Trends in the proportion of women as reviewers, editors, and editorial board members of 15 North American and British medical journals from 2014 to 2019: A retrospective study

This work was supported, in part, by grants-in-aid from the Canadian Institutes of Health Research (FDN159928) and the National Institute of General Medical Sciences of NIH (P20 GM135007). The funding sources had no involvement in the study design; collection, analysis, and interpretation of data; writing of the report; or the decision to submit the paper for publication. J.I.W. had full access to all the data in the study and had the final responsibility for the decision to submit the paper for publication.


Funding statement
This work was supported, in part, by grants-in-aid from the Canadian Institutes of Health Research (FDN-159928) and the National Institute of General Medical Sciences of NIH (P20 GM135007). The funding sources had no involvement in the study design; collection, analysis, and interpretation of data; writing of the report; or the decision to submit the paper for publication. J.I.W. had full access to all the data in the study and had the final responsibility for the decision to submit the paper for publication.

Authorship contributions
All listed authors qualify for authorship and all who were qualified to be authors are listed as authors. R.W. designed the experimental protocol and collected and analysed the data; J.C.F. and J.I.W. designed the experimental protocol and analysed the data; and R.R. and M.C. analysed the data. All the authors were involved in writing the manuscript and revising it.

Data sharing statement
The data sets used or analysed for the current study are available upon request at the discretion of the corresponding author.

Introduction
Although women now outnumber men in medical schools in the United States, 1 Canada, 2 and the United Kingdom, 3 approximately 67%, 57%, and 52% of practicing physicians in these countries, respectively, are men. [3][4][5] Gender disparity in North America appears to be narrowing: a survey of 18,000 physicians at 3500 practices in the United States, in 2017, reported that 80% of the physicians 65 years or older were men, whereas 60% of the physicians younger than 35 years were women, 6  internationally. [15][16][17] This gender imbalance may lead to bias that adversely effects the success of women in having their research published, thereby making it even more difficult for women to succeed in academia. 18 Men are twice as likely to be invited to submit articles -a clear marker of success or standing -than women. 19 However, manuscripts authored by women are more likely to be accepted than those authored by men if the authors' names are masked. 20

Determining gender
A gender was assigned by the first author, following a step-by-step process, to each of the peer reviewers, editors, and Table 1. Fifteen journals selected for the study of gender disparity in their reviewers, editors, and editorial board members. Only those editors assumed to be involved in the peer review process were considered. We were unable to source the lists of   Figure 1A).  Table   2). The mean proportion of women editors did not increase significantly in any of the three journal categories (Supplementary  Figure   1B).  the gender-balanced specialty (+2.5% per year; 95% CI: −1.1% to +6.0%). The overall p value for the difference was 0.90 (Supplementary Table   2 and Figure 1C).

Discussion
Although medical journals are making strides towards gender equity, this study shows that more needs to be done. In the medical journals we evaluated, only about a third of the reviewers, editors, and editorial board members were women.
These results are consistent with those from another study. 18 The academia, but the current rate of change suggests that this may take decades. 19 The data for our study were obtained prior to the COVID-19 pandemic. The pandemic may slow the progress being made towards gender equity because at least one study has shown that women submitted fewer manuscripts and accepted peer review invitations less frequently than men did during the first wave of the pandemic. 24 Therefore, more effort should be invested to ensure gender balance among editors and reviewers to encourage gender parity in publishing.

Representation of women in medical journals
Page 8 / 9 The importance of gender equity in medical academia has become increasingly recognized in recent years. 25  fields. Also, we inferred gender rather than relying on self-report, which could lead to misclassification. Lastly, we captured the percentages of women reviewers but do not know the extent of their engagement or how often they reviewed. If women reviewed more frequently than men, for example, our method would underestimate the impact of women reviewers on the journals.

Conclusion
The American Medical Association has stated that gender equity is key to achieving excellence in academic medicine. 29 The data from our study suggest that gender parity has not been achieved among the reviewers, editors, and editorial board members of the 15 journals that were analysed. Therefore, continued efforts are required to achieve gender equity in academic medicine.