Female Authors in Nuclear Medicine Journals: A Survey from 2014 to 2020

DISCUSSION

There was a marked sex gap in first and particularly last authorship of articles published in nuclear medicine journals from 2014 to 2020. Women’s representation increased over time from 28.2% to 35.5% (P < 0.001) for first authors and from 15.6% to 20.5% for last authors, with a peak of 21.8% in 2017 (P < 0.001). Relative increases of 72% and 79% for female first and last authorship, respectively, were observed between 2014 and 2020. Parity was predicted in 2035 for first authors and in 2052 for last authors. A significant increase in female first and last authorship was observed in Europe and for publications in high-ranking journals. Female participation increased in original articles and case reports but not in reviews or editorials/letters. The proportion of articles produced by male first and last authors decreased by 10% in favor of all other collaborations.

To our knowledge, this was the first exhaustive bibliometric analysis of author sex in a wide spectrum of anglophone nuclear medicine journals over several years. Similar sex gaps in authorship have been reported in other domains of medicine and the STEM (science, technology, engineering, mathematics) sciences (4,14,15). For example, in 2018 Bendels et al. reported 33.1% female first and 18.1% female last authorship in high-quality research in 54 journals listed in the Nature Index in the categories “Life Science,” “Multidisciplinary,” “Earth and Environmental,” and “Chemistry” (4).

The lower percentage and rate of increase in female last authorship, a senior position, compared with female first authorship found in our study seem to confirm the presence of an invisible barrier for women to attain leadership positions: the so-called glass ceiling. Moreover, female last authorship increased from 2014 to 2017 but plateaued from 2017 to 2020. These findings could fuel the discussion recently launched by 3 European female nuclear medicine physicians about the challenges women currently face in this field dominated by men (16) and the steps that should be taken to allow female talent to achieve its full potential. Scientific societies, journal editors and publishing companies, scientific institutions, industry, funding agencies, and governments all have their role to play in the promotion of female scientific careers and the creation of a diverse and inclusive research environment. As an example, Gelardi et al. and Evangelista et al. have recently highlighted the underrepresentation of women on editorial boards of nuclear medicine journals, regardless of the rank within the board or the geographic provenance of the journal (17,18). Female participation varied from 14% to a maximum of 32%. Because our study shows that 1 in 3 first authors in nuclear medicine are female, female participation in all ranks of editorial boards should at least mirror this proportion.

Strategies could be put in place in all the aforementioned bodies to promote parity, such as providing transparency on women’s representation metrics, providing training on the benefits of diversity in health care, and even proposing sex quotas just as in politics. Obviously, those propositions are not miracle solutions for equality, but they are tools with potentially strong symbolic effects. It is worth to mention here some successes. The Athena SWAN Charter and Horizon Europe within the European Research Area are examples of initiatives aiming to overcome persisting sex gaps (19,20). Also, within nuclear medicine societies, several initiatives now exist such as the EANM Women’s Empowerment or the SNMMI Women in Nuclear Medicine, aiming to promote female networks and careers (21,22).

Female authors were equally represented among the journal ranks, and their participation increased for both high-ranking and other-ranking journals, suggesting that a possible sex bias during peer review did not result in an unbalanced representation of women across the journal ranks. However, although female participation increased for original articles and case reports, it did not change for reviews and editorials/letters. Furthermore, female first authors were underrepresented for editorials/letters. The productivity puzzle comprises many intricate pieces, and explanations for our findings are probably multifactorial. Sex differences in time management and publication patterns, thereby taking into account the cost–benefit ratio of different article types, may partly explain the unchanged female participation in reviews in favor of an increased female participation in original articles. Reviews are time-consuming to write but have less academic value than original articles in the same journal type. The potential gain in visibility by publishing a review might thus not be worth the investment when time is limited. When it comes to case reports, female participation was large and increased, although the academic value of this article type is low. Should we consider this a symptom of lower consideration by team leaders rather than a scientific achievement? Another explanation for our findings might be the invitation that can be required to write certain article types (8,19). A case-control study of sex disparities in invited commentaries showed that women had a 21% lower odds of receiving such an invitation than men despite having similar experience and that this disparity was greater for senior researchers (23).

An almost 10% decrease in the proportion of articles with a male first and last author was observed, in favor of all other collaborations. This finding might be due to the feminization of the workforce or an increased will of senior male team members to collaborate with female team members. Overall, the increasing tendency for collaboration with female first and last authors is encouraging.

This study had some principal limitations: the use of a software application to assign sex, the relatively short study period from 2014 to 2020 due to the absence of last author provenance on PubMed before 2014, insufficient data for 3 of the 6 continents, the absence of nuclear medicine publications outside the 15 journals analyzed, and the absence of professional or demographic data on the workforce worldwide, which prevented subgroup analyses or comparisons. Furthermore, there are no available data thus far on factors that impact career choices and evolutions in nuclear medicine. Nor are there any data on sex inequity in the nuclear medicine workforce, such as measures of unconscious bias, sexual/racial harassment, and the sex division of domestic labor impacting scientific productivity. National and international nuclear medicine associations could follow in the footsteps of the European Society for Medical Oncology by conducting a survey of male and female workers on sex-related challenges (24). Lastly, 2020 was marked by lockdowns due to the coronavirus disease 2019 pandemic. However, a preliminary analysis showed no alterations in the quantity of publications in medical imaging by female authors during this period (25).