) = 6.75, P = .240
Otolaryngology Department Chair or Associate Department Chair	12 (28.6)	1 (14.3)	13 (26.5)
Division Chair (subspecialty)	8 (19.0)	1 (14.3)	9 (18.4)
Program Director	12 (28.6)	2 (28.6)	14 (28.6)
Other Leadership Role (undergraduate/postgraduate, research, CME, etc)	11 (26.2)	3 (42.9)	14 (28.6)
Total	47	7	54

No significant difference in type of leadership roles held by male and female otolaryngologists.

Abbreviation: OHNS, otolaryngology-head and neck surgery; CME, continuing medical education.

Research Metrics

Across the entire cohort, men had significantly higher mean h-indices and i10-indices than women [h-index mean (standard deviation, SD), 12.22 (11.47) for men vs 7.33 (5.36) for women, 95% CI 2.95 to 6.84, P < .001; i10-indices 22.61 (37.88) for men vs 8.17 (9.14), 95% CI 9.22 to 19.65, P < .001]. Male faculty had a greater mean number of publications [46.63 (65.18) vs 19.59 (23.40), 95% CI 16.73 to 36.69, P < .001], mean number of years publishing [15.64 (9.45) vs 12.44 (8.28), 95% CI .66 to 5.75, P = .014], and mean number of citations [1007.41 (2033.73) vs 339.98 (431.15), 95% CI 393.95 to 940.91, P < .001]. Significantly, more male than female first-authorship publications [8.18 (9.95) vs 4.89 (6.18), 95% CI 1.33 to 5.26, P = .001] and senior authorship publications [12.98 (22.72) vs 3.83 (6.89), 95% CI 5.87 to 12.44, P < .001] were identified. However, no significant gender difference was found for the mean number of citations per document [19.20 (14.85) vs 16.52 (13.83), 95% CI −1.22 to 6.58, P = .175] or mean number of coauthors [207.31 (969.87) vs 347.52 (2275.95), 95% CI −509.23 to 228.82, P = .455].

When subgroup analysis was completed for subspecialty, gender differences in h-index were observed in head and neck oncology and pediatrics, with male authors having a significantly higher h-index than female authors [mean (SD), 19.05 (15.13) vs 10.67 (4.97), P = .008 for head and neck oncology; 12.32 (10.20) vs 7.73 (5.12), P = .042 for pediatrics]. In the subspecialties of FPRS, sleep medicine, otology, and laryngology, there were no significant gender differences across all academic productivity metrics evaluated (Supplemental Table S1). In head and neck oncology, men had a greater mean number of publications [83.46 (91.01) vs 32.17 (26.43), P = .004)] and senior author publications [17.91 (24.92) vs 6.00 (7.72), P = .015] than women. Compared to women in pediatric otolaryngology, men had more publications [52.68 (65.82) vs 20.20 (17.56), P = .005], higher mean citation number [890.94 (1352.46) vs 333.60 (320.08), P = .029], first authorships [9.50 (10.96) vs 4.53 (4.05), P = .025], and senior authorships [18.71 (29.95) vs 3.73 (8.34), P = .010]. However, the mean number of citations per document was not significantly different between the 2 groups [16.69 (16.36) vs 14.11 (9.86), P = .575]. Additionally, male rhinologists had significantly more senior authorships than women [16.10 (21.47) vs 3.50 (3.87), P = .007].

When examining the same academic productivity variables by career stage, there were no significant differences in the productivity of female and male academic otolaryngologists in the early career stage. The mean (SD) h-index for early career otolaryngologists was 6.81 (4.45) for men, and 6.40 (4.39) for women (P = .854); and mean (SD) number of publications was 19.33 (19.60) for men and 20.80 (24.91) for women, (P = .887) (Table 1). While the number of physicians in the early career stage was low, women had a higher number of publications and total citations than men; however, no differences were statistically significant. In the middle career phase, men had a greater number of publications [39.85 (40.81) vs 22.57 (27.73), P = .041], number of years publishing [13.58 (5.75) vs 10.07 (6.67), P = .009], and first [10.24 (11.10) vs 6.00 (7.00) P = .023] and senior [8.53 (12.54) vs 4.11 (6.80), P = .023] authorships. In the late career stage, men and women had the same number of publishing years, but men had higher academic productivity than women across all other variables (Table 1).

We conducted univariate and multivariate analyses to examine interactions between subspecialty, practice stage, and gender, and relation to the academic productivity metrics of h-index, publication number, i10-index, and senior author publications (Table 3). For all univariate models, gender had a significant impact on productivity metrics, wherein men had higher markers of productivity than women. However, in multivariable models where subspecialty and practice stage were controlled, no significant gender differences emerged for h-index or i10-index. Gender had a statistically significant effect on productivity in the senior authorship and publication number multivariable models, with male otolaryngologists having higher likelihood of senior authorship and higher publication number than females, even when controlling for subspecialty and career stage (P = .019 for senior authorships; P = .047 for number of publications)

Table 3.

Regression Analyses.

Productivity metric	Variable	Univariable analysis		Multivariable analysis
h-index		B (95% CI)	P value	B (95% CI)	P value
	Gender	4.89 (1.99 to 7.79)	.001	2.67 (−0.14 to 5.35)	.063
	Subspecialty
	General	Reference	—	Reference	—
	Head and neck oncology	14.22 (10.89 to 17.55)	<.001	14.58 (11.28 to 17.88)	<.001
	Laryngology	3.46 (−1.53 to 8.45)	.173	5.70 (.69 to 10.71)	.026
	Otology	7.10 (3.11 to 11.10)	<.001	7.98 (4.05 to 11.91)	<.001
	Pediatric otolaryngology	6.80 (3.15 to 10.45)	<.001	8.01 (4.43 to 11.60)	<.001
	Rhinology	10.68 (6.61 to 14.75)	<.001	11.14 (7.13 to 15.14)	<.001
	Sleep	1.38 (−8.39 to 11.15)	.781	2.82 (−6.69 to 12.32)	.560
	Facial plastics	4.88 (1.12 to 8.65)	.011	4.63 (0.94 to 8.31)	.014
	Practice stage
	Early (1-5 yrs)	Reference	—	Reference	—
	Mid (6-15 yrs)	3.38 (−0.83 to 7.58)	.115	3.89 (0.16 to 7.63)	.041
	Late (16+ yrs)	5.50 (1.50 to 9.50)	.007	7.02 (3.45 to 10.59)	<.001
Publication number	Gender	27.04 (10.73 to 43.34)	.001	16.07 (0.22 to 31.91)	.047
	Subspecialty
	General	Reference		Reference
	Head and neck oncology	72.33 (53.21 to 91.45)	<.001	73.81 (54.76 to 92.86)	<.001
	Laryngology	13.78 (−14.85 to 42.41)	.344	26.92 (−2.01 to 55.84)	.068
	Otology	34.65 (11.69 to 57.60)	.003	39.01 (16.32 to 61.69)	<.001
	Pediatric otolaryngology	35.94 (14.96 to 56.92)	<.001	42.28 (21.61 to 62.95)	<.001
	Rhinology	47.47 (24.10 to 70.84)	<.001	49.69 (26.58 to 72.80)	<.001
	Sleep	0.96 (−55.13 to 57.04)	.973	8.05 (−46.78 to 62.88)	.773
	Facial plastics	18.98 (−2.65 to 40.60)	.085	17.21 (−4.07 to 38.49)	.113
	Practice stage
	Early (1-5 yrs)	Reference	—	Reference
	Mid (6-15 yrs)	13.69 (−9.98 to 37.36)	.256	16.99 (−4.57 to 38.55)	.122
	Late (16+ yrs)	26.58 (4.05 to 49.11)	.021	34.69 (14.10 to 55.28)	.001
Number of senior authorships	Gender	9.16 (3.50 to 14.81)	.002	6.94 (1.17 to 12.72)	.019
	Subspecialty
	General	Reference		Reference
	Head and neck oncology	15.27 (8.30 to 22.25)	<.001	15.60 (8.66 to 22.54)	<.001
	Laryngology	3.48 (−6.97 to 13.93)	.513	9.32 (−1.23 to 19.86)	.083
	Otology	15.85 (7.47 to 24.22)	<.001	17.28 (9.01 to 25.54)	<.001
	Pediatric otolaryngology	12.50 (4.84 to 20.15)	.001	14.61 (7.08 to 22.15)	<.001
	Rhinology	12.99 (4.46 to 21.52)	.003	13.81 (5.39 to 22.23)	.001
	Sleep	−1.38 (−21.85 to 19.09)	.895	0.52 (−19.46 to 20.50)	.959
	Facial plastics	5.31 (−2.59 to 13.20)	.187	4.45 (−3.31 to 12.20)	.260
	Practice stage
	Early (1-5 yrs)	Reference		Reference
	Mid (6-15 yrs)	−0.30 (−8.49 to 7.90)	.943	0.99 (−6.86 to 8.85)	.803
	Late (16+ yrs)	6.34 (−1.46 to 14.14)	.111	9.06 (1.56 to 16.57)	.018
i10 index	Gender	14.44 (5.04 to 23.83)	.003	8.04 (−1.18 to 17.25)	.087
	Subspecialty
	General	Reference		Reference
	Head and neck oncology	38.08 (26.93 to 49.24)	<.001	39.52 (28.43 to 50.60)	<.001
	Laryngology	4.93 (−11.78 to 21.63)	.560	13.04 (−3.78 to 29.86)	.128
	Otology	13.84 (0.45 to 27.23)	.043	16.94 (3.74 to 30.13)	.012
	Pediatric otolaryngology	15.11 (2.87 to 27.35)	.016	19.05 (7.02 to 31.07)	.002
	Rhinology	21.32 (7.55 to 35.08)	.003	23.12 (9.58 to 36.67)	<.001
	Sleep	0.56 (−32.16 to 33.28)	.973	4.87 (−27.02 to 36.75)	.764
	Facial plastics	8.47 (−4.15 to 21.08)	.187	7.75 (−4.63 to 20.13)	.219
	Practice stage
	Early (1-5 yrs)	Reference	—	Reference
	Mid (6-15 yrs)	6.42 (−7.12 to 19.97)	.352	8.02 (−4.53 to 20.57)	.210
	Late (16+ yrs)	16.76 (3.88 to 29.64)	.011	20.61 (8.64 to 32.59)	<.001

Gender has a statistically significant impact on all markers of academic productivity in all univariate models and on the multivariate models for number of publications and number of senior authorships. In the multivariate models for h-index and i10-index, gender had no significant effect.

Abbreviation: CI, confidence interval.

Discussion

Women in OHNS may face barriers to academic advancement. Earlier investigations have found that the academic productivity of female OHNS lags in the early career phase but catches up in later years.¹¹ Our results deviate from this historical pattern, finding that gender alone has a smaller impact on academic productivity metrics in Canadian OHNS than described in other studies.

Across the cohort of 316 academic otolaryngologists reviewed in this study, 79.7% were male. Male otolaryngologists had higher levels of research productivity when not controlled for other factors, and higher academic ranks than females. This is consistent with previous research showing that women in academic medicine generally have lower academic rankings than male counterparts.^3,18 In 2012, Sexton et al² demonstrated that the number of female full professors in surgery is increasing at a slower rate than the number of surgical residents. The “leaky pipeline” phenomenon is 1 explanation for the lack of women in otolaryngology and professorship ranks. This theory describes the attrition of people in minority groups from fields such as academic medicine as a result of the structural barriers they face.^19,20 Although this study found men to hold full professorship roles significantly more than women, the proportion of men and women in the associate professor rank is comparable and may thus be a promising indication of improving promotion practices.

Previous studies from the United States have found that women in academic OHNS were less likely to be promoted to leadership positions than their male colleagues.^4,21,22 Comparatively, the results of this study show parity in the type of leadership positions held by male and female otolaryngologists. This may represent a difference in practice between the American and Canadian academic OHNS landscapes. Conversely, this may be a sign of a cultural progression toward gender equity in academic OHNS. It may also be an issue of study power; only 7 leadership positions were held by females in our cohort (vs 47 held by males); as such, limited variability and small sample size within the female subgroup may have contributed to low statistical power, and consequently, nonsignificant findings.

Regarding subspecialty differences, gender disparities in academic productivity were most pronounced in head and neck oncology and pediatrics. These results may stem from subspecialty- and program-specific differences. Among academic OHNS subspecialties, receipt of higher amounts of industry funding is correlated with higher academic productivity.²³ Head and neck oncology and pediatrics receive the lowest amounts of industry support.²³ It is possible that greater industry funding provided to some subspecialties facilitates increased productivity of female otolaryngologists by correcting for the gendered imbalance in research grant and funding allocation.^24,25 Moreover, program-specific practices, such as resident research programs, mentorship opportunities, and support for obtaining research training affect research productivity, and may therefore explain subspecialty-specific variation.^26-28

Interestingly, while male faculty had a higher mean number of citations than women, the number of citations per document did not differ for men and women, implying similar quality of publication and contribution to the field. This contrasts with previous findings of a citation disadvantage for female-authored work.^29,30 Another promising indicator of cultural change is the finding that female and male otolaryngologists have equivalent academic productivity in the early career phase and in certain subspecialties. This mirrors an American study, finding similar early career productivity in general, otology, plastics, and rhinology between genders.³ After controlling for subspecialty and career stage, gender alone did not have a significant impact on any academic productivity markers, except for the number of senior authorships per physician and the total number of publications per physician. These results may be a signpost of diminishing barriers facing women pursuing careers in academic otolaryngology.

The early career stage coincides with the period when many female physicians begin families and take on a disproportionate burden of domestic duties, potentially leading to a lag in productivity during this career phase.^11,31 Recent evidence has shown that female surgeons delay childrearing, which may explain their higher productivity in the early career stage, though it raises concern of increased rates of pregnancy complications and infertility.^32-34 More encouragingly, the domestic workload may be lessening for female physicians as societal gender expectations change and domestic duties are more equally portioned.³⁵ Similarly, changing societal attitudes toward mothers hiring support for domestic duties may be easing the workload for female surgeons. Although childcare is 1 of the biggest barriers to career advancement for women in plastic surgery, 62.8% of female plastic surgeons benefit from hired help and schools for childcare.³⁶

Another well-established barrier to career advancement for women in medicine is the lack of female mentors in the workplace.^37,38 Previous work has found that male surgeons hold significantly more networking relationships with other male surgeons, and that this gender homophily is associated with inhibiting career advancement for female surgeons.³⁹ With the number of women in otolaryngology rising, it is possible that more women in training and in their early careers will have access to female mentors who can offer guidance about career advancement and navigate the unique barriers facing women in academic medicine.

This study is not without limitations. As this study relied on publicly available data to determine the genders of faculty members, it did not provide physicians with the opportunity to self-identify. All individuals were classified based on names, photos, and stated pronouns, which did not obviously indicate any participants whose gender identity exists elsewhere on the gender continuum. Only physicians listed on faculty websites were included, which may not always include up-to-date information on departmental composition, academic rank, or leadership roles. Scopus only lists publications from 1995 onward, meaning older publications may have been missed. Citation indices in Scopus can also vary from other databases, however Scopus was exclusively used for all faculty included.

Additionally, while career stage was defined as time since residency graduation, authors’ productivity metrics were calculated using all publications, which may include works published during medical school and/or residency. However, this was common to both the male and female cohorts. Moreover, because of the low numbers of physicians in some categories, such as sleep medicine and early career stage female physicians, some analyses may have been underpowered.

Finally, it has been shown that obstacles for women in academia deter many women from pursuing academic medicine careers.^40,41 This study reported only on academic otolaryngologists and does not account for the female otolaryngologists potentially publishing high-quality research in community practice without academic affiliation, though we did capture those affiliated with postgraduate training programs.

While previous research on the academic productivity of Canadian otolaryngologists has been limited to academic leaders, we examined gender-based productivity differences for all academic otolaryngologists across the nation. The similarity of findings in this cohort compared to those described in the United States helps to substantiate the conclusion that gender-based differences in scholarly productivity in OHNS may be changing across North America.³ Additionally, this study evaluated a comprehensive set of academic productivity metrics, providing a deeper understanding of the trends in productivity and overcoming the limitations of using h-index alone. Finally, we used univariable and multivariable analyses to understand the individual and joint effects of gender, subspecialty, and career stage on key markers of academic productivity. This study is thus the first to show how gender acts in concert with career stage and subspecialty to affect academic productivity but has a minimal effect on its own.

Conclusion

This study reports that Canadian female academic otolaryngologists have equivalent research productivity to their male counterparts in the early career stage and in some subspecialties, and that gender alone has a minimal impact on academic productivity. As academic productivity serves as a key metric determining career advancement, this study may identify the beginning of a shift toward breaking down barriers facing female academic otolaryngologists. Future studies should explore what supports and cultural patterns contribute to this change and how we can be encouraged to support diversity in academic otolaryngology.

Supplemental Material

sj-docx-1-ear-10.1177_01455613231190272 – Supplemental material for Understanding Gender Differences in Research Productivity of Canadian Otolaryngologists—A Comprehensive National Audit

Supplemental material, sj-docx-1-ear-10.1177_01455613231190272 for Understanding Gender Differences in Research Productivity of Canadian Otolaryngologists—A Comprehensive National Audit by Eva Gajic, Emily Aleksa, Agnieszka Dzioba, Julie E. Strychowsky, Amanda Hu, Yvonne Chan and M. Elise Graham in Ear, Nose & Throat Journal

Footnotes

Authors’ Note

This work was presented at the Canadian Society of Otolaryngology National Meeting, Vancouver, Canada, October 2022.

Data Availability Statement

All data presented herein are available to review on reasonable request.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Statement

By TCPS-Core 2 guidelines, this work is exempt from institutional ethical board approval as it utilized publicly available data.

Consent Statement

Participant consent was not required as all data obtained were publicly available.

ORCID iDs

Yvonne Chan

M. Elise Graham

Supplemental Material

Supplemental material for this article is available online.

References

Grose

Chen

Siu

Campisi

Witterick

Chan

. National trends in gender diversity among trainees and practicing physicians in otolaryngology – head and neck surgery in Canada. JAMA Otolaryngol Head Neck Surg. 2022;148(1):13-19. doi:10.1001/jamaoto.2021.143

Sexton

Hocking

Wise

, et al. Women in academic surgery: the pipeline is busted. J Surg Educ. 2012;69(1):84-90. doi:10.1016/j.jsurg.2011.07.008

Okafor

Tibbetts

Shah

Tillman

Agan

Halderman

. Is the gender gap closing in otolaryngology subspecialties? An analysis of research productivity. Laryngoscope. 2020;130(5):1144-1150. doi:10.1002/lary.28189

Battaglia

Farhan

Narmeen

, et al. Does gender influence leadership roles in academic surgery in the United States of America? A cross-sectional study. Int J Surg. 2020;83:67-74. doi:10.1016/j.ijsu.2020.08.029

Mousa

Boyle

Teede

, et al. Women physicians and promotion in academic medicine. N Engl J Med. 2021;384(7):679-681. doi:10.1056/NEJMc2035793

Campisi

Witterick

Chan

. Academic benchmarks for leaders in Otolaryngology-Head & Neck Surgery: a Canadian perspective. J Otolaryngol Head Neck Surg. 2020;49(1):27-27. doi:10.1186/s40463-020-00419-4

AAMC. Department chairs by department, sex, and race/ethnicity. Accessed September 9, 2022, www.aamc.org/download/495102/data/supplementaltablec.pdf.

Arrighi-Allisan

Shukla

Meyer

, et al. Gender trends in authorship of original otolaryngology publications: a fifteen-year perspective. Laryngoscope. 2020;130(9):2126-2132. doi:10.1002/lary.28372

Marrone

Berman

Brandt

Rothstein

. Does academic authorship reflect gender bias in pediatric surgery? An analysis of the Journal of Pediatric Surgery, 2007–2017. J Pediatr Surg. 2020;55(10):2071-2074. doi:10.1016/j.jpedsurg.2020.05.020

10.

Marusic

Bosnjak

Jeroncic

. A systematic review of research on the meaning, ethics and practices of authorship across scholarly disciplines. PloS One. 2011;6(9):e23477-e23477. doi:10.1371/journal.pone.0023477

11.

Eloy

Svider

Chandrasekhar

, et al. Gender disparities in scholarly productivity within academic otolaryngology departments. Otolaryngol Head Neck Surg. 2013;148(2):215-222. doi:10.1177/0194599812466055

12.

Castillo

. Measuring academic output: the h-index. AJNR Am J Neuroradiol. 2010;31(5):783-784. doi:10.3174/ajnr.A1888

13.

Hirsch

. An index to quantify an individual’s scientific research output. Proc Natl Acad Sci USA. 2005;102(46):16569-16572. doi:10.1073/pnas.0507655102

14.

Svider

Choudhry

Baredes

Liu

Eloy

. The use of the h-index in academic otolaryngology. Laryngoscope. 2013;123(1):103-106. doi:10.1002/lary.23569

15.

Sukotjo

Khan

Yuan

JCC

Afshari

Weatherspoon

Wee

. Research productivity of directors of U.S. advanced education in prosthodontics programs. J Dent Educ. 2018;82(12):1320-1326. doi:10.21815/JDE.018.136

16.

Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council, Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, December 2018.

17.

Royal College Directory [database online]. Royal College of Physicians and Surgeons of Canada.

18.

Tanya

Tang

, et al. Research productivity and impact of Canadian academic ophthalmologists: trends in H-index, gender, subspecialty, and faculty appointment. Can J Ophthalmol. 2022;57(3):188-194. doi:10.1016/j.jcjo.2021.03.011

19.

Freeman

Landry

Trevino

Grande

Shea

. Understanding the leaky pipeline: Perceived barriers to pursuing a career in medicine or dentistry among underrepresented-in-medicine undergraduate students. Acad Med. 2016;91(7):987-993. doi:10.1097/ACM.0000000000001020

20.

Barr

Gonzalez

Wanat

. The leaky pipeline: factors associated with early decline in interest in premedical studies among underrepresented minority undergraduate students. Acad Med. 2008;83(5):503-511. doi:10.1097/ACM.0b013e31816bda16

21.

Garstka

Randolph

Haddad

, et al. Gender disparities are present in academic rank and leadership positions despite overall equivalence in research productivity indices among senior members of American Head and Neck Society (AHNS) Fellowship Faculty. Head Neck. 2019;41(11):3818-3825. doi:10.1002/hed.25913

22.

Epperson

Gouveia

Tabangin

, et al. Female representation in otolaryngology leadership roles. Laryngoscope. 2020;130(7):1664-1669. doi:10.1002/lary.28308

23.

Svider

Bobian

Lin

, et al. Are industry financial ties associated with greater scholarly impact among academic otolaryngologists? Laryngoscope. 2017;127(1):87-94. doi:10.1002/lary.26027

24.

Eloy

Svider

Kovalerchik

Baredes

Kalyoussef

Chandrasekhar

. Gender differences in successful NIH grant funding in otolaryngology. Otolaryngol Head Neck Surg. 2013;149(1):77-83. doi:10.1177/0194599813486083

25.

Burns

KEA

Straus

Liu

Rizvi

Guyatt

. Gender differences in grant and personnel award funding rates at the Canadian Institutes of Health Research based on research content area: A retrospective analysis. PLoS Med. 2019;16(10):e1002935-e1002935. doi:10.1371/journal.pmed.1002935

26.

Allen

Vogt

Mele

Ott

Leslie

Colquhoun

. Evaluating the impact of a resident research program in general surgery. Can Med Educ J. 2017;8(3):e13-e20.

27.

Svider

Husain

Mauro

Folbe

Baredes

Eloy

. Impact of mentoring medical students on scholarly productivity. Int Forum Allergy Rhinol. 2014;4(2):138-142. doi:10.1002/alr.21247

28.

Pizzo

. The role of academic medical centers and medical schools in the training and support of physician-scientists. In: Schafer

, ed. The Vanishing Physician-Scientist? Cornell University Press; 2011:120-37. doi:10.7591/9780801462429-010.

29.

Benjamens

Banning

LBD

van den Berg

TAJ

Pol

. Gender disparities in authorships and citations in transplantation research. Transplant Direct. 2020;6(11):e614. doi:10.1097/TXD.0000000000001072

30.

Bendels

MHK

Müller

Brueggmann

Groneberg

. Gender disparities in high-quality research revealed by Nature Index journals. PLoS One. 2018;13(1):e0189136. doi:10.1371/journal.pone.0189136

31.

Jolly

Griffith

DeCastro

Stewart

Ubel

Jagsi

. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344-353. doi:10.7326/M13-0974

32.

Ponzio

Bell

Stavrakis

, et al. Discrepancies in work-family integration between female and male orthopaedic surgeons. J Bone Joint Surg Am. 2022;104(5):465-472. doi:10.2106/JBJS.21.00345

33.

Parsons

Duke

Snow

Edwards

. Physicians as parents: parenting experiences of physicians in Newfoundland and Labrador. Can Fam Physician. 2009;55(8):808-809.e4

34.

Bering

Pflibsen

Eno

Radhakrishnan

. Deferred personal life decisions of women physicians. J Womens Health (Larchmt). 2018;27(5):584-589. doi:10.1089/jwh.2016.6315

35.

Collie

Lew

Peate

. Merging motherhood and medicine: a qualitative study exploring barriers and enablers to motherhood among female doctors in Australia. Womens Health (Lond). 2022;18:17455057221114268. doi:10.1177/17455057221114268

36.

Naidu

Patrick

Bregman

Jianu

. Challenges to professional success for women plastic surgeons: An international survey. Aesthetic Plast Surg. 2021;45(5):2464-2472. doi:10.1007/s00266-021-02171-0

37.

Zhuge

Kaufman

Simeone

Chen

Velazquez

. Is there still a glass ceiling for women in academic surgery? Ann Surg. 2011;253(4):637-643. doi:10.1097/SLA.0b013e3182111120

38.

Robinson

. Stresses on women physicians: consequences and coping techniques. Depress Anxiety. 2003;17(3):180-189. doi:10.1002/da.10069

39.

Suurna

Leibbrandt

. Underrepresented women leaders: lasting impact of gender homophily in surgical faculty networks. Laryngoscope. 2022;132(1):20-25. doi:10.1002/lary.29681

40.

Edmunds

Ovseiko

Shepperd

, et al. Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence. Lancet. 2016;388(10062):2948-2958. doi:10.1016/S0140-6736(15)01091-0

41.

Sinden

Sherriff

Westmore

Greenfield

Allan

. Patterns of child-bearing behaviour amongst female hospital doctors and GPs. Fam Pract. 2003;20(4):486-488. doi:10.1093/fampra/cmg427

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.02 MB

0.00 MB