Research findings published by women in elite medical journals are substantially less likely to be cited than are similar articles authored by men, a study finds.
The study1, published in JAMA Network Open, examined citation data for more than 5,500 papers published in top medical journals between 2015 and 2018.
Previous work has found that male-authored articles in some other disciplines receive more citations than do articles authored by women2. Paula Chatterjee, a physician-researcher who studies medical and hospital care at the University of Pennsylvania in Philadelphia, and is co-author of the latest study, says that some people have proposed that the gap exists because male authors produce higher-quality and more impactful work than do female authors. But she doubted that. She had heard anecdotally that her female colleagues’ work received fewer citations than did her male colleagues’ work, even when published in high-impact journals.
She and Rachel Werner, a physician and economist at the University of Pennsylvania, analysed 5,554 articles published in Annals of Internal Medicine, BMJ, JAMA, JAMA Internal Medicine and The New England Journal of Medicine. Using an online database that assigns gender to names, the researchers identified the gender of the primary and senior authors of each paper. (Chatterjee says that the database was able to categorize names only as male or female, and couldn’t account for non-binary authors.) They found that only 36% of the primary authors and 26% of the senior authors in the sample were female.
When Chatterjee and Werner analysed the number of citations that each article had received, they found that papers with women as primary authors had one-third fewer median citations than did those with men as primary authors, and that papers with women as senior authors received about one-quarter fewer citations than did those with men as senior authors. And papers whose primary and senior authors were both female received just half as many citations as did papers whose primary and senior authors were both male.
The findings have significant implications for female researchers’ career progression. Citations are considered a key measure of a paper’s importance, and — although the system is flawed — university and funding administrators often take them into account when deciding whether to give a researcher tenure or grants, and whether to hire or promote them.
Chatterjee doubts that the bias is intentional. She suspects that the most likely cause of the disparity is the relative visibility of men and women in the medical field. Male researchers are more likely than are their female counterparts to be invited to speak at scientific and medical conferences3, and to have their work promoted on social media. As a result, authors might be more likely to remember their work when looking for papers to cite. Furthermore, female researchers generally have smaller professional social networks than men do, meaning that their work might be less likely to come to mind4.
Julie Silver, a medical researcher at Harvard Medical School in Boston, Massachusetts, isn’t surprised by the results. She suspects a number of factors are at play. Male researchers, for instance, are more likely to cite their own papers than women are5. And a 2019 paper6 found that male authors are more likely than female authors to describe their findings with words such as ‘novel’ and ‘promising’, which could make those papers stand out to other researchers looking for references.
But Silver says that implicit bias could play a part, as well. For instance, she speculates that conference attendees might subconsciously be less likely to attend a talk by a female speaker, or to assign high value to her work, meaning that they don’t remember her when they are preparing an article in that field. And journals and institutions might not spend as many resources promoting female-authored articles. Silver’s own research has found that medical societies are less likely to mention female scientists’ work in newsletters7 or to give them recognition awards8, gaps that lead to lower visibility for them.
Redressing the balance
The paper is compelling because “it shows just how much impact unconscious biases can have”, says Reshma Jagsi, a radiation oncologist and bioethicist at the University of Michigan in Ann Arbor. If high-quality work by women is cited less often, Jagsi says, the disparity perpetuates gender inequity. It also creates a vicious cycle: those whose work is promoted tend to become leaders in their field, meaning that their work continues to be cited more often than does others’.
Silver says that, regardless of the reasons for the citation gap, it should not exist. Medical societies, for instance, could take more care to invite female plenary speakers to their conferences and to promote their talks. And funding agencies, such as the US National Institutes of Health, can ensure that fields in which researchers are disproportionately female, such as gynaecology, receive as much funding as do fields in which men are over-represented.
The good news, Chatterjee says, is that the gender gap in medical publishing is shrinking. Between 1994 and 2014, the proportion of female first authors in high-impact medical journals increased from 27% to 37%9, and the number of women invited to be speakers at conferences is starting to rise.
Chatterjee hopes that her and Werner’s study will remind researchers to consider how they know about a paper, and help them to be more aware of the gender of the people whose work they cite. “I would hope it’s a conversation starter between men and women in academia to understand why those differences might be there,” she says.
Chatterjee, P. & Werner, R. M. JAMA Netw. Open 4, e2114509 (2021).
Dion, M. L., Sumner, J. L. & Mitchell, S. M. Polit. Anal. 26, 312–327 (2018).
Arora, A. et al. JAMA Netw. Open 3, e2018127 (2020).
Mickey, E. L. STEM Faculty Networks and Gender: A Meta-analysis (ARC Network, 2019).
King, M. M., Bergstrom, C. T., Correll, S. J., Jacquet, J. & West, J. D. Socius https://doi.org/10.1177/2378023117738903 (2017).
Lerchenmueller, M. J., Sorenson, O. & Jena, A. B. BMJ 367, l6573 (2019).
Silver, J. K. et al. PM&R 10, S8–S8 (2018).
Silver, J. K. et al. Neurology 91, e603–e614 (2018).
Filardo, G. et al. BMJ 352, i847 (2016).