Cardiology Research Roadblock: Female First Authors on the Rise, but Senior Names Have Stayed Male

Over the last three decades, the number of women listed as first authors on papers in cardiovascular journals has risen substantially, but this increase has not translated into a greater number of women appearing in the senior-author position—typically the domain of team leaders and department heads.

In fact, during this time, women have been listed as senior authors at roughly half the rate of men, a pattern that has stayed consistent despite the rising number of women seemingly taking the lead on research.

“Whereas women have become overall more likely to earn first-author positions in cardiovascular research and across the life sciences, this advantage exists mostly for publications in less influential journals,” Carolin Lerchenmüller, MD (Massachusetts General Hospital, Boston, MA), and colleagues write. “These first authorships, moreover, appear to not translate into last authorships a few years later; the senior author gender gap has remained large and stable.”

The analysis appears as a research letter in the special “Go Red for Women” issue of Circulation, published February 20, 2018.

Lerchenmüller and her colleagues speculate that the dismal representation of women with faculty appointments in cardiology—around 17%—may stem in part from the fact that they may have fewer “prestigious authorships” then men.

“In order to become faculty, you need to have some research activity,” often measured by the number and caliber of publications, Lerchenmüller explained to TCTMD. She herself is at this stage of her career, she noted. “I’ve just completed my post doc. I’m a physician scientist involved in basic cardiovascular research and clinical cardiology. If I want to apply to faculty positions, there will be places where if I don’t have one of the very high impact, first-author papers then I shouldn’t even apply. Other places will probably say, well, if you have a good number of mid-tier publications, that’s equally good. It’s very subjective and I think very dependent on where you’re applying to, but you can generally say that the more publications you have and the higher their impact, the better your chances of getting a good faculty position.”

That’s what we call the leaky pipeline: the transition from junior to senior scientist. Carolin Lerchenmüller

Lerchenmüller et al’s analysis considered authorships across more than 12,000 National Institutes of Health R01-supported cardiovascular research articles indexed in PubMed for 107 cardiovascular research journals published between 1985 and 2015. To get a wider snapshot of authorship by sex beyond cardiology, they also considered more than 600,000 medical research articles, more broadly, published in 3,849 medical journals.

In the past decade, they found, women have come to earn first authorship 5% more frequently than men in cardiovascular publications—a substantial rise from the mid-80s, when male first authors were dominant. Of note, an even greater leap in the number of female first authors was seen among medical publications more generally, where women were 20% more likely than men to be named as first author in 2015.

That rise, however, was not mirrored at the other end of the list, where men have continued to be 50% more likely than women to be named as the last or “senior” author over the 30-year span.

“That’s what we call the leaky pipeline: the transition from junior to senior scientist. What we’ve shown for the first time is that in these junior positions, we women are doing pretty well. That’s a good sign,” Lerchenmüller said. “But we are really, really concerned that if you look at the general sciences, not just cardiovascular research, although women are actually doing proportionally a little better in first-author positions since the mid-90s, even though these might be lower-impact [publications], but the last author gap hasn’t [shifted]. There’s not even a trend that it is closing.”

In separate analyses that took into account the quality of the medical journal based on impact factor, the numbers indicate that first authorship positions by women are more common in the lower-impact journals, whereas in the higher-impact journals, women had significantly lower rates of first authorship than men.

Closing the Gap

People have speculated that, following a lag, an increase in the number of female first authors will gradually lead to an increase in senior authors who are also female, but over the course of the current study, that doesn’t appear to be the case. “And that’s what’s so concerning,” Lerchenmüller said.

Reasons for this gap remain unclear, she continued. “Do we women choose groups that target lower-impact [journals]? Or within research groups, are we allocated to the lower-impact projects? Are mentors treating women and men differently? Or is it discrimination within the review process? We don’t know. . . . As a young female scientist, you just have to be very aware that there’s still this unknown block in the road.

“We shouldn't be discouraged—that can’t be the answer,” she stressed. “We need to do good, thorough science, but then also be aware that there might be something there, a block in the road, that we need to circumvent or climb over.”

Lerchenmüller is listed as the first of three authors on the research letter; Olav Sorenson, PhD (Yale University, New Haven, CT), holds the "senior" spot, but as a footnote clarifies, the authors—by intent—are listed in alphabetical order.