BoSS Library

• Aguwa UT, Srikumaran D, Green LK, et al. Analysis of sex diversity trends among ophthalmology match applicants, residents, and clinical faculty. JAMA Ophthalmol 2021; 139:11841190.

* This study found that the percentage of women in the field of ophthalmology remains lower than percentages in other specialties, and the percentage of female ophthalmology residents has decreased in recent years. More efforts are needed to improve female representation in ophthalmology.

• Gill HK, Niederer RL, Shriver EM, et al. An eye on gender equality: a review of the evolving role and representation of women in ophthalmology. Am J Ophthalmol 2022; 236:232240.
  
  
• Rousta N, Hussein IM, Kohly RP. Sex Disparities in Ophthalmology from Training Through Practice: A Systematic Review. JAMA Ophthalmol. 2024 142(2):146-154. doi: 10.1001/jamaophthalmol.2023.6118. PMID: 38236584.
  
  
  
• Burton MJ, Ramke J, Marques AP, et al. The Lancet Global Health Commission on global eye health: vision beyond 2020. Lancet Glob Health. 2021;9(4):e489-e551. doi:10.1016/S2214-109X(20)30488-5

 *The Lancet Global Health Commission on Global Eye Health reported that change is required to improve equity, diversity, and inclusion for females in ophthalmology.

• Linz MO, Jun AS, Clever SL, Lawson SM, Sanyal A, Scott AW. Evaluation of medical students’ perception of an ophthalmology career. Ophthalmology. 2018;125(3):461-462. doi:10.1016/j.ophtha.2017.10.032

*A 2018 single-center survey (n = 89) found that more students who were underrepresented in medicine (URM) (2 of 8 females [25%]; 0 of 8 males) than students who were not URM (0 of 73, including 34 females; P = .03) cited insufficient same-sex role models or mentors as a reason for not pursuing ophthalmology.

 

• Lin F, Oh SK, Gordon LK, Pineles SL, Rosenberg JB, Tsui I. Gender-based differences in letters of recommendation written for ophthalmology residency applicants. BMC Med Educ. 2019;19(1):476. doi:10.1186/s12909-019-1910-6

*In a single-center analysis12 of 440 applicants in the 2017 to 2018 SF Match, terminology used in reference letters written for females vs males was different despite applicants having similar academic and service achievements, and sex distribution of letter writers.

 

• Tuli SS. Status of women in academic ophthalmology. J Acad Ophthalmol. 2019;11(02):e59-e64. doi:10.1055/s-0039-3401849

*The percentage of female ophthalmology residents in 2017 was 41.0% (593 of 1446); this has been mostly constant between 2007 and 2017. Females in academic ophthalmology increased from 24% to 34% between 2003 and 2017, mostly at the assistant professor rank (44% female); 19% of professors and 12% of chairs were female.

 

• Gong D, Winn BJ, Beal CJ, et al. Gender differences in case volume among ophthalmology residents. JAMA Ophthalmol. 2019;137(9):1015-1020. doi:10.1001/jamaophthalmol.2019.2427

*An analysis of resident case logs (n = 1271) in 24 US programs between 2005 and 2017 revealed that females performed a mean (SD) of 451.3 (158.8) total procedures, whereas males performed 509.4 (208.6) procedures (MD, 58.1; 95% CI, 36.0-80.2; P < .001). There was no sex difference in the increase of cataract volumes in this period (β = −1.6; 95% CI, −3.7 to 0.4; P = .11); however, male surgical volumes increased more for total procedures (β = −8.0; 95% CI, −14.0 to −2.1; P = .008).

 

• Gill HK, Niederer RL, Danesh-Meyer HV. Gender differences in surgical case volume among ophthalmology trainees. Clin Exp Ophthalmol. 2021;49(7):664-671. doi:10.1111/ceo.13969

*Similar results were observed in a cohort analysis from Australia and New Zealand of resident logbooks (n = 241) between 2008 and 2020.17 A subanalysis in this study using 2020 data of 181 residents who performed 32 992 surgical procedures found no association between complication rate and trainee sex. 

• McAlister C, Jin YP, Braga-Mele R, DesMarchais BF, Buys YM. Comparison of lifestyle and practice patterns between male and female Canadian ophthalmologists. Can J Ophthalmol. 2014;49(3):287-290. doi:10.1016/j.jcjo.2014.02.007

*A 2012 survey of 385 ophthalmologists reported that 50 of 102 females (49%) vs 181 of 283 males (64%; P = .001) had 2 or more operating room days per month.

• Feng PW, Ahluwalia A, Adelman RA, Chow JH. Gender differences in surgical volume among cataract surgeons. Ophthalmology. 2021;128(5):795-796. doi:10.1016/j.ophtha.2020.09.031

*In a 2017 population-based study of 8620 ophthalmologists (1829 females [21.2%]) who performed cataracts for Medicare beneficiaries, multivariate analysis revealed that males performed an estimated 101.1 more cataract surgeries (95% CI, 67.9-134.2; P < .001), after controlling for clinical productivity and number of years in practice.

• Fountain TR. Ophthalmic malpractice and physician gender: a claims data analysis (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2014;112:38-49.

*In an analysis of 2251 claims, males were sued 54% more than females between 1990 and 2008 (claim frequency was 5.69% [SD, 0.13%] for males vs 3.70% [SD, 0.25%] for females) and were 1.7 times more likely to have claims associated with permanent injury (616 of 35 773 males [1.72%] vs 58 of 5811 females [1.0%]) and nearly 8 times more likely to have claims associated with death (48 of 35 773 males [0.13%] vs 1 of 5811 females [0.02%]). However, females paid 47.4% more in indemnity for treatment and procedural claims ($190 185 vs $100 099).

 

• Ahmad S, Ramulu P, Akpek E, Deobhakta A, Klawe J. Gender-specific trends in ophthalmologist Medicare collections. Am J Ophthalmol. 2020;214:32-39. doi:10.1016/j.ajo.2019.12.024

*After adjusting for subspecialty, the average female collected $133 289 (42%) less than males in Medicare payments between 2012 and 2015, with the median male ophthalmologist out-earning the 75th percentile of female ophthalmologists in all subspecialties.

• Sedhom JA, Patnaik JL, McCourt EA, et al. Physician burnout in ophthalmology: US survey. J Cataract Refract Surg. 2022;48(6):723-729. doi:10.1097/j.jcrs.0000000000000837

*In an early 2020 survey, female ophthalmologists had almost twice the odds of reporting burnout (odds ratio, 1.9; 95% CI, 1.3-2.7; P <.001) and were more likely to report feeling high work-related stress (125 of 199 [62.8%] vs 168 of 342 [49.1%]; P = .002). 

 

• Goldstein T, Lessen S, Moon JY, Tsui I, Rosenberg JB. The significance of female faculty and department leadership to the gender balance of ophthalmology residents. Am J Ophthalmol. 2022;238:181-186. doi:10.1016/j.ajo.2022.01.022

*A more recent US study found that 18 of 108 chairs (16.7%) were female, and 43 of 117 programs (37.7%) had female program directors in 2020 to 2021. Greater female faculty increased the odds of having more female residents (OR, 1.19; 95% CI, 1.08-1.3; P < .001); department chair sex did not correlate with proportions of female faculty or residents.

 

• Pinho-Gomes AC, Vassallo A, Thompson K, Womersley K, Norton R, Woodward M. Representation of women among editors in chief of leading medical journals. JAMA Netw Open. 2021;4(9):e2123026-e2123026. doi:10.1001/jamanetworkopen.2021.23026

*In a review exploring editors-in-chief of the top 5 high-impact journals in 2011, ophthalmology was among the 5 specialties that had no female editor-in-chief; females represented less than 35% of board members.

 

• Camacci ML, Lu A, Lehman EB, Scott IU, Bowie E, Pantanelli SM.  Association between sex composition and publication productivity of journal editorial and professional society board members in ophthalmology. JAMA Ophthalmol. 2020;138(5):451-458. doi:10.1001/jamaophthalmol.2020.0164

*In 2018, 1 of 24 editors-in-chief (4.2%) of the 20 highest-ranked ophthalmology journals was female. Two of the 15 professional society presidents (13.3%) were female. 

 

• Patel SH, Truong T, Tsui I, Moon JY, Rosenberg JB. Gender of presenters at ophthalmology conferences between 2015 and 2017. Am J Ophthalmol. 2020;213:120-124. doi:10.1016/j.ajo.2020.01.018

*Of 14 214 speakers in 9 conferences between 2015 and 2017, 4335 (30.5%) were female, 1435 of 4335 females (33.1%) gave a paper presentation, and 1236 of 4335 females (28.5%) gave a non-paper presentation; this was higher than the American Board–certified Ophthalmologists (ABO) sex ratio of 25.4% (P < .001 for all).

 

• Sridhar J, Kuriyan AE, Yonekawa Y, et al. Representation of women in vitreoretinal meeting faculty roles from 2015 through 2019.  Am J Ophthalmol. 2021;221:131-136. doi:10.1016/j.ajo.2020.09.001.

*Vitreoretinal meetings between 2015 and 2019 with at least 1 female committee member had more female invited speakers (23.1% vs 17.0%; P =.02) and invited moderators and panelists (28.3% vs 22.7%; P =.02) but no sex association for noninvited abstract speakers (21.2% vs 21.7%; P =.77). 

 

• Shah DN, Huang J, Ying GS, Pietrobon R, O’Brien JM.  Trends in female representation in published ophthalmology literature, 2000-2009. Digit J Ophthalmol. 2013;19(4):50-55. doi:10.5693/djo.01.2013.07.002

*Between 2000 and 2009, female first and last authorship increased in American Journal of Ophthalmology, Archives of Ophthalmology, and Ophthalmology when considered together (from 21.0%-34.2%; P < .001 and from 18.5%-20.5%; P = .005, respectively). When considered individually, first authorship increased in all 3 journals; last authorship increased only in Ophthalmology. 

 

• Franco-Cardenas V, Rosenberg J, Ramirez A, Lin J, Tsui I.  Decade-long profile of women in ophthalmic publications. JAMA Ophthalmol. 2015;133(3):255-259. doi:10.1001/jamaophthalmol.2014.4447

*Similar sex findings were reported in another 2000 to 2010 authorship review; however, 13% of editorials (5 of 38) were written by females in 2000, compared with 10% (5 of 51) in 2010.

 

• Amarasekera DC, Lam SS, Rapuano CJ, Syed ZA. Trends in female authorship in cornea from 2007 to 2019. Cornea. 2021;40(9):1152-1157. doi:10.1097/ICO.0000000000002598

*A 2015 to 2019 review of 17 100 articles contradicts earlier findings whereby female last authorship increased for general (P = .007) and subspecialty journals (P = .03).

 

• Lopez SA, Svider PF, Misra P, Bhagat N, Langer PD, Eloy JA. Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists. J Surg Educ. 2014;71(6):851-859. doi:10.1016/j.jsurg.2014.03.015

*In a 2013 rank and scholarly impact factor analysis of 1460 academic ophthalmologists, females were underrepresented among senior academic positions (147 of 419 females had senior rank vs 697 of 1041 males; P < .001).47 Females had lower median h-indices (scholarly productivity and citation impact) early in their publishing careers but had equal or greater h-indices than their male counterparts in later career stages (31-40 years publication experience; h-index = 20.4 vs 15.7; P = .05).

 

• Kalavar M, Watane A, Balaji N, et al. Authorship gender composition in the ophthalmology literature from 2015 to 2019. Ophthalmology. 2021;128(4):617-619. doi:10.1016/j.ophtha.2020.08.032

*A 2015 to 2019 review of 17 100 articles contradicts earlier findings whereby female last authorship increased for general (P = .007) and subspecialty journals (P = .03). 

 

• Svider PF, D’Aguillo CM, White PE, et al. Gender differences in successful National Institutes of Health funding in ophthalmology. J Surg Educ. 2014;71(5):680-688. doi:10.1016/j.jsurg.2014.01.020

*A cross-sectional analysis48 of 590 National Institutes of Health (NIH) grants awarded between 2011 and 2013 found that females had lower mean awards (mean award value, $353 170 vs $418 605; P = .005). 

 

• Chiam M, Camacci ML, Lehman EB, Chen MC, Vora GK, Pantanelli SM. Sex differences in academic rank, scholarly productivity, National Institutes of Health funding, and industry ties among academic cornea specialists in the US. Am J Ophthalmol. 2021;222:285-291. doi:10.1016/j.ajo.2020.09.011

*An association between sex and the median amount of NIH awards granted to cornea specialists was not identified, despite most female cornea specialists being in early stages of their careers.

 

• Reddy AK, Bounds GW, Bakri SJ, et al. Representation of women with industry ties in ophthalmology. JAMA Ophthalmol. 2016;134(6):636-643. doi:10.1001/jamaophthalmol.2016.0552

*Sex differences among 21 531 ophthalmologists in 2014 found that industry payments were less for females (255 of 4352 [6%] vs 1263 of 17 179 [7.4%]; P < .001).

 

• Nguyen AXL, Ratan S, Biyani A, et al. Gender of award recipients in major ophthalmology societies. Am J Ophthalmol. 2021;231:120-133. doi:10.1016/j.ajo.2021.05.021

*Society awards granted from 1970 to 2020 increased from 0% to 33.2% (121 of 364; P < .001) for female recipients. 

 

• Meyer JA, Troutbeck R, Oliver GF, Gordon LK, Danesh-Meyer HV. Bullying, harassment, and sexual discrimination among ophthalmologists in Australia and New Zealand. Clin Exp Ophthalmol. 2021;49(1):15-24. doi:10.1111/ceo.13886

*In a survey of over 1400 ophthalmologists and trainees in 2015 and 2018, females experienced 3 times more discrimination and up to 6 times more sexual harassment compared with males; this harassment was more severe and most commonly reported in training.

 

• Scruggs BA, Hock LE, Cabrera MT, et al.  A US survey of sexual harassment in ophthalmology training using a novel standardized scale. J Acad Ophthalmol (2017). 2020;12(1):e27-e35. doi:10.1055/s-0040-1705092

*In a 2017 survey of 112 ophthalmologists, 29 of 53 females (54.7%) and 18 of 59 males (30.5%) reported experiencing sexual harassment weekly (95% CI, 1.29-5.71; P = .01).

 

• Chiam M, Camacci ML, Khan A, Lehman EB, Pantanelli SM. Sex disparities in productivity among oculoplastic surgeons. J Acad Ophthalmol. 2021;13(02):e210-e215. doi:10.1055/s-0041-1740312

*Sex differences in academic ranks and h-indices are likely due to the smaller proportion of females with long career durations. ASOPRS membership may confer opportunities for increased scholarly output.

 

• Felfeli T, Canizares M, Jin YP, Buys YM. Pay gap among female and male ophthalmologists compared with other specialties. Ophthalmology. 2022;129(1):111-113. doi:10.1016/j.ophtha.2021.06.015

*The trends identified suggest that female ophthalmologists are comparatively productive to male ophthalmologists, but despite this, disparity in median payments for female ophthalmologists exists and is more prominent than in any other specialty groups.

 

• Jia JS, Lazzaro A, Lidder AK, et al. Gender compensation gap for ophthalmologists in the first year of clinical practice. Ophthalmology. 2021;128(7):971-980. doi:10.1016/j.ophtha.2020.11.022

*Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables.

 

• Watane A, Kalavar M, Patel M, et al. A 5-year analysis of physician-industry interactions, physician gender, and anti-VEGF use in US ophthalmologists. Semin Ophthalmol. 2021;36(8):804-811. doi:10.1080/08820538.2021.1922710

*Men were more likely to receive industry payments (P = .01), receive >5 payments (P = .003), and receive payments totaling >$1000 (P = .008). Men administered more injections on average than women when receiving >3 industry payments (P < .001) or when receiving >$100 (P < .01).

 

• Charlson ES, Tsai L, Yonkers MA, Tao JP. Diversity in the American Society of Ophthalmic Plastic and Reconstructive Surgery. Ophthalmic Plast Reconstr Surg. 2019;35(1):29-32. doi:10.1097/IOP.0000000000001127

*The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs.

 

• Hucko L, Robles-Holmes H, Watane A, et al. Trends in gender representation at the American Academy of Ophthalmology annual meeting. Ophthalmology. 2022;129(7):831-833. doi:10.1016/j.ophtha.2022.02.028

*The AAO Annual Meeting had 38.7% female faculty member representation in 2021, a record. Although this is a positive finding for the field, there remains room for improvement to encourage equitable representation for female ophthalmologists in academic settings. The majority of U.S. ophthalmology residency program directors (72%) are male, and female physicians are less likely to receive promotions to leadership positions in academic medicine, even after adjustment for publication-related productivity. 

 

• Kramer PW, Kohnen T, Groneberg DA, Bendels MHK. Sex disparities in ophthalmic research: a descriptive bibliometric study on scientific authorships. JAMA Ophthalmol. 2019;137(11):1223-1231. doi:10.1001/jamaophthalmol.2019.3095

*Bibliometric data were abstracted from 87 640 original articles published in 248 ophthalmologic journals. Of 344 433 total authorships, female scholars held 34.9% (120 305 of 344 433) of all authorships, 37.1% (24 924 of 67 226) of first authorships, 36.7% (77 295 of 210 372) of coauthorships, and 27.1% (18 086 of 66 835) of last authorships. 

 

• Chien JL, Wu BP, Nayer Z, et al. Trends in authorship of original scientific articles in Journal of Glaucoma: an analysis of 25 years since the initiation of the journal.  J Glaucoma. 2020;29(7):561-566. doi:10.1097/IJG.0000000000001503

*Consistent with authorship trends across various other medical specialties, glaucoma has seen an increase in the number of authors and disclosures per article, authors with dual degrees, and authors from the “Far East” and “Other” regions. However, contributions of women to articles published in Journal of Glaucoma remain low.

 

• Hsiehchen D, Hsieh A, Espinoza M. Prevalence of female authors in case reports published in the medical literature. JAMA Netw Open. 2019;2(5):e195000. doi:10.1001/jamanetworkopen.2019.5000

* In this cross-sectional study of 20 427 case reports, female first (36%) and last (25%) authors were underrepresented in nonresearch publications, and female first authors were associated with female last authors and academic environments. Bibliometric data was abstracted from 20 427 case reports published across 2538 journals. A total of 7252 (36%) and 4825 (25%) case reports had a female first and last author, respectively. In comparison, 44% and 34% of US trainees and physicians, respectively, were female in 2015.

 

• Wong MYH, Tan NYQ, Sabanayagam C. Time trends, disease patterns and gender imbalance in the top 100 most cited articles in ophthalmology. Br J Ophthalmol. 2019;103(1):18-25. doi:10.1136/bjophthalmol-2018-312388

*For first authorship, excluding group authorships (n=10 for T100-Eye, n=2 for T100-Gen), 84% (n=76) of the first authors in T100-Eye, and 73% (n=72) in T100-Gen were men (table 3). For last authorship, 78% (n=70) in the T100-Eye and 81% (n=79) in the T100-Gen were men. 

 

• Aguwa UT, Srikumaran D, Green LK, et al. Analysis of sex diversity trends among ophthalmology match applicants, residents, and clinical faculty. JAMA Ophthalmol. 2021;139(11):1184-1190. doi:10.1001/jamaophthalmol.2021.3729

*This study found that the percentage of women in the field of ophthalmology remains lower than percentages in other specialties, and the percentage of female ophthalmology residents has decreased in recent years. More efforts are needed to improve female representation in ophthalmology.

 

• Patel M, Salazar H, Watane A, et al. Representation of women in ophthalmology receiving private industry funding 2015-2018.  Am J Ophthalmol. 2022;235:56-62. doi:10.1016/j.ajo.2021.09.001

*Female ophthalmologists remain underrepresented in terms of the percentage of women who receive private industry funding and dollar value of the funding.

• Pershing S, Stell L, Fisher AC, Goldberg JL. Implicit bias and the association of redaction of identifiers with residency application screening scores. JAMA Ophthalmol. 2021. doi:10.1001/jamaophthalmol.2021.4323

 

• Woreta F., Gordon L.K., Knight O.J., Randolph J., et al: Enhancing diversity in the ophthalmology workforce. Ophthalmology 2022; 129: pp. e127-e136

 

• Faridi A, Green L, Woreta F. Diversity and Inclusion Education - American Academy of Ophthalmology. Retrieved April 24, 2023, from https://www.aao.org/education/diversity-and-inclusion-education

 

• Randolph JD, Zebardast N, Pérez-González CE. Improving ophthalmic workforce diversity: a call to action. Ophthalmology 2022; 129:10811082.

 

• Fairless EA, Nwanyanwu KH, Forster SH, Teng CC. Ophthalmology departments remain among the least diverse clinical departments at united states medical schools. Ophthalmology 2021; 128:11291134.

 

• Atkuru A, Lieng MK, Emami-Naeini P. Trends in racial diversity among united states ophthalmology residents. Ophthalmology 2022; 129:957959.

 

• Aguwa UT, Srikumaran D, Canner J, et al. Trends in racial and ethnic diversity of ophthalmology residents and residency applicants. Am J Ophthalmol 2022; 240:260264.

 

• Pineles S. Racial diversity among united states ophthalmology residents: a call to action. Ophthalmology 2022; 129:960961.

 

• Aguwa UT, Wang J, Woreta F, et al. Residency program diversity recruitment and education: survey of efforts and barriers to implementation. J Surg Educ 2022; 79:595605.

 

• Ledesma Vicioso N, Woreta F, Sun G. Presence of diversity or inclusion information on US ophthalmology residency program websites. JAMA Ophthalmol 2022; 140:606609.

 

• Harrell MJ, Barnett KG, Rowe S. Strategies potentially associated with increasing racial and ethnic groups underrepresented in medicine: application to ophthalmology. JAMA Ophthalmol 2021; 139:825826.

 

• Olivier M.M.G., Forster S., Carter K.D., et al: Lighting a pathway: the minority ophthalmology mentoring program. Ophthalmology 2020; 127: pp. 848-851.

• Duong AT, Law JC, Ramirez DA, et al. Advancing lesbian, gay, bisexual, transgender, and queer (LGBTQ+) diversity, equity, and inclusion in ophthalmology. Ophthalmology 2022; 129:12321234.

 

• Ramirez D.: Support for LGBTQ Members in Ophthalmology – American Academy of Ophthalmology. YO Info.

https://www.aao.org/young-ophthalmologists/yo-info/article/support-for-lgbtq-members-in-ophthalmology

 

• LGBTQ+ Community and the Academy. American Academy of Ophthalmology. Published 2021.

https://www.aao.org/lgbtq-community

 

• Chang TC, Candelario C, A R, et al. LGBTQ+ identity and ophthalmologist burnout. Am J Ophthalmol 2023; 246:6685.

• Bennett CL, Baker O, Rangel EL, Marsh RH. The gender gap in surgical residencies. JAMA Surg. 2020;155(9):893-894. doi:10.1001/jamasurg.2020.2171.
  
  
  
• Singh C, Loseth C, Shoqirat N. Women in surgery: a systematic review of 25 years. BMJ Leader. 2021; 5:283-290. doi:10.1136/leader-2019-000199.
  
  
  
• Koichopolos J, Ott MC, Maciver AH, Van Koughnett JAM. Gender-based differences in letters of recommendation in applications for general surgery residency programs in Canada. Can J Surg. 2022;65(2):E236-E241. doi:10.1503/cjs.025120

* In general surgery, a study found that female medical students applying to residency had more letters written by female staff, corroborating female sex preferences in mentors.

• Lulla T, Behmer Hansen RT, Smith CA, Silva NA, Patel NV, Nanda A. Women neurosurgeons around the world: a systematic review. Neurosurg Focus. 2021;50(3):E12. doi:10.3171/2020.12.FOCUS20902

*A systematic review in neurosurgery identified that female mentorship was the most cited factor contributing to sex differences in its field.

 

• Turrentine FE, Dreisbach CN, St Ivany AR, Hanks JB, Schroen AT. Influence of gender on surgical residency applicants’ recommendation letters. J Am Coll Surg. 2019;228(4):356-365.e3. doi:10.1016/j.jamcollsurg.2018.12.020.

* In general surgery, reference letters for males were found to emphasize leadership abilities, achievements, and ability; letters for females more often referenced physical appearance, compassion, communication skills, and adaptability.

 

• Stephens EH, Heisler CA, Temkin SM, Miller P. The current status of women in surgery: how to affect the future. JAMA Surg. 2020;155(9):876-885. doi:10.1001/jamasurg.2020.0312.

*Behaviors celebrated in male colleagues, such as decisiveness and assertiveness, which typically fall within the gender schema for males, were often perceived as aggressive in females.

• Barnes KL, McGuire L, Dunivan G, Sussman AL, McKee R. Gender bias experiences of female surgical trainees. J Surg Educ. 2019;76(6):e1-e14. doi:10.1016/j.jsurg.2019.07.024

* There are multiple studies reporting female surgical residents altering their appearance, interests, or habits, downplaying stereotypically female characteristics, as well as feeling the need to increase their efforts to prove their ability and intellect.

 

• Dossa F, Simpson AN, Sutradhar R, et al. Sex-based disparities in the hourly earnings of surgeons in the fee-for-service system in Ontario, Canada. JAMA Surg. 2019;154(12):1134-1142. doi:10.1001/jamasurg.2019.3769

*A population analysis not captured in this review found that ophthalmology had the third greatest mean difference in hourly earnings in a single-payer system, with females earning $54.06 less per hour, just behind orthopedic and cardiothoracic surgery.111 In comparison, the mean difference in hourly earnings in plastic surgery was only $2.68.

 

• Dossa F, Zeltzer D, Sutradhar R, Simpson AN, Baxter NN. Sex differences in the pattern of patient referrals to male and female surgeons. JAMA Surg. 2022;157(2):95-103. doi:10.1001/jamasurg.2021.5784

* Male physicians had higher odds of same-sex referrals compared with female physicians, even after accounting for patient characteristics and physician experience and availability.112 Females were also less likely to receive procedural referrals.112 Referral preferences result in lower volumes and fewer operative referrals to female surgeons and correlate with sex-based income disparities.

 

• Sexton KW, Hocking KM, Wise E, 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.

* Although it has been proposed that the paucity of females in leadership positions may be attributed to a lack of available candidates, Sexton et al demonstrated that stable growth curves among female surgical residents did not improve the representation of female professors of surgery over 25 years. This suggests that increasing the number of females in surgery was insufficient to improve leadership representation.

 

• Abelson JS, Chartrand G, Moo TA, Moore M, Yeo H. The climb to break the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. Am J Surg. 2016;212(4):566-572.e1. doi:10.1016/j.amjsurg.2016.06.012

* A 2016 study found the rate of female full professors of surgery increased by on average 0.3% per year from 1994 to 2015; with this rate of increase, female full professors are not expected to achieve sex parity until 213.

 

• Lim WH, Wong C, Jain SR, et al. The unspoken reality of gender bias in surgery: a qualitative systematic review. PLoS One. 2021;16(2):e0246420. doi:10.1371/journal.pone.0246420

*Although scholarly productivity, including authorship, impacts career promotion, a study exploring authorship trends from 2008 to 2018 among the 25-highest impact journals in general surgery and other subspecialties found that although female authorship was improving overall, the rise in female last authorship had been slower than first authorship. Yet, the data were clear: where there was greater female representation in positions of leadership, other females benefit. Having a female department chair was associated with a greater proportion of female faculty and residents, and female last authorship was associated with increased female first authorship.

• Hill K.A., Samuels E.A., Gross C.P., et al: Assessment of the prevalence of medical student mistreatment by sex, race/ethnicity, and sexual orientation. JAMA Intern Med 2020; 180: pp. 653-665.

 

• Samuels EA, Boatright DH, Wong AH, et al. Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students. JAMA Netw Open. 2021;4(2):e2036136. doi:10.1001/

 

• Mori WS, Gao Y, Linos E, et al. Sexual Orientation Diversity and Specialty Choice Among Graduating Allopathic Medical Students in the United States. JAMA Netw Open. 2021;4(9):e2126983. doi:10.1001/

• Kaakour A, Hua H, Rachitskaya A. Representation of race and ethnicity in randomized clinical trials of diabetic macular edema and retinal vein occlusion compared to 2010 US census data. JAMA Ophthalmol 2022; 140:10961102.
  

 

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