Female Mentors Likely Play Key Role in Boosting Numbers of Female ‘Corresponding’ Authors

Academic cardiology is once again looking inwards to better understand the dearth of women in leadership positions with a new study addressing the proportion of women listed as corresponding authors on cardiology publications.

This latest analysis has found that women are far less likely than men to be listed as the corresponding author, but that this number increases when more women are listed as authors and, in particular, as senior author.

That, according to authors David Ouyang, MD, Robert A. Harrington, MD, and Fatima Rodriguez, MD (Stanford University, CA), speaks to the extent that women in leadership positions are recruiting and mentoring junior female investigators.

“The big take-home for academic cardiologists is that more work needs to be done to narrow the gender gap in our profession,” Rodriguez, the senior author, told TCTMD in an email. “By working to promote and retain women researchers, we can work towards creating a pipeline of junior women investigators.”

Ouyang, the corresponding author on the study, highlighted the need to fix what is often characterized as a “leaky” pipeline from physician trainees to junior faculty and from junior faculty to senior faculty, saying that this needs investment by senior academics, both men and women.

“Our paper is generalizable across all of medicine and particularly academic medicine, in which advancement is directly correlated with how widely you publish and how much research you do, and that’s related to how many research papers you have,” Ouyang told TCTMD. “And it’s not just personal motivation that leads to advancement, because opportunities are related to the mentorship you have and the authorship opportunities given by those mentors.”

Plugging the Leaks

The authors make the oft-cited point that while over 50% of med-school graduates are women, only a quarter of cardiology fellowship trainees are women and just 12% of practicing cardiologists are female. The proportion of female cardiologists in academia is even smaller. Other recent studies have documented a rise in both first and senior female authors on cardiology papers, but have also shown that these numbers remain low and that the expected transition from first to last authorship (denoting a leadership role) has been sluggish.  

In their study, Ouyang and colleagues describe the corresponding author as the one who typically leads and organizes the research projects and is recognized as such by the wider community. For their study, they analyzed author names and roles for 2,379 articles published in 2017 in the twenty top cardiology journals using rigorous methods to verify the gender of the corresponding author.

More work needs to be done to narrow the gender gap in our profession. Fatima Rodriguez

In all, 9,597 unique authors were identified, of which 2,800 (29.2%) were female. A full 445 articles were single-author publications, of which only 67 were written by women. In an analysis looking only at multi-authored papers, the corresponding author was the first author in 98.6% of papers, which may be a hint of progress in mentoring: the senior author being the one to decide who should be the point person for the research.

Elsewhere in the numbers were some signals of the kind of research teams behind the publications themselves. While the number of co-authors was no different between papers with female corresponding authors versus male corresponding authors, papers with a female corresponding author tended to have more female names as co-authors, as well as more female senior authors. What’s more, 71% of papers listing a woman as corresponding author had at least one other female author compared with just 50% of papers with a male corresponding author.

Ouyang provided some additional numbers to TCTMD that are not included in the paper. Overall, he said, women made up 26.1% of all authors on the papers included in the analysis. Just 16% of senior authors were female, 18% of first authors were female, and 18.4% of corresponding authors were female.

“Our study suggests that in a research setting, female investigators are likely serving as mentors for other female researchers,” Ouyang et al conclude.

Both Rodriguez and Ouyang stressed to TCTMD that both male and female leaders can do more to ensure that women advance in academic cardiology. Rodriguez pointed out that many of her “strongest” mentors were men, including co-author Harrington. “And I served as a mentor to the extremely talented first-author of this paper, who is a male cardiology fellow,” she said. “Ensuring diversity in our profession is everyone's responsibility.”

It was Rodriguez, said Ouyang, who insisted that he be the corresponding author on this paper.

Making Thoughtful Decisions on Authorship

One of the more surprising findings in this analysis, Ouyang added, was that the vast majority of corresponding authors were first authors, an observation that also struck Carolin Lerchenmüller, MD (Heidelberg University Hospital, Germany), who commented on the study for TCTMD.

Lerchenmüller, who has also studied representation of female cardiologists and academics in authorship roles, called the paper—which included just a year’s worth of papers—a “snapshot” of the field. And the preponderance of first authors in the role of corresponding author raises additional questions, as to why there may be a shift from year’s past.

“I think it’s more usual for the last author to be the corresponding author, and if the last is not the corresponding author, then it is certainly the last author who decides who that will be,” she said. “The last author has a huge influence on deciding who will be the lead junior author and corresponding author, and the team composition as a whole.”

These choices, Lerchenmüller said, play a critical role in the career of the junior academic, and shouldn’t be taken lightly.

“I think people usually make these decisions without putting much thought into how important they are for the younger faculty,” she continued. “There’s a lot of unconscious decision-making and unconscious biases that do affect the young, and maybe the young female more than the young male investigators. And one of the most pressing questions we ask is: how do we stop this leaky pipeline? And one thing is, it’s very important to be very conscious of how you assemble a [research] team. Who will be leading this project and what will be their recognition in the manuscript?”

Lerchenmüller notes that she has been in a position of doing research, writing it up, then handling all of the submissions and correspondence with the journal, only to be told by the senior author that she would not be the corresponding author.

“You do need to advocate for yourself,” she said. “If the last author is going to receive an email asking about certain aspects of the experience, and he or she needs to ask me, because he or she doesn’t know the answers, then I should be the corresponding author. And if I do all the correspondence with the journals, then I should be the corresponding author. It’s still clear that there is a senior author who will be responsible for managing the lab, acquiring the funding, and assembling the team, but if there are more junior people who are actually doing the work and they are leading the project, then they should get the recognition.”