Women now account for 37.1% of all physicians, 25.0% of all ophthalmologists, and 29.6% of academic ophthalmology faculty in the United States.1,2 Despite the growing number of women in ophthalmology, women remain underrepresented in this surgical field and in others.3-6
Disparities in Leadership Positions and Academic Ranks
Several studies have highlighted the gender gaps in ophthalmic positions of leadership, including on journal editorial boards, on professional society boards, and within academic departments.7,8 Lopez and colleagues found that only 13% of women in ophthalmology achieved full professorship compared with 34% of men in ophthalmology.9 Further, studies have indicated that the sex ratios in each academic rank (ie, associate professor, assistant professor, and full professor) have not changed significantly between 2003 and 2017.6,8
This pattern and trend can be observed among pediatric ophthalmologists and cornea specialists. Men pediatric ophthalmologists and cornea specialists were twice as likely to be ranked full professor than their women counterparts, and women had a higher proportion of assistant professor titles compared with their men counterparts.2,8-10 It has been suggested that the inequity in academic ranking between genders may be attributed to women physicians’ reluctance to pursue subspecialty training and their disproportionate entry into primary care and nonsurgical specialties.11,12
When gender disparities among residency program directors (PDs) were analyzed, Kloosterboer et al observed that the majority of ophthalmology PDs in the United States were men.13 Women were significantly underrepresented as leaders of ophthalmology residency programs, holding only 28% of PD positions.13 The disproportionate number of women PDs versus men PDs affects other surgical specialties, including general surgery and internal medicine, with women having a lower percentage of PD positions than men in these fields.14,15
Increasing the representation of women in ophthalmology requires providing them with greater opportunities, such as mentorship, collaboration, and involvement in scholarly work to facilitate academic achievement.
National Institutes of Health Funding
The National Institutes of Health (NIH) is the world’s largest funder of biomedical research, and women account for 34% of all NIH grant recipients.16 Several studies analyzing NIH funding have found that women ophthalmologists received lower NIH awards than their male counterparts.2,9,10,13 Additionally, although men and women may be equally represented as recipients of NIH funding, women tended to achieve less NIH funding than men in their early and middle career stages.2,9,10
Publication Productivity
Gender disparities are also evident in publication productivity. The h-index, which is a tool for evaluating publication output and citation impact, has been commonly used to describe publication productivity.5,8,13 Multiple studies have noted a significantly lower h-index among women ophthalmologists compared to men.2,9,10 They have also found a strong association between higher h-index and higher academic ranking, underscoring the importance of publication productivity for career promotion and advancement. Still, women have lower h-indices and lower academic ranks. To note, some studies have found that men ophthalmologists tended to have greater publication productivity in the early stages of their careers, whereas women surpassed them in later stages, possibly due to familial obligations that women encounter in the earlier stages.9
Conclusion
The gender disparities that exist within ophthalmology are concerning, and they require continued attention and action. Despite some progress in recent years, women are still underrepresented in leadership positions, academic rank, and grant funding, and they have lower publication productivity than men. These disparities can be attributed to a variety of factors, including a lack of mentorship, bias, and systemic barriers. Organizations such as YoungMD Connect can help women ophthalmologists by providing them with mentorship, networking, and career advancement opportunities and by empowering them to reach their full potential. By working together, we can create a more inclusive and equitable future for women in ophthalmology
1. Physician Specialty Data Report. AAMC. Accessed June 15, 2023. www.aamc.org/data-reports/data/2022-physician-specialty-data-report-executive-summary
2. 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 United States. Am J Ophthalmol. 2021;222:285-291.
3. Lopez NE, Nguyen NH, Hull TL, Peters WR, Singh S, Ramamoorthy SL. Gender related differences in surgeon compensation. Ann Surg. 2023;277(4):e832-e838.
4. Bhala S, Rubin A, Srivastava R, Firoz B. Gender disparities in reimbursement among dermatologists and dermatologic surgeons. Dermatol Surg. 2023;49(1):31-35.
5. Colaco M, Svider PF, Mauro KM, Eloy JA, Jackson-Rosario I. Is there a relationship between National Institutes of Health funding and research impact on academic urology? J Urol. 2013;190(3):999-1003.
6. Tuli SS. Status of women in academic ophthalmology. Nepal J Ophthalmol. 2019;11(02):e59-e64.
7. Kung GP, Cruz OA, Israel H. Changes in leadership: a 20-year study of trends in tenure of chairs of departments of ophthalmology. Nepal J Ophthalmol. 2019;11(02):e35-e39.
8. 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.
9. 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.
10. Camacci ML, Ikpoh B, Lehman EB, et al. Gender disparities among United States academic pediatric ophthalmologists: an analysis of publication productivity, academic rank, and NIH funding. J AAPOS. 2020;24(6):337.e1-337.e6.
11. Zhuge Y, Kaufman J, Simeone DM, Chen H, Velazquez OC. Is there still a glass ceiling for women in academic surgery? Ann Surg. 2011;253(4):637-643.
12. Borman KR. Gender issues in surgical training: from minority to mainstream. Am Surg. 2007;73(2):161-165.
13. Kloosterboer A, Yannuzzi NA, Gedde SJ, Sridhar J. Residency program directors of United States ophthalmology programs: a descriptive analysis. Am J Ophthalmol. 2020;209:71-76.
14. Amersi F, Choi J, Molkara A, Takanishi D, Deveney K, Tillou A. Associate program directors in surgery: a select group of surgical educators. J Surg Educ. 2018;75(2):286-293.
15. Willett LL, Halvorsen AJ, McDonald FS, Chaudhry SI, Arora VM. Gender differences in salary of internal medicine residency directors: a national survey. Am J Med. 2015;128(6):659-665.
16. Nicholson JM, Ioannidis JPA. Research grants: conform and be funded. Nature. 2012;492(7427):34-36.
