The proportion of women authoring papers in the most prestigious medical journals has not seen any “substantive” improvement in almost 20 years and is likely perpetuating gender inequality in the discipline, a new study has concluded.

Researchers analysed a random sample of more than 1,000 papers published in three of the most prestigious medical journals, The Lancet, New England Journal of Medicine (NEJM) and Journal of the American Medical Association (JAMA), between 2002 and 2019.

They found that compared with 37 per cent of full-time US medical school faculty being women over the time period, the overall shares of women among first and last authors across the journals were much lower, at 27 per cent for first authors, who generally make the biggest contribution to medical papers, and 19 per cent for last authors, who tend to be senior project leaders.

When looking at first authors only and by each journal, only JAMA had a figure (35 per cent) comparable with the US faculty percentage, with the Lancet (29 per cent) and NEJM (16 per cent) even lower over the period.

The new study, published in Plos One, also found “there were no substantive improvements over time in the proportion of women holding first author, second author, last author, or any significant author positions”.

“Given that these lower women authors rates were sustained from 2002 to 2019, these dramatic differences in women versus men’s authorship raise serious concerns of gender inequity.”

To gauge the likelihood of women going on to publish further work, the study also looked at the degree of multiple publications by male and female first authors in the journals, finding that only 3 per cent of female first authors had multiple publications compared with 13 per cent of the men.

The authors of the study, mainly based at Stony Brook University in the US, say publications in top medical journals are “used to inform decisions for future academic promotions, grant funding, and appointment to leadership positions”.

“Unfortunately, the differences in women versus men [authorship outcomes] identified here may likely serve to perpetuate the current gender inequalities found throughout medicine.”

They add that the causes for the disparities were likely complex and involved issues around the career pipeline for women in medicine and implicit gender bias at institutions. However, they also called on journals to be transparent about paper submission data so the impact that editorial decisions had on the gaps could be assessed.

The paper concludes that “persistent and dramatic gender disparities persist” in authorship despite the growth in awareness around the issue and “women first authors appear to continue to face great difficulty in breaking through academic medicine’s glass ceiling”.

“Regardless of the cause, a steep uphill climb remains for women who aim to have a successful career in academic medicine.”

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