Representation of Female and Osteopathic Physicians on Editorial Boards of High-Impact Journals Across 24 Medical Specialties

Introduction

The medical field has progressed significantly over the last decade in regards to the representation of female and osteopathic physicians. The proportion of female medical school matriculants has steadily increased over the last decade and is now consistent with the proportion of male counterparts.¹ However, females remain underrepresented in the physician workforce, comprising only 37.1% as of 2021.² Similar trends persist with osteopathic physicians of all genders. The current number of practicing Doctors of Osteopathic Medicine (DO) and osteopathic medical students has quadrupled over the past three decades.³ Furthermore, osteopathic medical students comprise more than 25% of all United States medical students.³ Nonetheless, DOs only represent 11% of all practicing physicians as of 2023.³ The current rise in female matriculants and osteopathic matriculants is encouraging but continued support, opportunities, and mentorship is needed to maintain these trends.

Additionally, the difficulties faced by female and osteopathic physicians do not diminish upon entry into the field; rather, they develop into barriers that impede career advancement and achievement of academic prestige across most medical specialties. Currently, there is limited data examining leadership opportunities and academic achievements across multiple specialties. Moreover, studies that simultaneously investigate female and osteopathic physicians as editorial board members across multiple specialties are lacking. Therefore, we sought to determine if there was a difference in female physician and osteopathic physician representation among editorial board members of high impact journals across 24 distinct medical specialties.

Methods

This was a cross-sectional analysis of all editorial board members for journals organized into three different categories. These categories included: the seven-core osteopathic clinical rotations (family medicine, internal medicine, pediatrics, psychiatry, obstetrics and gynecology, general surgery, and emergency medicine), eight medical subspecialties (dermatology, critical care, endocrinology, infectious disease, cardiology, hematology/oncology, neurology, and physical medicine & rehabilitation), and nine surgical subspecialties (anesthesia, neurosurgery, thoracic surgery, urology, otolaryngology, orthopedics, plastic surgery, ophthalmology, and vascular surgery). Scimago Journal and Country Rank was used to determine journals that met inclusion criteria of being published in the English language within each specialty and was used to create reference list for high impact journals. Next, Clarivate was used to determine the impact factor from reference list and the top five journals from each specialty with the highest impact factor were included in the study. Although a minor number international journals were included in the study, the criterion for journals published in the English language was to help ensure United States of America-based or have a significant U.S.A. editorial influence as osteopathic physicians are not as common in countries outside the U.S.A. Editorial board members were categorized based upon their title located on the journal’s website and divided into the following groups: Editor in Chief, Associate/Assistant/Deputy Editor in Chief, Executive/Senior/Section Editors, Associate/Assistant Editor, and Other Editors.

The gender of each editorial board member was identified by an extensive internet search of publicly available databases using the board members’ first and last names. Gender was assigned using available profile images, pronouns listed on research databases, or biographies on hospital-affiliated websites. This process was carried out by two independent reviewers, with a third reviewer available to resolve any discrepancies. If authors were unable to identify the gender of an editorial board member, the data point was classified as unknown and removed from the analysis. Medical degree was assigned similarly to gender and all of those without a medical degree were removed from the data set. Following the completion of data collection, two independent reviewers examined 10% of the other reviewers’ work for disagreements. All disagreements were resolved by a third reviewer and found to have a Kappa greater than 0.90.

The total number of female and osteopathic physicians was determined based upon the 2021 AAMC Physician Specialty Data Report.^2,4 A binomial proportion test was used to compare the distribution of female and osteopathic physicians serving on editorial boards and the number of female physicians (42.36%, 38.24%, 18.99%) and osteopathic physicians (9.06%, 6.57%, 4.70%) in current practice among the three categories previously defined as the seven-core osteopathic clinical rotation specialties, eight medical subspecialties, and nine surgical subspecialties, respectively.

Results

Overall Characteristics

A combined total of 120 journals were included in the final data set, which contained 5007 editorial board members, each individually reviewed under the inclusion criteria. The percent of active female and osteopathic physicians within the workforce for each specialty were used for statistical comparison of the proportion of editorial board members [Table 1].

Seven Core Osteopathic Rotation Specialties

A total of 1282 editors were reviewed with 29.41% (p<0.0001) categorized as female physicians and 1.25% (p<0.0001) categorized as osteopathic physicians [Table 2].

Females comprised 16.67% of Editors in Chief (p=0.002), 35.48% of Associate/Assistant/Deputy Editors in Chief (p=0.21), 26.87% of Executive/Section/Senior Editors (p=0.013), 38.27% of Associate/Assistant Editors (p=0.30), and 27.92% of editors categorized as other (p<0.0001)[Table 2]. Osteopathic physicians consisted of 0% of Editors in Chief (p=0.07), 0% of Associate/Assistant/Deputy Editors in Chief (p=0.0003), 4.48% of Executive/Section/Senior Editors (p=0.28), 0.62% of Associate/Assistant Editors (p<0.0001), and 1.19% of editors categorized as other (p<0.0001)[Table 2].

Eight Medical Subspecialties

A total of 1030 editors were reviewed with 36.60% (p=0.29) categorized as female physicians and 0.68% (p<0.0001) categorized as osteopathic physicians [Table 3].

Females consisted of 28.13% of Editors in Chief (p=0.28), 31.52% of Associate/Assistant/Deputy Editors in Chief (p=0.20), 45.95% of Executive/Section/Senior Editors (p=0.06), 44.16% of Associate/Assistant Editors (p=0.14), and 33.50% of editors categorized as other (p=0.02)[Table 3]. Osteopathic physicians consisted of 0.00% of Editors in Chief (p=0.27), 1.09% of Associate/Assistant/Deputy Editors in Chief (p=0.03), 0% of Executive/Section/Senior Editors (p=<0.0001), 0.65% of Associate/Assistant Editors (p=0.0008), and 0.83% of editors categorized as other (p<0.0001)[Table 3].

Nine Surgical Subspecialties

A total of 2695 editors were reviewed with 18.48% (p=0.49) categorized as female physicians and 0.57% (p<0.0001) categorized as osteopathic physicians [Table 4].

Females consisted of 16.07% Editors in Chief (p=0.73), 18.57% of Associate/Assistant/Deputy Editors in Chief (p=1), 22.85% of Executive/Section/Senior Editors (p=0.05), 26.04% of Assistant/Associate Editors (p=0.001), and 15.67% of editors categorized as other (p=0.004) [Table 4]. Osteopathic physicians consisted of 0.00% of Editors in Chief (p=0.11), 0.71% of Associate/Assistant/Deputy Editors in Chief (p=0.02), 0% of Executive/Section/Senior Editors (p<0.0001), 0.27% of Assistant/Associate Editors (p<0.0001), and 0.76% of editors categorized as other (p<0.0001) [Table 4].

Discussion

Over the past few decades, the number of female medical school matriculants has risen significantly, resulting in near-equal representation between male and female students.¹ This trend is also seen in osteopathic medical schools, whose students now make up nearly a quarter of all U.S. medical students.³ While the growth in female and osteopathic matriculants is encouraging, sustained progress depends on continued access to support, opportunities, and mentorship. Despite these advances, disparities remain—particularly in gaining entry into certain specialties. Female and osteopathic physicians are often underrepresented in highly competitive fields and more proportionally represented in less competitive ones.^2,4 These challenges persist beyond medical school, evolving into barriers to career advancement and academic recognition across many specialties.

Among the professional challenges faced by female physicians is their underrepresentation on the editorial boards of high-impact journals. Within the seven-core osteopathic rotation specialties, women were consistently underrepresented as editorial board members relative to their proportion among actively practicing physicians. These findings mirror broader trends in academic medicine, where female physicians often hold lower academic ranks and are less likely to attain leadership positions or serve as manuscript authors—particularly in internal medicine and general surgery.^5–7 However, this disparity is not uniform across all osteopathic core specialties. Psychiatry has demonstrated a positive trend, with female physicians increasingly represented in leadership roles in proportion to their presence in the.⁸ Similarly, pediatrics has achieved parity in first-author publications between male and female physicians.⁹ In obstetrics and gynecology, women not only make up the majority of the workforce but also hold a significant number of leadership positions, including the majority of program director roles.¹⁰

Notably, data collected on female physician editorial board representation in the medical and surgical subspecialties revealed appropriate representation compared to the current active workforce. However, editorial board representation reflects only one dimension of female physician representation, and alternative analytical approaches have revealed contrasting outcomes. Studies examining leadership roles within academic societies, specialty committees, program directorships, and prestigious faculty appointments have consistently demonstrated female underrepresentation and highlighted systemic barriers to career advancement in both medical and surgical subspecialties.^11–20 Anesthesiology is one of the few subspecialties where female physicians hold an equivalent proportion of leadership at academic societies, although this is only a small step forward for subspecialty representation when considering all other possible leadership opportunities.²¹ The cause of these disparities in leadership positions could be the result of inequalities in opportunity for demonstrating academic achievement as selections for prestigious positions often place a high degree of importance on research productivity and contributions. The underlying causes of these disparities are likely multifactorial. However, research has consistently demonstrated significant differences in academic productivity between male and female physicians in medical and surgical subspecialties. Female physicians in these fields are less likely to attain prominent authorship positions, publish scholarly manuscripts, receive academic awards, or present at national conferences—disproportionate to their overall representation within the specialty.^{7,12,15,17,22–26} Improved representation among editorial board members is a movement in the correct direction, however, the data is compared to the entire workforce in which female physicians are disproportionally underrepresented.

In contrast to female physicians, osteopathic physicians are underrepresented as editorial board members across all three categories: the seven-core osteopathic clinical rotations, medical subspecialties, and surgical subspecialties. While multiple discrepancies have been identified in the literature regarding osteopathic physicians attaining competitive leadership and academic positions, far fewer studies have investigated this issue. The available evidence is also limited in terms of both the number of studies and the diversity of medical specialties analyzed. Similar to female physicians, osteopathic physicians are underrepresented in leadership positions across multiple medical specialties. Osteopathic physicians are less likely to be accepted into fellowships, hold editorial board positions, and achieve leadership roles at academic meetings.^27–31 Hinderance to gaining academic prestige remains systemically pervasive as osteopathic physicians receive less grant funding, have fewer first and last author publications, and have an overall lower h-index compared to peers.^28,31–37

There are many possible explanations for the underrepresentation of female and osteopathic physicians as editorial board members. Contributing factors may include limited research exposure during medical school, fewer mentorship opportunities throughout training, and whether an individual pursued an advanced degree before or during medical education. All of these factors contribute to the eventual exclusion of osteopathic and female physician candidates during the appointment process of new editorial board members, as the final consequence of these circumstances is a less competitive research résumé. Addressing disparities related to physician gender and medical degree is essential, as they have broader implications for healthcare quality, alignment with patient preferences, and the diversity of perspectives that drive innovation and advancement within these unique medical specialties.^38–40

Limitations

This study has several limitations. First, we included only the top five journals by impact factor in each specialty. Only including five journals may not fully encompass the diversity of editorial board composition in broad fields with many journals or niche specialties with fewer major journals. However, the inclusion of five journals was done for consistency across specialties and focused our analysis on the most influential journals. We also acknowledge that certain specialties may overlap, meaning some editors could appear on multiple editorial boards, potentially influencing our counts. Although this is unlikely to affect our results due to the small number of editorial board members that may be on several editorial boards. Furthermore, our study included a large variety of specialties where editorial board overlap is even more unlikely. Additionally, focusing on high-impact journals also introduces a bias toward publications affiliated with allopathic institutions and societies, which have historically underrepresented osteopathic physicians and potentially women in editorial roles. While this could be seen as a limitation, we believe it reflects a broader reality in academic medicine as these journals often set the standard for academic advancement and prestige. Unfortunately, this also means that osteopathic physicians, and to a lesser extent women, remain underrepresented in these areas. Including lower-impact or osteopathic-specific journals might have shown higher representation of osteopathic and female physicians, but the goal of the study was to investigate journals with the highest impact. Finally, although we examined 24 specialties, it’s possible that journals in other specialties could have shown different patterns of representation. However, based on current trends and the consistency of our findings across a wide range of specialties, it is unlikely that including more specialties would significantly alter the results. Additionally, general interest and multidisciplinary medical journals were not included, as this study focused on specialty-specific journals to allow for consistent comparisons within medical specialties. This study also included English-language journals that contained a minor number of international editorial boards. While osteopathic physicians are licensed to practice in several countries, they remain far more common in the United States. However, the focus of the study was on osteopathic and female physician representation in the highest impact journals. While they are not explicitly barred from serving on editorial boards of international journals, their underrepresentation is more likely due to systemic barriers that exist both internationally and within the United States.

Conclusion

Although the representation of female physicians as editorial board members in medical and surgical subspecialties is proportional to the current workforce, female physicians remain underrepresented in the seven-core osteopathic rotation specialties. Furthermore, osteopathic physicians remain underrepresented in every specialty as editorial board members. This study is only a small contribution to the literature covering the long and arduous course that female and osteopathic physicians face when it comes to obtaining leadership positions and academic prestige throughout their careers. Future research efforts should focus on identifying where the systemic disparity begins for female and osteopathic physicians, as early mentorship and superior supporting resources from undergraduate medical education programs can likely have lasting ramifications throughout the course of a candidate’s medical career. This would allow directed efforts to help alleviate these disparities and diversify many cutting-edge research efforts in medical specialties that have thus far remained unconsciously numb to the valuable input of many hardworking colleagues.

Acknowledgements

The authors would like to acknowledge the following members of the Midwestern University MIRAGE Research Group for their assistance in data collection: Christina Mortensen, Elias Sherzad, Mohammad Rifai, Jacob Ryu, Lucas Gerbasi, Manjinder Gill, Angelique Shumway, Jen Riedel, Tara Mohanroy, Dhairya Shah, Muhammad Kashif, Samantha Gluzinski, Scott Farr, O’Neil Fillon, Alexander Candel, Wyatt Furnell, Julius Vellutato, Christopher Sleiman, McKay Wilding, Oren Saghian, Jared Logsdon, Kori Kelley, Ruthvik Gundala, Kevin Vander Werff, and Brian Mayer.