Association of Women Leaders with Women Program Director and Trainee Representation Across US Academic Internal Medicine

Abstract

Background Women are underrepresented within internal medicine (IM). Whether women leaders attract women trainees is not well explored. Objective To characterize leader and trainee gender across US academic IM and to investigate the association of leader gender with trainee gender. Design Cross-sectional study. Participants Leaders (chairs, chiefs, program directors (PDs)) in 2018 and trainees (residents, fellows) in 2012–2016 at medical school-affiliated IM and seven IM fellowship programs. Exposure Leadership (chair/chief and program director; and, for resident analyses, fellow) gender. Main Measures Our primary outcome was percent women trainees (IM residents and, separately, subspecialty fellows). We used standard statistics to describe leadership and trainee gender. We created separate multivariable linear regressions to evaluate associations of leader gender and percent women fellows with percent women IM residents. We then created separate multivariable multilevel models (site as a random effect) to evaluate associations of leader gender with percent women subspecialty fellows. Key Results Our cohort consisted of 940 programs. Women were 13.4% of IM chairs and <25% of chiefs in each fellowship subspecialty (cardiology: 2.6%; gastroenterology: 6.6%; pulmonary and critical care: 10.7%; nephrology: 14.4%; endocrinology: 20.6%; hematology-oncology: 23.2%; infectious diseases: 24.3%). IM PDs were 39.7% women; fellowship PDs ranged from nearly 25% (cardiology and gastroenterology) to nearly 50% (endocrinology and infectious disease) women. Having more women fellows (but not chairs or PDs) was associated with having more women residents (0.3% (95% CI: 0.2–0.5%) increase per 1% fellow increase, p <0.001); this association remained after adjustment (0.3% (0.1%, 0.4%), p =0.001). In unadjusted analyses, having a woman PD (increase of 7.7% (4.7%, 10.6%), p <0.001) or chief (increase of 8.9% (4.6%, 13.1%), p <0.001) was associated with an increase in women fellows; after adjustment, these associations were lost. Conclusions Women held a minority of leadership positions in academic IM. Having women leaders was not independently associated with having more women trainees. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07635-w.

Current state of female pediatric urologists at Societies for Pediatric Urology fellowship accredited programs

“…directorship positions provide more mentorship opportunities to female trainees and could lead better recruitment of female residents and fellows into respective programs. A recent study of internal medicine programs, however, did not find this to be the case with no association found between presence of a female program director and number women trainees (15); this has of yet to be investigated in pediatric urology, however. It has been suggested that an apparent discrepancy between representation of women in program directorship positions compared to department/division chief positions is a result of women generally being guided toward more clinic-educator career tracks rather than traditional researchbased tracks that have a higher likelihood of major departmental leadership advancement and thus promotion (16).…”