NOTES Pharmacy literature

Women as authors in the pharmacy literature: 19892009

BRYAN DOTSON
ver the past 60 years, the enrollment of women at U.S. pharmacy schools has increased substantially. In 1950, only 9.4% of pharmacy students were women 1; that percentage had increased to 36% by 1978,2 and in the 200809 academic year, 64.6% of pharmacy school graduates were women.3 Approximately 46% of actively practicing pharmacists are women.4 Womens participation in academic pharmacy has also increased over the past four decades. In 1972, only 4.8% of pharmacy faculty at or above the level of assistant professor were women.5 By 1992, 21.7% of associate professors and 5.5% of full professors were women; in 1999, 10.3% of full professors were women.6 Currently, 59% of assistant professors and 43% of associate professors at pharmacy schools are women.7 However, women continue to be underrepresented in leadership roles at colleges of pharmacy. In the 200910 academic year, only 25% of pharmacy school deans and 22% of full professors were women.7 In academia, success and advancement are largely based on authorship of publications in peer-reviewed journals. Studies have found that female authorship in medical jour-

Purpose. Trends in the authorship of original research articles by female U.S. pharmacists in three peer-reviewed pharmacy journals over the period 19892009 were evaluated. Methods. The sex distribution of the authors of all original research articles published in 1989, 1999, and 2009 in three prominent pharmacy journals (American Journal of Health-System Pharmacy, Annals of Pharmacotherapy, and Pharmacotherapy) was evaluated. A total of 608 original research articles were assessed to determine the sex of the rst listed author (typically the person with primary responsibility for the research and article preparation) and the last listed, or senior, author (usually a senior faculty member under whose academic purview the research was conducted). Pharmacist authors with U.S. aliations were included in the analysis. Results. In each of the three journals evaluated, female authorship increased

from 1989 to 2009. Overall, the proportion of articles listing a woman as the rst author increased signicantly during the study period, from 29.9% in 1989 to 44.3% in 1999 and to 52.2% in 2009. However, after a signicant rise in the proportion of articles listing a woman as the last author from 1989 to 1999 (from 16.8% to 37.0%), female last authorship in the three journals declined to 33.8% in 2009. Conclusion. There was a signicant overall increase in female authorship of original research articles in the pharmacy literature from 1989 to 2009, but gender dierence persists among pharmacists serving as last listed authors. Index terms: American Journal of HealthSystem Pharmacy; Annals of Pharmacotherapy; Authorship; Journals; Pharmacists; Pharmacotherapy; Pharmacy; Publications; Research; Women Am J Health-Syst Pharm. 2011; 68:1736-9

nals remains less common than male authorship, although the number of women authors of articles published in medical journals has increased significantly over time. 8-12 To my knowledge, no studies have evaluated gender differences in the authorship of articles in pharmacy journals. The objective of the study described here was to evaluate changes over time

in the sex distribution of authors of original research articles published in pharmacy journals. Methods The methods used in this study were similar to those of Jagsi et al.8 in their study of female authorship in medical journals. The analysis was restricted to original research articles

BRYAN DOTSON, PHARM.D., BCPS, is Clinical Pharmacist Specialist Critical Care, Department of Pharmacy, Harper University Hospital, and Adjunct Assistant Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI. Address correspondence to Dr. Dotson at the Department of Pharmacy, Harper University Hospital, 3990 John R., Detroit, MI 48201 (bdotson@dmc.org).

The author has declared no potential conicts of interest. Copyright 2011, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/11/0902-1736$06.00. DOI 10.2146/ajhp100597

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published in 1989, 1999, and 2009. Three prominent, clinically oriented pharmacy journals were chosen for the study: American Journal of Health-System Pharmacy ( AJHP , called American Journal of Hospital Pharmacy in 1989), Annals of Pharmacotherapy (called Drug Intelligence and Clinical Pharmacy in 1989), and Pharmacotherapy. Original research articles were dened as those containing original data and a dened study objective.13 Contemporary sections of the three targeted journals that include original research are Reports and Notes in AJHP, Research Reports in Annals of Pharmacotherapy, and Original Research Articles and Brief Reports in Pharmacotherapy. Original research articles published in 1999 and 2009 were accessed from the Wayne State UniversityDetroit Medical Center library website. For research articles published in 1989, hard copies of the journals were reviewed, as full-text online versions of those articles were not accessible. Data were collected using a standardized spreadsheet. Each original research article was evaluated to identify the rst and last authors (i.e., those whose names appeared rst and last in the byline or author list), the authors sex (male, female, or indeterminate), degree designation, and country of afliation (United States or other). If an article listed only one author, that author was considered to be the rst and last author. The analysis was restricted to rst and last authors for a number of reasons. Traditionally, the first listed author is the person who had overall responsibility for the study and usually did substantially more work to prepare the article than other authors. 11 The last author listed is sometimes considered to be the senior author (i.e., a senior faculty member, such as an associate or full professor), although that is not always the case. Academic rank

committees often view rst and last authorship of peer-reviewed research as a key factor in decisions about promotions, while middle authorship has a much smaller impact on the promotion process.11 Whenever possible, an authors sex was classied according to the rst name. If an initial was used in place of a rst name (e.g., J. John Doe), the authors sex was classied according to the middle name. For all authors whose sex was not clearly indicated by the rst or middle name (i.e., the published author information listed unfamiliar or nongenderspecic names), information about the author was obtained by performing an Internet search with the Google search engine or by visiting the website of the authors institutional afliation (in some cases, this included identification by online photographs); if an authors sex still could not be determined, the sex was classied as indeterminate. This method of author sex classication is similar to that used in studies evaluating female authorship in medical journals.8-12 Authors whose sex was classied as indeterminate, authors with nonU.S. afliations, and nonpharmacist authors were not included in the final analysis. Pharmacist authors were identied by degree designation (Pharm.D., B.S.Pharm., B.Pharm., or R.Ph). Pharmacy students were considered pharmacists for purposes of the study. All data were collected and entered in Microsoft Excel (version 11.0, Microsoft Co., Redmond, WA), and statistical calculations were performed using Prism 5.0 (GraphPad Software Inc., San Diego, CA). The sex distributions of the rst and last authors are expressed as percentages; differences in proportions were compared with a chi-square test. The Bonferroni correction was used for multiple comparisons. The a priori level of signicance was set at <0.05.

Results A total of 608 original research articles in the three pharmacy journals were reviewed (189, 201, and 218 articles published in 1989, 1999, and 2009, respectively). Those articles listed a total of 648 U.S.-based pharmacist authors, of whom 382 were rst authors and 266 were last authors. A classication of male or female sex was made in 642 (99%) cases; the remaining 6 cases (4 rst authors and 2 last authors) were excluded from the nal analysis. The data analysis showed a signicant increase in female authorship in the three journals during the study period (Table 1). For the three journals combined, the proportion of articles listing a woman as rst author increased from 29.9% in 1989 to 44.3% in 1999 and to 52.2% in 2009 (p = 0.0013); the increases in female rst authorship from 1989 to 1999 and from 1989 to 2009 were signicant (p < 0.05 for both comparisons with 1989 data), while the increase from 1999 to 2009 was not statistically signicant. The proportion of articles with a woman as rst author increased over time in all three journals; the increases were statistically signicant in AJHP and Annals of Pharmacotherapy, with the largest increase seen in the latter journal. Overall, the proportion of evaluated articles listing a woman as last author was 16.8% in 1989, 37.0% in 1999, and 33.8% in 2009 (p = 0.0041). Female last authorship was significantly greater in both 1999 and 2009 relative to 1989 (p < 0.05 for both comparisons); the decline in female last authorship from 1999 to 2009 was not signicant. Female last authorship increased from 1989 to 1999 in all three journals but declined from 1999 to 2009 (Table 1). Women were less likely to be listed as last author than as rst author of the evaluated articles during all three study years combined (28.4% versus 41.5%, p = 0.0008) and during 2009 and 1989 (33.8% versus 52.2% in
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Table 1.

Female Authorship of Original Research Articles in Evaluated Pharmacy Journalsa

No. Women/Total No. Authors (%) Publication
Total for all journals evaulated First author Last author American Journal of Health-System Pharmacy First author Last author Annals of Pharmacotherapy First author Last author Pharmacotherapy First author Last author
a b

1989
40/134 (29.9) 17/101 (16.8) 26/83 (31.3) 13/76 (17.1) 10/37 (27.0) 3/18 (16.7) 4/14 (28.6) 1/7 (14.3)

1999
58/131 (44.3) 34/92 (37.0) 31/59 (52.5) 14/44 (31.8) 10/20 (50.0) 6/13 (46.2) 17/52 (32.7) 14/35 (40.0)

2009
59/113 (52.2) 24/71 (33.8) 19/40 (47.5) 4/22 (18.2) 30/46 (65.2) 16/35 (45.7) 10/27 (37.0) 4/14 (28.6)

pb
0.0013 0.0041 0.029 0.15 0.0025 0.09 0.85 0.38

Analysis included U.S.-based pharmacists for whom a classication of sex was made. Dierences in proportions were compared via chi-square testing.

2009, p = 0.016; 37.0% versus 44.3% in 1999, p = 0.33; 16.8% versus 29.9% in 1989, p = 0.02). For the three journals overall, female first authorship was more common in articles with a female last author than in articles with a male last author (50.8% versus 38.5%) but the difference was not statistically significant (p = 0.099). Similarly, articles with a female rst author were more likely than articles with a male rst author to have a female last author (34.8% versus 24.4%); that difference also was not statistically signicant (p = 0.099). Discussion This is, to my knowledge, the rst study evaluating female authorship in peer-reviewed pharmacy journals. Overall, the proportion of articles with a woman as rst or last author was lower than the proportion of articles with a male author, and women served more often as first author than as last author. However, there was a signicant increase in female rst and last authorship of original research articles from 1989 to 2009. When comparing the current percentage of female faculty at colleges and schools of pharmacy (22% of full professors, 43% of associate profes1738

sors, and 59% of assistant professors) to the rates of female authorship in 2009 observed in this study (52.2% of rst authors and 33.8% of last authors), these numbers should be encouraging to women in academic pharmacy.7 The proportion of rst authors who were women increased over time in all three journals. AJHP and Annals of Pharmacotherapy each had a statistically signicant increase in female rst authorship. The longitudinal increase in female rst authorship in Pharmacotherapy did not reach the level of statistical signicance; that nding might have been related to the relatively small number of research articles published in that journal in 1989. The largest rise in the proportion of articles with a woman as rst author was in Annals of Pharmacotherapy. The proportion of articles with a woman as last listed author increased from 1989 to 1999 in each of the journals studied. However, female last authorship declined in all three journals from 1999 to 2009. Although there is no longer a gender gap among those listed as rst authors, a significant gender gap persists among those serving as last authors.

The findings of the study described here are similar to those reported in studies of female authorship in medical journals.8-12 Jagsi et al.8 found that female rst authorship in prominent medical journals increased from 5.9% in 1970 to 29.3% in 2004; during that period, the proportion of articles listing women as senior authors increased from 3.7% to 19.7%. Another study, focusing on female authorship in peerreviewed British journals, found that the proportion of evaluated articles with female rst authors increased from 10.5% in 1970 to 36.5% in 2004.9 In a third study, which evaluated female authorship in dermatology journals from 1976 to 2006, the proportion of articles with a woman as rst author increased from 12% to 48%; the proportion of articles with a woman as last listed author increased from 6.2% to 31%.12 The overall increase in female authorship documented in this study is likely the result of the large number of women entering the profession of pharmacy and a parallel increase in womens involvement in academic pharmacy. Since there are now more women than men entering the profession, the relatively higher proportion of women serv-

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ing as rst authors rather than last authors in 2009 may be partially due to a signicant number of pharmacy students and residents serving as rst authors.3 The persistent gender imbalance among last listed authors may be related to the relatively small percentage of full professorships held by women (22%). Potential barriers to the further advancement of women in academia and their participation in the authorship of articles in peer-reviewed journals have been debated in the medical community; those potential barriers include the constraints of traditional gender roles, sexism, and the relative scarcity of women in leadership roles to serve as mentors to female students and residents.14 In the pharmacy community, strategies to help narrow the gender disparity among last listed authors of original research articles in pharmacy journals should be investigated. Furthermore, efforts to address factors that might be impeding the promotion of more women to full professorships should be considered; possibilities include relaxing traditional time constraints on the attainment of academic-rank milestones and continued efforts to create a exible work environment that is more accommodating of women with children. Among several limitations of the study described here, the original research articles evaluated were limited to three pharmacy journals, and they are not representative of all journals to which pharmacists submit articles. Articles from other pharmacy journals (e.g., Journal of the American Pharmacists Association, American Journal of Pharmaceutical Education) and medical journals were not reviewed. Although publications in high-impact general medical journals and subspecialty medical journals may be regarded more highly than publications in

pharmacy journals, articles from these journals were not evaluated because the majority of these articles are not authored by pharmacists. Another study limitation was that only articles published in 1989, 1999, and 2009 were reviewed, precluding the detection of any peaks or troughs in female authorship that might have occurred in other years. Also, only the sex of the rst and last authors was evaluated; thus, the ndings do not reect possible changes over time in the sex distribution of middle authors. Moreover, the last listed author was assumed to be the senior author (an assumption also made in some studies of female authorship in medical journals8,9), but in some articles the authors could have been listed in the order of their contributions to the work. Finally, the journals from which the articles evaluated were sampled are clinically oriented journals that publish many articles written by clinical faculty and practice-based researchers; pharmacy faculty with a management, outcomes, or other focus would likely publish in other journals in their specialty which would not be captured in this analysis. Despite those important limitations, the studyto my knowledge, the first to focus specifically on trends in female authorship of original research articles in pharmacy journalsprovided encouraging data indicating that the gender gap in professional publishing has narrowed considerably in recent decades. The study also provided valuable insights for decision-makers in academic pharmacy to consider in exploring potential barriers to increased involvement of women in high-level academic positions. Conclusion There was a signicant overall increase in female authorship of original research articles in the pharmacy

literature from 1989 to 2009, but a gender difference persists among pharmacists serving as last listed authors.
References
1. Report of the executive committee for the association year, 1950-1951. Am J Pharm Educ. 1951; 15:544. 2. Henderson ML. Women in pharmacy: twenty-ve years of growth. Ann Pharmacother. 2000; 34:943-6. 3. American Association of Colleges of Pharmacy. Academic pharmacys vital statistics. www.aacp.org/about/Pages/ Vitalstats.aspx (accessed 2010 Sep 6). 4. American Association of Colleges of Pharmacy. 2009 National Pharmacist Workforce Survey executive summary. www.aacp.org/resources/research/ p h a r m a c y m a n p ow e r / D o c u m e n t s / 2009%20NPWS%20Executive% 20Summary.pdf (accessed 2011 May 11). 5. Report on enrollment in schools and colleges of pharmacy, rst semester, term or quarter, 1971-1972. Am J Pharm Educ. 1972; 36:125. 6. Henderson ML, Broedel-Zaugg K. A historical perspective on women pharmacy faculty. Am J Pharm Educ. 1999; 63:4025. 7. American Association of Colleges of Pharmacy. 2009-10 prole of pharmacy faculty. www.aacp.org/career/salarydata/ Pages/default.aspx (accessed 2011 May 11). 8. Jagsi R, Guancial EA, Worobey CC et al. The gender gap in authorship of academic medical literaturea 35-year perspective. N Engl J Med. 2006; 355:2817. 9. Sidhu R, Rajashekhar P, Lavin VL et al. The gender imbalance in academic medicine: a study of female authorship in the United Kingdom. J Res Soc Med. 2009; 102:337-42. 10. Kurichi JE, Kelz RR, Sonnad SS. Women authors of surgical research. Arch Surg. 2005; 140:1074-7. 11. Li SF, Latib N, Kwong A et al. Gender trends in emergency medicine publications. Acad Emerg Med. 2007; 14:1194-6. 12. Feramisco JD, Leitenberger JJ, Redfern SI et al. A gender gap in the dermatology literature? Cross-sectional analysis of manuscript authorship trends in dermatology journals during 3 decades. J Am Acad Dermatol. 2009; 60:63-9. 13. Singer AJ, Homan CS, Stark MJ et al. Comparison of types of research articles published in emergency medicine and non-emergency medicine journals. Acad Emerg Med. 1997; 4:1153-8. 14. Yedidia MJ, Bickel J. Why arent there more women leaders in academic medicine? The views of clinical department chairs. Acad Med. 2001; 76:453-65.

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