Gender inequities in academic medicine: Peer review and beyond

In the past half-century, women have seen substantial increases in representation in the biomedical sciences. In 1979, a mere 23% of medical graduates were women, however, by 2023, women were in the majority at 52%. Additionally, women now comprise 59% of graduate students in doctoral programs in biological, biomedical, and clinical sciences. Yet, progress has been slower in academic medicine. Women represent only 45% of full-time faculty at medical schools and only about one-quarter of department chairs, deans, and health system leaders. Academic career advancement is driven by favorable peer review in many forms, of grant proposals for essential funding, of promotion dossiers, by search committees, and—perhaps the most fundamental metric of academic success—of academic publications. Manuscript publication is the culmination of a process that, early in a career, requires a combination of training, mentorship, sponsorship, and research funding. It leads to recognition of expertise and invitations for speaking, collaborations, and leadership. Successful completion of even 1 study provides positive reinforcement to continue to pursue the research career path. However, women have lower publication and citation rates, and previous studies have demonstrated that peer review and manuscript acceptance processes may be inherently biased against women.

In this issue of CHEST, Gershengorn et al assess the effectiveness of double-blind peer review (DBPR), in which authors and peer reviewers are both masked to the identities of the other, an intervention meant to reduce bias in selecting manuscripts for publication. Although well intended, DBPR has not lived up to its promise; prior studies have been mixed, with at best small improvements in manuscript acceptance rates by underrepresented groups. This is the first study to examine the role of DBPR in journals focused on pulmonary and critical care, a specialty in which women are underrepresented across all career pathways. The authors estimated the causal effect of DBPR on differences in manuscript acceptance by author gender by comparing CHEST, which implemented DBPR in July 2022, to Annals of the American Thoracic Society (AATS), which used single-blind peer review during the study period. The authors used a state-of-the-art causal framework, using a large sample size across 2 impactful journals within the field and thoughtful adjustment for differences between the journals. Among 3,494 CHEST and 1,157 AATS manuscripts sent for peer review from January 2020 through June 2022, the primary conclusion was that DBPR did not impact rates of manuscript acceptance for women vs men, findings that were robust to multiple sensitivity analyses.

Rachel Kohn, Meeta Prasad Kerlin