Medical Degree Disparity Among Authors in Obstetrics and Gynecology Journals

Methods

This study was a retrospective analysis of medical degree (DO vs MD) trends in publications from the journals Obstetrics & Gynecology (Obstet Gynecol), the American Journal of Obstetrics and Gynecology (Am J Obstet Gynecol), Fertility and Sterility (Fertil Steril), and Menopause. These 4 journals were chosen based on their having a minimum impact factor of 3.0 (range, 3.172-5.656) and 5-year impact factor of 3.0 (range, 3.019-5.488) according to the 2015 Journal Citation Reports, as well as a citation half-life of at least 15 years according to their websites. The senior author (J.A.) trained the other study authors (B.M. and T.S.) in proper abstracting technique by identifying the authors and degrees for the first 2 months of Obstet Gynecol.

Each research article was reviewed to determine the medical degree held by its first and senior authors. This determination was accomplished by inspecting either the abstract or the article that was publicly available on the journal's website. For authors with more than 1 advanced degree, both the medical degree and the second advanced degree (eg, MPH, MSc, PhD) were tallied for analysis. Each publication by a given author was tallied independently, and authors were not excluded if they had multiple publications or served in multiple author roles during the years studied. Only original research articles for the years 2000, 2005, 2010 and 2015 were included in the final analysis. Media reviews, editorials, book reviews, letters to the editor, review articles, and case reports were excluded, as were articles in which the first or senior author was not a physician.

The proportions of DO and MD authors across the years were compared using simple descriptive statistics. The proportions of those holding both a medical degree and a second advanced degree were also analyzed using descriptive statistics. Overall comparison of authorship by DOs and MDs was performed using trends in authorship and simple linear regression analyses. Statistical significance was defined as P≤.05.

Results

A total of 3311 articles and 5909 authors were reviewed for the years included in analysis. A total of 3311 authors were considered first authors, 832 of whom held dual degrees, and 2598 were considered senior authors, 860 of whom held dual degrees.

Overall, 0.80% of authors (47 of 5909) held a DO degree, and 99.20% (5862 of 5909) held an MD degree. Among first authors, 1.10% (36 of 3311) were DOs, compared with 0.42% (11 of 2598) among senior authors (Table 1). Similarly, 0.72% of first authors (6 of 832) and 0.35% of senior authors (3 of 860) with dual advanced degrees had a DO degree. Further subgroup analysis by journal revealed that 0.87% of all authors (13 of 1494) in Obstet Gynecol, 1.03% (21 of 2038) in Am J Obstet Gynecol, 0.44% (9 of 2030) in Fertil Steril, and 2.20% (4 of 347) in Menopause were DOs (Table 1). For all analyses of authorship by DOs compared with MDs, both overall and for individual journals, results were statistically significant (all P<.05).

In 2000, DOs accounted for 0.74% (7 of 994) in the first author and 0.52% (4 of 772) in the senior author role; in 2015, the equivalent numbers were 2.20% (14 of 635) and 0.79% (4 of 507). However, no statistically significant trend was found for either first (P=.35) or senior (P=.80) authorship by DOs over time (Table 2). Likewise, among first authors with dual advanced degrees, 0.61% (1 of 165) were DOs in 2000, compared with 1.46% (3 of 205) in 2015; for the senior author role, the percentages were 0% (0 of 144) in 2000 and 0.84% (2 of 237) in 2015 (Table 3). No statistically significant trend in authorship was found for either first (P=.20) or senior (P=.06) authors with dual degrees who were DOs over time.

Although we found no statistically significant trends for publication by DOs (including those with dual advanced degrees) as first or senior authors in any journal we reviewed, for MDs as first authors we found significant negative linear trends in Obstet Gynecol (P=.01) and Am J Obstet Gynecol (P=.05), and a significant positive linear trend in Menopause (P=.02), and as senior authors in Obstet Gynecol (negative linear trend, P=.02) and Menopause (positive linear trend, P=.04) (Table 2). For MDs with dual degrees, no statistically significant trends could be established for either first or senior authors (Table 3).

Discussion

The results of the current study indicate that DOs served as first or senior authors of published original research articles in obstetrics and gynecology journals less frequently than their MD counterparts in the years studied. To our knowledge, this study is the first to highlight the medical degree disparity among physician authors in obstetrics and gynecology journals, but our findings resemble those of previous research. In emergency medicine, Lammers et al³ found that osteopathic emergency physicians had significantly fewer published articles than their allopathic counterparts when the roles of first and senior author were considered during a 2-decade period in high-impact journals. However, the exact reasons for the medical degree disparity remain unclear.

One reason for the disparity in publications between DOs and MDs could be the difference in training that allopathic and osteopathic medical students receive with regard to research. Historically, the osteopathic curriculum has not been research oriented, despite medical students’ expressed desire for increased clinical research electives.^6,7 According to a 2011 survey, osteopathic medical students reported devoting only 2% of their time during clerkship to research, and a large number of those graduating believe that not enough time is spent on learning research techniques.⁸ In a 2016 study, Smith et al⁹ found that senior medical students understand only about half of evidence-based medicine question topics, with the most poorly understood subjects being number needed to treat, CIs, 2-by-2 grids, magnitude, internal validity, relevance, and study design. Without acquiring proficiency with foundational techniques during medical school, it may be difficult for a novice researcher to break into publication.

In 2015, Muffly et al¹⁰ reported that it takes an average of 25.6 months for an abstract presented at an obstetrics and gynecology meeting to become a published article and that 54% of all abstracts presented at major obstetrics and gynecology conferences in 2005 had been published. Although many abstracts are transitioned to articles in obstetrics and gynecology journals, DOs rarely serve as first or senior authors, based on the data from the current study. This finding could be related to the fact that few published articles are authored or coauthored by DOs with dual degrees.

Physician-scientists, or those holding dual degrees, are integral to the continued development of medical knowledge and produce an average of 4 or more publications during their training.¹¹ However, several factors, including financial and family obligations, the time it takes to obtain dual degrees, and the “publish or perish” mentality, may discourage young physicians from pursuing careers as physician-scientists.^12-14 For the academic year 2018-2019, a total of 77 dual-degree programs were offered by osteopathic medical schools.¹⁵ However, these physician-scientist trainees are years away from being academically productive in their specialties.

Another suggested reason for the degree disparity in academic medicine is that there are many more MDs than DOs in practice. According to data from the American Congress of Obstetricians and Gynecologists for 2010, there were 33,624 practicing general obstetrician-gynecologists in the United States.¹⁶ An AOA workforce analysis for the same year stated that there were 2170 DOs practicing obstetrics and gynecology.¹⁷ Based on these data, it can be inferred that 6.45% of all practicing obstetrician-gynecologists in 2010 were DOs. However, despite this percentage, only 0.66% (11 of 1666) of original research articles published that same year in obstetrics and gynecology journals we studied featured a DO as first or senior author.

Since the announcement of the single accreditation system, the AOA and The Journal of the American Osteopathic Association have made strides not only to aid the novice physician researcher but also to lay the groundwork for increased numbers of DO researchers. In 2013, the AOA published a strategic plan for research that focused on increased production, collaboration, and funding for research in the osteopathic medical profession.¹⁸ Although the groundwork is being laid for current physicians, future studies need to focus on how residencies are coping with the need for heightened academic productivity and the resources that may be needed to fulfill this requirement.

Conclusion

Compared with MDs, DOs rarely served as first or senior authors of articles published in 4 high-impact obstetrics and gynecology journals from 2000 to 2015. No trend over time could be established for publication of articles with DO first or senior authors, including those with dual degrees.

Author Contributions

All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.