Disparities by Sex in Promotion to Associate Professor Among a National Cohort of Academic Physicians: Causal Mediation Analysis.
Disparities by Sex in Promotion to Associate Professor Among a National Cohort of Academic Physicians: Causal Mediation Analysis.
复制标题
全国学术医师队伍中晋升副教授的性别差异：因果中介分析。
DOI：
10.1097/acm.0000000000005344
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Jeffe,DonnaB
中科院分区：
文献类型：
--
作者：
Freeman,WilliamE;Yan,Yan;Jeffe,DonnaB
Purpose: Women comprise about half of US medical school applicants, matriculants, graduates, and residents and have been increasingly appointed as full-time academic medicine faculty since 2009 but remain underrepresented among associate professors and full professors. 1 Recent investigations suggest that historical disparities in promotion continue to persist, 2 yet, to our knowledge, the effects of potential mediators that explain this disparity have not been reported.Method: The Association of American Medical Colleges (AAMC) provided linked, deidentified data for a national cohort of US MD-granting medical school matriculants in academic years 1993–1994 through 2000–2001. Data were used from the AAMC Student Record System (sex, race/ethnicity, degree program at graduation), Matriculating Student Questionnaire (parent occupation), Graduation Questionnaire (career preference, medical school research and authorship, research-intensive medical school), Faculty Roster (faculty track, initial rank [assistant professor vs instructor], department at initial appointment, research-intensive faculty institution), National Board of Medical Examiners United States Medical Licensing Exam (USMLE) first-attempt Step 1 and Step 2 Clinical Knowledge scores, and National Institutes of Health Information for Management, Planning, Analysis and Coordination (IMPAC II) grants awarded. Our outcome of interest was promotion to the rank of associate professor. We used Cox cause-specific proportional hazards model to estimate women’s hazard of promotion to associate professor. We employed causal mediation analysis using the inverse odds ratio-weighting technique with bootstrapping 3 to estimate mediation effects and their 95% confidence intervals (CI), which we represent as the proportion of the total sex disparity in promotion. We report hazard ratios (HR) and percentages, each with respective 95% CI.Results: Of 38,752 matriculants appointed to full-time faculty positions, 33,288 (85.9%) had complete data for analysis. Female (vs male) faculty had lower hazard of promotion to associate professor (HR 0.77 [0.74, 0.80]), controlling for race/ethnicity, parent occupation, and year of appointment as confounders. In single-mediator models, department at initial appointment explained the largest proportion of the total effect of sex on promotion (22.8%[16.1, 31.2]), followed by medical student research and authorship (10.6%[7.4, 14.8]) and USMLE Step 1 scores (9.1%[6.0, 13.3]). Receipt of federal grants (6.1%[3.2, 9.2]), initial faculty rank (5.2%[2.3, 8.3]), and faculty career preference at graduation (2.4%[0.05, 4.7]) also were significant mediators. Other mediators did not explain a significant proportion of the sex disparity in promotion. A block of all significant mediators explained 43.0%(34.5, 54.8) of the total effect of sex on promotion.
