Poster Number-45 - Gender Disparity Persists in Pain Medicine: A Cross-Sectional Study of Chairpersons within ACGME-Accredited Chronic Pain Fellowship Programs in the United States

Gender Disparity Persists in Pain Medicine: A Cross-Sectional Study of Chairpersons within ACGME-Accredited Chronic Pain Fellowship Programs in the United States

Purpose:

The importance of gender equity among medical providers is becoming increasingly recognized within academia. Attaining a diverse workforce in healthcare has been linked to reduced health disparities, increased trust in the healthcare system by marginalized patient groups, and increased provider comfort with diverse patient populations. While gender representation among medical students has seen significant improvements with women now representing slightly over half of all medical students, gender gaps remain a significant issue among trainees, providers and leaders of various medical specialties including pain medicine. In 2019, less than 20% of all active physicians practicing within pain medicine identified as females. More recently, a study showed roughly 30% of chronic pain medicine fellowship programs had a female program director. Despite these findings, the degree of gender disparity among leadership ranks within pain medicine, specifically departmental and divisional chairpersons, has yet to be studied.

 

The importance of female representation within pain medicine leadership ranks cannot be overstated. It is likely to foster an inherent attraction of talented female trainees to the field, promote interest in academia, provide a mentorship pipeline essential to success in academia, and facilitate retention of female providers within the field.

 

In this cross-sectional study, we sought to assess gender disparity within chairpersons of ACGME-accredited chronic pain medicine programs across the country and its associations with various demographic, academic, and program metrics. We hypothesize that female chairpersons would be under-represented and that they would have fewer academic accomplishments including less publications and lower academic rank status.

 



Methods:

We identified all chronic pain fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME) on 4/19/2021. We queried institutional websites or contacted programs directly to identify the respective departmental/divisional program chairperson

 

After determining the final list of chairperson names, we utilized publicly available sources including fellowship program websites, state licensure boards, and online curriculum vitae to identify the chairperson’s age, gender, academic degree (MD, PhD, and/or MBA), academic rank (professor, associate professor, assistant professor, or instructor), number of publications and Hirsch-index (H-index), board certification status (initial or continued), and residency training specialty (anesthesiology, physical medicine and rehabilitation, neurology, psychiatry, emergency medicine). The ACGME website was queried to abstract data on the following variables: total approved and filled fellow positions, and fellowship program accreditation status.

 

The primary outcome included comparisons of the following demographic, academic, and program-related characteristics between female and male program chairpersons:

(1)       Demographic characteristics: age, geographic location (Midwest, Northeast, South, West). Geographic regions were determined based on the United States Census Bureau Regions and Divisions

(2)       Academic characteristics: academic rank, dual appointment as chairperson and program director, completion of MD/PhD degree, completion of MBA degree, duration of clinical practice, number of publications, H-index, board certification status, chairperson residency training specialty

(3)       Program characteristics: number of approved fellow positions, number of filled fellow positions, program accreditation status

 

Continuous outcomes were reported as medians with a 25%-75% interquartile range (IQR), while dichotomous categorical outcomes are reported as numbers with percentages. The Mann-Whitney rank-sum test was used to compare continuous outcomes between female and male chairpersons, while the Fisher’s exact test was used to compare categorical variables between female and male chairpersons. A P-value < 0.05 was considered statistically significant.

This study was approved by the Mayo institutional review board (IRB). The requirement for written informed consent was waived.




Results:

Identification and Selection of Chairperson

We identified a total of 111 ACGME-accredited chronic pain fellowship programs at the time of study initiation (4/19/21). Chairperson name was obtained from the departmental and/or institutional website for a total of 80 programs. An additional seven fellowship programs provided the chairperson name and contact information after we contacted them via e-mail and/or phone call. Twenty-four programs did not provide chairperson information as they did not respond to e-mail or phone requests.

 

Demographic Characteristics of Chairpersons

Our overall cohort comprised of 17 female chairpersons (19.5%) and 70 male chairpersons (80.5%). No differences in age were detected between female and male chairpersons (P=0.645). The proportion of female and male chairpersons based on geographic location was similar.

 

Academic Characteristics of Chairpersons Based on Gender

When comparing academic characteristics based on gender, a higher proportion of female chairpersons (35.3%) reported an academic rank of assistant professor compared to male chairpersons (11.4%, P=0.027). However, similar proportions of other academic rankings (senior academic rank, full professor, associate professor, and instructor position) were noted between female and male chairpersons. Male chairpersons published more peer-reviewed articles (32.0 publications, 10.0-92.0 IQR) compared to female chairpersons (10.0 publications, 2.5-17.5 IQR, P=0.001). Concordantly, male chairpersons achieved a higher H-index score (10.0, 5.0-28.0 IQR) compared to female chairpersons (3.0, 1.0-6.0 IQR; P=0.001). There were no differences in other academic characteristics including dual appointment as program director, academic degrees (PhD, MBA), years in clinic practice, board certification status, and primary residency training specialty.

 

Program-related Characteristics Based on Gender

The ACGME reported one program was assigned probationary accreditation. Six (6.9%) programs had initial ACGME accreditation status, while 80 (92.0%) had continued ACGME accreditation status. No differences in fellow positions and program accreditation status were identified when stratified by chairperson gender.

 



Conclusion:

Female representation in pain medicine leadership and clinicians is crucial. Population-based research has demonstrated that pain prevalence is generally higher among women relative to men, and it is not uncommon for pain practices to have a greater composition of female patients Furthermore, research has demonstrated that patient-physician gender concordance may be associated with greater patient satisfaction scores Thus, female patients may be able to relate more to female providers caring for them. This association is also reflected in the leadership setting, where female program directors are more likely to have female fellows in the pain program they lead.

 

Our study demonstrates that this important role is currently and overwhelmingly held by males within the specialty of pain medicine with significant underrepresentation among female physicians. This disparity is also reflected in other academic metrics including number of peer-reviewed publications, H-indices, and attainment of assistant professor rank. This study highlights the need for continued measures designed to address and eliminate barriers that persistently preclude female representation from leadership positions within our specialty.

 



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