From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City.
N Engl J Med. 2020 Nov 26;383(22):2148-2157. doi: 10.1056/NEJMsa1916935.
BACKGROUND: In 2000, a landmark study showed that women who graduated from U.S. medical schools from 1979 through 1997 were less likely than their male counterparts to be promoted to upper faculty ranks in academic medical centers. It is unclear whether these differences persist. METHODS: We merged data from the Association of American Medical Colleges on all medical school graduates from 1979 through 2013 with faculty data through 2018, and we compared the percentages of women who would be expected to be promoted on the basis of the proportion of women in the graduating class with the actual percentages of women who were promoted. We calculated Kaplan-Meier curves and used adjusted Cox proportional-hazards models to examine the differences between the early cohorts (1979-1997) and the late cohorts (1998-2013). RESULTS: The sample included 559,098 graduates from 134 U.S. medical schools. In most of the cohorts, fewer women than expected were promoted to the rank of associate or full professor or appointed to the post of department chair. Findings were similar across basic science and clinical departments. In analyses that included all the cohorts, after adjustment for graduation year, race or ethnic group, and department type, women assistant professors were less likely than their male counterparts to be promoted to associate professor (hazard ratio, 0.76; 95% confidence interval [CI], 0.74 to 0.78). Similar sex disparities existed in promotions to full professor (hazard ratio, 0.77; 95% CI, 0.74 to 0.81) and appointments to department chair (hazard ratio, 0.46; 95% CI, 0.39 to 0.54). These sex differences in promotions and appointments did not diminish over time and were not smaller in the later cohorts than in the earlier cohorts. The sex differences were even larger in the later cohorts with respect to promotion to full professor. CONCLUSIONS: Over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to the rank of associate or full professor or to be appointed to department chair, and there was no apparent narrowing in the gap over time. (Funded by the University of Kansas Medical Center Joy McCann Professorship for Women in Medicine and the American Association of University Women.).
背景：2000 年，一项具有里程碑意义的研究表明，1979 年至 1997 年毕业于美国医学院的女性晋升为学术医学中心高级教职的可能性低于男性同行。目前尚不清楚这些差异是否仍然存在。
方法：我们合并了美国医学协会关于 1979 年至 2013 年所有医学院毕业生的数据，以及 2018 年的教职员工数据，并比较了根据毕业班级中女性的比例预计晋升的女性百分比与实际晋升的女性百分比。我们计算了 Kaplan-Meier 曲线，并使用调整后的 Cox 比例风险模型来检查早期队列（1979-1997 年）和晚期队列（1998-2013 年）之间的差异。
结果：样本包括来自 134 所美国医学院的 559098 名毕业生。在大多数队列中，晋升为副教授或正教授或担任系主任的女性人数均低于预期。基础科学和临床部门的研究结果相似。在包括所有队列的分析中，在校正毕业年份、种族或族裔以及系别类型后，女性助理教授晋升为副教授的可能性低于男性同行（风险比，0.76；95%置信区间[CI]，0.74 至 0.78）。在晋升为正教授（风险比，0.77；95%CI，0.74 至 0.81）和担任系主任（风险比，0.46；95%CI，0.39 至 0.54）方面也存在类似的性别差异。随着时间的推移，这些晋升和任命方面的性别差异并未缩小，并且在后期队列中并不小于早期队列。在后期队列中，晋升为正教授的性别差异更大。
结论：在 35 年的时间里，学术医学中心的女性医生晋升为副教授或正教授或担任系主任的可能性低于男性，而且随着时间的推移，这种差距似乎并没有缩小。（由堪萨斯大学医学中心的 Joy McCann 教授职位为女性医学和美国大学妇女协会提供资助。）
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