Association of Academic Physiatrists Women’s Task Force

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Association of Academic Physiatrists Women’s Task Force Follow-up Report

Julie K. Silver, MD1, Sara Cuccurullo, MD

2, Lyn Weiss, MD

3, Christopher Visco, MD

4,

Gwendolyn Sowa, MD, PhD5, Mooyeon Oh-Park, MD

6, Danielle Perret Karimi, MD

7,

Walter R. Frontera, MD, PhD8, Talya K. Fleming, MD

9, Glendaliz Bosques, MD

10,

Anne Felicia Ambrose, MD, MS11

, Tiffany Knowlton, JD, MBA12

1Harvard Medical School and Spaulding Rehabilitation Network; Association of Academic

Physiatrists Women’s Task Force Co-Chairperson

2JFK Johnson Rehabilitation Institute and Rutgers Robert Wood Johnson Medical

School/Hackensack Meridian School of Medicine; Association of Academic Physiatrists

Women’s Task Force Co-Chairperson

3New York University, Winthrop Hospital, Professor of Rehabilitation Medicine

4Ursula Corning Associate Professor of Rehabilitation Medicine and Vice Chair of Education,

Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College

of Physicians and Surgeons; Director of Residency Training in Physical Medicine and

Rehabilitation and Director of Fellowship Training in Sports Medicine, NewYork-Presbyterian

Hospital, Columbia and Cornell

5University of Pittsburgh School of Medicine

6Burke Rehabilitation Hospital, Albert Einstein College of Medicine, Montefiore Health System

7University of California Irvine School of Medicine

8University of Puerto Rico School of Medicine

American Journal of Physical Medicine & Rehabilitation Articles Ahead of Print DOI: 10.1097/PHM.0000000000001670

Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

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9JFK Johnson Rehabilitation Institute and Rutgers Robert Wood Johnson

Medical School/Hackensack Meridian School of Medicine

10McGovern Medical School at University of Texas Health Science Center, Shriners Hospital for

Children in Houston, and TIRR Memorial Hermann Hospital

11Montefiore Medical Center, Albert Einstein College of Medicine

12Executive Director, Association of Academic Physiatrists

J.K.S. and S.C contributed equally

Corresponding Author

Julie K. Silver, MD

Address: 300 1st Avenue, Charlestown, MA 02025

Email: [email protected]

Phone: 617-680-9504

Fax: 508-718-4035

Author Disclosures

Julie K. Silver, MD – None related to this work. As an academic physician, Dr. Silver has

published books and receives royalties from book publishers, and she gives professional talks

such as grand rounds and medical conference plenary lectures and receives honoraria from

conference organizers. She has participated in research funded by The Arnold P. Gold

Foundation (physician and patient care disparities), Binational Scientific Foundation (culinary

telemedicine research, and the Warshaw Institute and Massachusetts General Hospital


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Department of Medical Oncology (pancreatic cancer). Dr. Silver is an uncompensated founding

member of TIMES UP Healthcare.

Sara Cuccurullo, MD – None related to this work. As an academic physician, Dr. Cuccurullo has

published textbooks and receives royalties from publishers; which are donated to the JFK

Johnson Resident Education fund. She has participated in research funded by The Wallerstein

Foundation, The North Eastern Cerebrovascular Consortium and an unrestricted grant from

NuStep. Dr. Cuccurullo speaks at Medical Conferences, and all honoraria are donated to

education.

Anne Felicia Ambrose, MD – None related to this work. As a researcher, Dr. Ambrose has

received and is currently receiving funding from National Institute of Aging.

Glendaliz Bosques, MD – No related or unrelated disclosures to report.

Talya K. Fleming, MD – None related to this work. Dr. Fleming has participated in research

funded by The Wallerstein Foundation, The North Eastern Cerebrovascular Consortium, an

unrestricted grant from NuStep, and the Fred C. Rummel Foundation.

Walter R. Frontera, MD, PhD – Editor in Chief of the American Journal of Physical Medicine

and Rehabilitation. Unrelated to this work, Dr. Frontera reports speaker honoraria, book

royalties, and National Institutes of Health funding.


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Danielle Perret Karimi, MD – None related to this work. Unrelated to this work, Dr. Karimi has

participated in research funded by the Arnold P. Gold Foundation (humanism in medicine). She

has a financial investment as a shareholder in Graceland Hospice.

Mooyeon Oh-Park, MD – No disclosures related to this work. Unrelated, Dr. Oh-Park discloses

that she has grant funding from the David Ju Foundation for transition of care for stroke

rehabilitation.

Gwendolyn Sowa, MD, PhD – No disclosures related to this work. Unrelated Dr. Sowa reports

funding from National Institutes of Health, Patient-Centered Outcomes Research Institute, and

The Pittsburgh Foundation. Unrelated non-financial disclosure member of UPMC for You Board

of Directors.

Christopher Visco, MD – None related to this work. Unrelated Dr. Visco reports speaking at

medical conferences with honoraria. Consulting services to Mimedx for ultrasound and injection

topics.

Lyn Weiss, MD - None related to this work. As an academic physician, Dr. Weiss has published

books and receives royalties from book publishers, and she gives professional talks such as grand

rounds and medical conference lectures.

Tiffany Knowlton, JD, MBA – No related or unrelated disclosures to report.


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Article Disclosures

Funding Information – No funding was received for this work.

Previous Presentation – No previous presentation of this research, manuscript, or article occurred

in the public domain.


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Abstract

The Association of Academic Physiatrists (AAP) convened a Women’s Task Force in 2016,

under the leadership of then AAP President Gerard Francisco, MD, to evaluate data and metrics

pertaining to the representation and inclusion of women physiatrists in the society. An initial

published report focused on a retrospective analysis of data in categories such as leadership,

conference presentations, and recognition awards. The findings, which highlighted areas in

which the AAP had been successful in supporting gender equity as well as areas in which women

physiatrists were underrepresented, provided a base from which to strategically focus on closing

gaps in representation. The task force developed an action plan that was approved by the Board

of Trustees and included strategies aimed at closing gaps and collecting data to determine

corresponding effectiveness. Because most of the categories fell under the supervision of various

AAP committees, an appointee from each committee ("diversity steward") liaised with the

Women’s Task Force. The diversity stewards reviewed the plan with their respective committees

and collected data within their committee’s purview. This task force follow-up report documents

recent progress, consistent with the AAP Board of Trustees commitment to transparency and

gender equity.

Keywords

Physicians, women; leadership; societies; education, medical


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Introduction

Gender disparities for women in academic medicine are well documented,1-8

and there are

numerous studies that have focused on the specialty of Physical Medicine and Rehabilitation

(PM&R).9-14

Thus, in 2016, the Association of Academic Physiatrists (AAP), the sole

professional society focused on academic physiatry, organized a presidential task force to

identify priority areas, needs, existing resources, opportunities, barriers, and other issues related

to advancing women physicians in the field and achieving the goal of gender equity in physiatry.

The members included a group of 12 academic physiatrists with diversity in gender,

race/ethnicity, career stage, geographic region, institution, and subspecialty focus. The task force

also received support from AAP staff members. Meetings were held on a regular basis from

2016-2020 and, throughout, the task force followed a 6-step process that has been previously

described in the literature.14

The steps included: 1) examining data; 2) transparently reporting

results to stakeholders; 3) investigating causality; 4) implementing strategic interventions; 5)

tracking outcomes and adjusting strategies; and 6) publishing and disseminating results.

In 2018, the task force published an initial report that focused on a retrospective analysis of AAP

staff-supplied society data from 2008 to 2017 in relevant categories such as leadership positions

(ie, board membership, board presidents, committee membership, committee chairs, and resident

fellow physician chairs), conference presentations (ie, annual meeting session proposals, annual

meeting faculty, annual meeting plenary speakers) and recognition awards (ie, recognition award

nominations and recipients).9 The findings highlighted areas in which the AAP had been

successful in supporting gender equity as well as areas in which women physiatrists were

underrepresented. These data provided a base from which to strategically focus on closing gaps


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in representation where they existed. Thereafter, the task force developed an action plan,

approved by the AAP’s Board of Trustees on November 2, 2017, which included strategies

aimed at closing gender equity gaps and collecting data to determine effectiveness. The Board of

Trustees, in making a commitment to transparency and reporting to members and stakeholders,

requested the task force generate an approximately 3-year follow-up report including data

acquired after the original report was published.

Methods

In this approximate 3-year update to an original report analyzing society metrics for years 2008

through 2017, the focus again was the representation of women versus men physiatrists. Non-

physiatrists were generally excluded (unless noted). Like the initial report, this study did not

involve work with human subjects, did not require institutional review board approval. This

study conforms to all CONSORT guidelines and reports the required information accordingly

(see Supplemental Checklist, Supplemental Digital Content 1, http://links.lww.com/PHM/B193).

To facilitate the update of society metrics for years 2008 through 2019 or 2020 depending on the

category, the task force convened in person meetings annually at the AAP 2017 through 2020

conferences and participated in regularly scheduled conference calls. The task force members,

having agreed on a list of metrics in the original report,9 used the same categories to

prospectively collect an additional approximately 3 years of data for this follow-up report. The

aforementioned 6-step process was used,14

and the task force created a list of goals and

recommendations that was shared with key stakeholders. Categories examined are listed in Table

1.


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From the initial Women’s Task Force publication in 2018, key targeted areas were identified as

areas that could be improved upon, and an initial action plan formulated to address these

findings. Each of the key targeted areas was specific to an AAP committee that was responsible

for the oversight. For example, recognition awards fell under oversight of The Leadership

Development and Recognition Committee (LDRC). A Diversity Data Steward (DDS) was

chosen from each of the committees. The Women’s Task Force worked with the DDSs

collaboratively to develop and execute an action plan specific for their targeted area.

The DDSs were asked to educate their AAP committee members on the metrics and results and

investigate possible causality (eg, whether lack of nominations was one factor why women were

underrepresented in the recognition awards category). Each committee was challenged with the

development and implementation of a specific action plan that was to be directed at the gaps that

were identified in the data presented (eg, include more female faculty presenters at the annual

AAP meetings). The task force met with the DDSs at the national meeting annually and during

the year via phone conference for the duration of the data collection. Updated data were shared

with the DDSs. All members of the Leadership Development and Recognition Committee, a

committee that has considerable influence over some of the key metrics, also participated in

mandatory implicit bias training.

AAP staff provided the task force members with medical society data that was used in both this

and the original report. During each year for which subsets of membership data were available

(2013-2019), 0 to 20 (average [SD], 11 [6.7]) physiatrist members were reported as unknown

gender; accounting for 0 to 1.4% (average [SD], 0.9% [0.5%]) of all physiatrists. The members


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of unknown gender were not included in gender-related analyses and therefore the number of

members reported in gender-related analyses differs slightly from those reported for overall

physiatrist membership. In this report, the term “all physiatrists” refers to the sum of physiatrists

and physiatrists-in-training.

Results

To facilitate comparison, findings for each of the examined categories are presented in Table 1

alongside data from the original report.

Physiatrist Membership

Key Point: Compared to the original report, membership in the AAP increased by 11%, but the

proportion of women physiatrists remained stable at 41%, consistent with the representation of

women physicians in academic PM&R nationally.

Physiatrist membership in the AAP before and after the follow-up study period is summarized in

Tables 1 and 2 and Figure 1. Overall, the number of physiatrist members (Table 2) increased by

157 individuals (10.9%) between 2017 and 2019. The proportion of women physiatrists (Table

1) remained consistent at approximately 41%.

Proportional membership in the AAP was similar to the most recent physician gender data

reported by the Association of American Medical Colleges (AAMC). The AAMC reported that

the percentage of active women PM&R physicians in 2017 was 35.3% (n=3,284 of 9,316)15

and

the percentage of women physicians in academic PM&R departments in 2018 was 41.9% (n=487


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of 1162).16

Thus, the gender membership of the AAP is very similar to the percentages of men

and women physicians in academic PM&R.

Board of Trustees Membership

Key Point: Compared to the original report, there was an increase in the percentage of women

physiatrists overall and among the voting members of the AAP Board of Trustees, with women

physiatrists equitably represented when compared with their percentages among the general

membership.

There was an improvement in the representation of women members on the AAP Board of

Trustees and Voting Board of Trustees. Board members who were not physiatrists were excluded

from these data. From the original report, between 2008 and 2017, the percentage of women

among the physiatrist members of the Board of Trustees ranged from 18% to 38%. Follow-up

analysis revealed overall progress as demonstrated in Table 1 and Figure 2. Importantly, a key

marker of equitable inclusion is voting membership, and the representation of women voting

members doubled from 25% in 2017 to 50% in 2020.

Presidential Leadership

Key Point: Compared to the original report, there was a decrease in the percentage of women

physiatrist-years as president because the succession order was set, and men were slated for

president during the follow-up study period. However, between 2021 and 2025, 2 women are

slated to be president.


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The AAP has 2-year presidential terms, and from 2008 to 2020, a woman was president for 2

years (15.4%; a decrease from the original study at 20%) [Table 1]. However, at the time of the

original report, the presidential succession plan was already set for the follow-up study period

and, therefore, there was no opportunity to make changes either positive or negative. Notably,

between 2021 and 2025, 2 women will serve in successive terms as president.

Committee Membership

Key Point: Compared to the original report, there was progress in closing the gender gap

among committee members and chairs; women were equitably included as committee members

from 2017-2020 and as committee chairs from 2019-2020.

There were 7 committees within the AAP. These included: education, governance, leadership

development and recognition, membership, program, public policy, and research. Until 2017, the

representation of women physiatrists on committees lagged the overall percentage of women

physiatrists in the AAP. Notably, in 2017, there were 7 men and no women physiatrists serving

as committee chairs. From 2018-2020, women physiatrists became equitably represented as

committee members and chairs at approximately 45% [Table 1 and Figure 3A]. In 2018, because

1 woman was included as a committee chair, the proportion increased from 0% to 14%. In 2019

and 2020, there were 3 women and 4 men chairs, so women physiatrists were equitably

represented at 42.9% [Table 1 and Figure 3B].


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Resident Fellow Council Chair

Key Point: Compared to the original report, there was progress in closing the gap regarding the

representation of women physiatrists-in-training among chairs of the AAP’s Resident Fellow

Council.

The Resident Fellow Council leadership process begins with an application from a resident or

fellow, which is reviewed by the LDRC. If there are more than 3 applicants, they are ranked by

the LDRC, and the 3 highest-ranked residents/fellows are listed on a ballot. The Council chair is

then selected by vote of the attendees at the Resident Fellow Council meeting held during the

annual national conference. During the original study period (2008-2017), the proportion of

women in-training physiatrists among council chairs was 20%. The follow-up 2018-2020 study

period included 1 man and 2 women chairs (n=2 of 3; 66.7%). This increased the proportion of

women Resident Fellow Council chairs from 20% to 33.3% (n=4 of 12) over the entire study

period (2008-2020). For comparison, women comprised approximately 40% of AAP’s

physiatrists-in-training in 2019 [Table 1] and 39.6% of ACGME residents and fellows in

physical medicine and rehabilitation in 2017.17

Annual Meeting Session Proposals, Faculty & Plenary Speakers

Key Point: Compared to the original report, there was progress in maintaining the equitable

inclusion of women faculty in the sessions presented at the AAP annual meeting overall. Women

physiatrist plenary speakers were not included in the AAP’s 2018 or 2019 standalone annual

meetings. However, the 2020 combined AAP/ International Society of Physical and


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Rehabilitation Medicine (ISPRM) meeting included 60% (n=3 of 5) women physiatrist plenary

speakers.

There was an upward trend in women physiatrists presenting at the annual meeting prior to the

work of this task force, and the trend was further supported by members’ general awareness of

the task force’s efforts (eg, the original published report) and the diversity steward’s work with

the Program Committee and the Women’s Task Force. For example, in 2015, the first year

during which there was a call for session proposals, the annual meeting consisted of proposed

sessions as well as sessions developed internally by the program committee. Regarding session

submissions, 29% were submitted by women in 2015. Representation markedly improved the

following 2 years, 2016 and 2017, and women comprised 47% and 40%, respectively, of lead

faculty on submissions. The percentage of women physiatrists presenting at the annual meeting

increased from 21% in 2010 to 44% in 2017. In 2018 and 2019, slightly more than 40% of

submissions were led by women, and women physiatrists comprised approximately 44% of

presenters. In 2020, the AAP held a combined meeting with the ISPRM, and the number of

presenters approximately doubled with women comprising 39.8% (n=129 of 324) [Figure 4A].

In the original report, women physiatrists were represented at disproportionately low levels as

plenary speakers at AAP annual meetings. Because no women physiatrists were selected as

plenary speakers for the 2018 and 2019 meetings, this gap increased in this follow-up report. At

standalone AAP meetings during 2010-2019 among plenary speakers who were physiatrists, 3

(21.4%) were women and 11 (78.6%) were men. In 2020, at the combined AAP/ISPRM meeting,

women were included among physiatrist plenary speakers (n=3 of 5; 60.0%) for the first time


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since 2017 [Figure 4B]. The AAP and ISPRM worked together to select plenary speakers, and

there was a different format than the usual 3 plenary speakers allotted 1 hour each. At the

AAP/ISPMR joint meeting, 11 plenary speakers were allotted 30 minutes each. Notably, the

AAP attempts to find non-physiatrist experts on a broad range of topics for plenary speakers.

Recognition Award Recipients

Key Point: Compared to the original report, there was progress from 23.6% to 32.9% of the

AAP recognition awards being received by women.

Between 2008 and 2017 (original report), a total of 55 recognition awards were given to

physicians in 8 categories with 13 (23.6%) women recipients. In the follow-up report (2008-

2020), there were 82 awards and the proportion of women recipients increased to 32.9% (n=27).

During the 4 years leading up to our original report (2014-2017), there was 1 woman among 22

physician recipients (4.5%) across all categories. In contrast, during the follow-up study period

(2018-2020), 14 (53.8%) women received awards. Although progress has been made, women

physicians were underrepresented in all award categories except the 2 early career awards.

Award categories in which women physicians continue to be underrepresented were: Carolyn

Braddom Ritzler Research (0%), American Journal of Physician Medicine & Rehabilitation

(AJPM&R) Outstanding Reviewer (0%), Distinguished Member (14%), AJPM&R Excellence in

Research Writing (33%), McLean Outstanding Resident/Fellow (22%), Outstanding Service

(25%), Distinguished Academician (31%), and Innovation & Impact in Education (33%) [Figure

5A].


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Corresponding nomination data were available for years 2014 to 2020. In the original report of

award and nomination data from 2014 to 2017, comparison of the likelihood of success (%

awardees / nominees) revealed that men (46.7%) were far more likely to win an award than

women (5.6%). Moreover, a lack of nominations was identified as 1 causal factor. For example,

no women were nominated for the Distinguished Academician and Outstanding Service Awards

during the original study period. To determine the impact of recent efforts to increase the

nomination of women since our original report, success analysis was performed on equal subsets

of years during which nomination data were available (ie, 2015-2017 versus 2018-2020). During

2015-2017, even when women were nominated, their likelihood of success in winning awards

was zero, as evidenced by the absence of women awardees in the Carolyn Braddom Ritzler

Research, Early Career Young Academician, and McLean Outstanding Resident/Fellow

categories [Figure 5B]. Concerted effort during years 2018-2020 resulted in an ~10% increase in

the nomination of women for awards [Figure 5C]. A woman’s likelihood of success in winning

any award during these years increased to 35.0% and was higher than that of men (21.1%).

Specifically, a woman’s likelihood of success increased from 15.4%-50.0% for all awards except

the Carolyn Braddom Ritzler Research award which remained at 0%. During years 2018-2020,

men had greater likelihood of success than women in winning the Outstanding Service, Carolyn

Braddom Ritzler Research, and Distinguished Academician Awards. In contrast, women had

greater likelihood of success than men in winning the Innovation & Impact in Education,

McLean Outstanding Resident/Fellow, and Early Career Young Academician Awards.


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Program for Academic Leadership (PAL) and Rehabilitation Medicine Scientist Training

Program (RMSTP)

Key Point (PAL): Compared to the original report, inclusion of women among PAL candidates

decreased overall, although equity was maintained with both the general and early career

member groups because women were previously overrepresented.

PAL is currently a 3-year mentored program to enhance leadership skills and has run annually in

its current form since 2007. Early career members of the AAP who are between 2 and 8 years

post training and are at or below the associate professor level are eligible to apply. Since 2007,

PAL accepted 54 (59%) men and 37 (41%) women. Between 2013 and 2017, the percentage of

women among PAL candidates ranged from 28% to 60% [Figure 6A]. There was a decline in the

percentage of women in PAL in 2015 (33%) and 2016 (29%). Although this trend began

reversing in 2017 (50%), it declined again thereafter, albeit not to the same degree (range, 38%

to 40%).

Compared with the original report, the representation of women among PAL graduates since

1999 remained consistent, with women accounting for 35% (34 of 98) of PAL graduates through

2016 and 34% (37 of 108) of PAL graduates through 2019. Although graduates were tallied

according to their highest combined (academic and administrative) rank in the original report, for

this follow-up report, graduates were tallied separately according to their highest academic and

highest administrative ranks [Figure 6B]. This change reflects that promotion along academic

and administrative ladders may be independent, but inhibits direct comparison with the original

data. Academically, men and women PAL graduates were equally represented among assistant


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professors (men, 48%; women, 52%). However, women PAL graduates were represented at

progressively lower levels than men as rank advanced to associate professor (men, 66%; women,

34%; difference, 32%) and full professor (men, 87%; women, 13%; difference, 74%).

Administrative rank analysis revealed a similar pattern, with women PAL graduates represented

at progressively lower levels than men as rank advanced from director (men, 59%; women, 41%;

difference, 18%), to vice-chair (men, 75%; women, 25%; difference, 50%), and department chair

or chief (men, 86%; women, 14%; difference, 72%).

The RMSTP accepts pre-applicants on a competitive basis. Successful completion of the

program includes participation in training workshops and mentorship. From 2006-2016, the

RMSTP included 53 men pre-applicants (46%) and 62 women pre-applicants (54%). As

described in the original report, between 2013 and 2016 (the years for which comparable

membership data were available), the percentage of women pre-applicants accepted into the

RMSTP exceeded the percentage of women physiatrist AAP members and exceeded or matched

the percentage of women members in the early career or in-training AAP membership categories.

In this follow-up report (2017-2019), the percentages of women RMSTP pre-applicants (range,

44%-55%) continued to meet or exceed the proportion of women physiatrists in general, early

career, and in-training AAP membership categories [Figure 6C]. Comparison of data from 2019

and 2020 revealed a considerable decrease in both the numbers of RMSTP pre-applicants (n=20

vs n=8, respectively) and in the percentage of women among RMSTP pre-applicants (55% vs

25%, respectively).


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In the original report including data through 2016, women accounted for 41% (11 of 27) of

RMSTP graduates. In this follow-up report, women accounted for 37% (14 of 38) of RMSTP

graduates through 2019. Although graduates were tallied according to their highest combined

(academic and administrative) rank at the time of the original report, for this follow-up report,

graduates were tallied separately according to their current highest academic and highest

administrative ranks [Figure 6D]. This change reflects that promotion along academic and

administrative ladders may be independent, but prevents direct comparison with the original

data. Academically, the representation of women was lower than men at the ranks of assistant

professor (difference, 18%) and associate professor (difference, 38%). However, equal numbers

of men and women ranked as full professors (n=3 each of 6; 50%). Administrative rank analysis

revealed similar results, with the representation of women lower than that of men at the ranks of

director (difference, 28%) and vice-chair (difference, 20%). However, there were more women

than men ranked at the level of department chair or chief (n=2 versus 1, respectively) in 2019.

AJPM&R Editors

Key Point: Compared to the original report, there was progress in closing the gender gap for

all women editors and US women physiatrist editors, with the percentages of women increasing

from 24% to 33% and 28% to 38%, respectively.

The AJPM&R is the official journal of the AAP. The gender distribution of AJPM&R editorial

board members from 2005 to 2020 was analyzed, including editors-in-chief, all associate editors,

and all editorial board members. Excluded were an emeritus editor, executive editors, managing

editors, and special section editors, because historical data on these categories were not available.


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Most of the editors were physiatrists from the United States (US) although there were also US

non-physician (PhD), international physiatrist, and international non-physiatrist editors. In the

original report, both the number of editorial positions as well as the representation of women

editors increased during the 13-year study period (2005-2017). At the end of the original study

period (2017), 24% of the national and international editors were women (n=12 of 51). At the

end of the follow-up study period (2019), this percentage increased to 37.5% (n=18 of 48).

Similarly, 28% of the US physiatrist editors were women in 2017, increasing to 38% (n=18 of

47) in 2020 [Figure 7].

Discussion

Professional societies are critically important to the advancement and representation of academic

faculty. Overall, this follow-up report demonstrates progress in the equitable representation of

women physicians in the AAP when compared with the original report. Stability in the equitable

inclusion of women between the original report and this follow-up report was found in the

General Membership, Committee Membership, Annual Meeting Session Proposal, Annual

Meeting Faculty, PAL candidate, and RMSTP pre-applicant (through 2019) categories.

Improvement in the representation of women between the original report and this follow-up

report was found in the Board of Trustee Membership, Voting Board of Trustee Membership,

Committee Chair, Resident Fellow Council Chair, aggregate Recognition Award Recipient and

Nominee, and AJPM&R Editor categories. However, there were several categories in which

women remain represented at much lower levels than their representation among the membership

and in the field: Presidential Leadership (which is prospectively set to improve from the years

2021 through 2025), Resident Fellow Council Chair, Plenary Speaker at stand-alone (non-


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ISPMR-combined) Annual Meetings, 7 of 9 individual Recognition Award Recipient, PAL

Graduate in higher rank academic and administrative position, RMSTP Pre-applicants (in 2020)

and RMSTP Graduate in intermediate rank academic and administrative position categories.

Regarding future efforts, the AAP has conveyed an ongoing commitment to diversity, equity,

and inclusion for women physiatrists. The AAP is also focusing its efforts on people across the

gender spectrum and who identify with racial/ethnic groups that are underrepresented in

medicine. A commitment to supporting physiatrists with disabilities also remains strong. In

alignment with these efforts, the Membership Committee was renamed the Diversity and

Community Engagement Committee, given a revised focus, and allocated a non-voting seat on

the board. The AAP Board Action is a positive outcome related to the diversity work initiated by

the Women’s Task Force started in 2016. It speaks to the AAP’s commitment to supporting the

diversity of the AAP Membership.

Limitations

Although attempts were made to clarify any discrepancies, the task force members were not able

to account for errors in reporting of the data. Employment factors such as full-time versus part-

time and practice setting, each of which may impact an individual physician’s career growth and

participation in the AAP, were not evaluated. Notably, data sets were often small. Additionally,

data was generally not available to explain causality.


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Conclusion

More than 40% of the AAP members are women physicians. Retaining and supporting this

population is critically linked to achieving the mission of the organization: creating the future of

academic physiatry through mentorship, leadership, and discovery. This report demonstrates that

in a relatively short period of time, 2 to 4 years, important gains were made in closing gender

gaps at the AAP by using a data-driven approach with an action plan that included goal-setting,

diversity stewards, and implicit bias training. The AAP’s approach may serve as a model for

other professional organizations addressing workforce equity issues.


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Acknowledgements

Acknowledgement and thanks to the AAP Diversity Stewards for their support: Adam Stein,

MD, Thiru Annaswamy, MD, Michael Saulino, MD, Miguel Escalon, MD, William Bockenek,

MD, Gary Clark, MD, and John Whyte, MD, PhD. Acknowledgement and thanks to Julie A.

Poorman, PhD for her assistance with manuscript preparation.


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References

1. Nocco SE, Larson AR. Promotion of women physicians in academic medicine [published

online ahead of print May 14, 2020]. J Womens Health. doi:10.1089/jwh.2019.7992

2. Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in

academic medicine: Retention, rank, and leadership comparisons from the National

Faculty Survey. Acad Med. 2018;93:1694-1699.

3. Helitzer DL, Newbill SL, Cardinali G, Morahan PS, Chang S, Magrane D. Changing the

culture of academic medicine: Critical mass or critical actors?. J Womens Health.

2017;26:540-548.

4. Silver JK, Bean AC, Slocum C, et al. Physician workforce disparities and patient care: A

narrative review. Health Equity. 2019;3:360-377.

5. Jagsi R, Means O, Lautenberger D, et al. Women's representation among members and

leaders of national medical specialty societies. Acad Med. 2020;95:1043-1049.

6. Silver JK, Ghalib R, Poorman JA, et al. Analysis of gender equity in leadership of

physician-focused medical specialty societies, 2008-2017. JAMA Intern Med.

2019;179:433-435.

7. Larson AR, Cawcutt KA, Englander MJ, et al. Representation of women in authorship

and dissemination of analyses of physician compensation. JAMA Netw Open.

2020;3:e201330.

8. Larson AR, Sharkey KM, Poorman JA, et al. Representation of women among invited

speakers at medical specialty conferences. J Womens Health. 2020;29:550-560.


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9. Silver JK, Cuccurullo SJ, Ambrose AF, et al. Association of Academic Physiatrists

Women's Task Force report. Am J Phys Med Rehabil. 2018;97:680-690.

10. Houtrow AJ, Pruitt DW, Zigler CK. Gender-based salary inequities among pediatric

rehabilitation medicine physicians in the United States. Arch Phys Med Rehabil.

2020;101:741-749.

11. Hwang J, Byrd K, Nguyen MO, Liu M, Huang Y, Bae GH. Gender and ethnic diversity

in academic PM&R faculty: National trend analysis of two decades. Am J Phys Med

Rehabil. 2017;96:593-595.

12. Silver JK, Bhatnagar S, Blauwet CA, et al. Female physicians are underrepresented in

recognition awards from the American Academy of Physical Medicine and

Rehabilitation. PM R. 2017;9:976-984.

13. Silver JK, Blauwet CA, Bhatnagar S, et al. Women physicians are underrepresented in

recognition awards from the Association of Academic Physiatrists. Am J Phys Med

Rehabil. 2018;97:34-40.

14. Silver JK, Slocum CS, Bank AM, et al. Where are the women? The underrepresentation

of women physicians among recognition award recipients from medical specialty

societies. PM R. 2017;9:804-815.

15. Association of American Medical Colleges. 2018 Physician specialty data report: Table

1.3. Number and percentage of active physicians by sex and specialty, 2017. Association

of American Medical Colleges. Available at: https://www.aamc.org/data-

reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017. Accessed

November 17, 2020.


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16. Association of American Medical Colleges. AAMC faculty roster: Table 14. U.S.

medical school faculty by sex, degree, and department, 2018. Association of American

Medical Colleges. Available at: https://www.aamc.org/system/files/2020-

01/2018Table14.pdf. Accessed November 17, 2020.

17. Association of American Medical Colleges. Table 2.2: Number and percentage of

ACGME residents and fellows by sex and specialty, 2017. Association of American

Medical Colleges. Available at: https://www.aamc.org/data-

reports/workforce/interactive-data/acgme-residents-and-fellows-sex-and-specialty-2017.

Accessed November 17, 2020.


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Figure Legends

Figure 1. Trends in AAP member gender, 2013-2019.

Figure 2. Distribution of women physiatrists among Board of Trustees, Voting Board of

Trustees, and general AAP physiatrist members, 2013-2020

Figure 3. Physiatrist committee members (A) and chairs (B) by gender, 2014-2020

Figure 4. Gender distribution among annual meeting physiatrist faculty (A) and physiatrist

plenary speakers (B).

Figure 4 Legend. In 2020 the number of faculty and plenary speakers increase dramatically

because the AAP and the ISPRM hosted a combined meeting.

Figure 5. Gender distribution among physician recognition award recipients 2008-2020 (A),

physician recognition award nominees and awardees 2015-2017 (B), and physician recognition

award nominees and awardees 2018-2020 (C)

Figure 5 Legend. For writing awards all eligible authors are considered.

Figure 6. Representation of women among training program participants and graduates: PAL

candidates (A), PAL graduates (B), RMSTP pre-applicants (C), and RMSTP graduates (D)

Figure 7. Gender distribution among US physiatrist editors of the AJPM&R


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Figure 1


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Figure 2


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Figure 3A

Figure 3B


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Figure 4A

Figure 4B


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Figure 5A

Figure 5B

Figure 5C


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Figure 6A

Figure 6B


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Figure 6C

Figure 6D


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Figure 7


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Tables

Table 1. Summary of changes in AAP gender equity-related metrics between original and

follow-up Association of Academic Physiatrists Women’s Task Force reports

Table 1 Legend. Because the original and follow-up task force reports were written mid-year, not

all data for each category were available for years 2017 and 2020. For data related to the original

report, data are labeled with the applicable year (2016 or 2017). For data related to the follow-up

report, 2020 data that was unavailable at the time of writing is marked as not available (NA). For

each category, the equity indicator represents the difference between the percentage of women in

the respective data category and the percentage of women among AAP physiatrist members.

Because complete membership data were not available for 2020 at the time of writing, 2020

equity indicators are marked NA. Negative numbers reflect less than equitable representation of

women in a category (ie, percentages of women in the category that are lower than percentages

of women among physiatrist members), with the value of the equity indicator reflecting the

magnitude of the underrepresentation of women in the category. Positive numbers reflect better

than equitable representation of women (ie, percentages of women in the category that are higher

than percentages of women among physiatrist members).


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Category Original report

outcomes

2019 Follow-up

report outcomes

(Change from

original report, %)

2020 Follow-up

report outcomes

(Change from

original report,

%)

General membership

Women physiatrists 2017: 40.8% 40.7% (-0.1%) NA

Presidenta

Presidential years since

2008

2017: 10 12

13

Women presidential years

since 2008

2017: 20.0% 16.7% (-3.3%)

15.4% (-4.6%)

Equity indicator 2017: -20.8 -24.0% (-3.8%) NA

Board of Trustees

Board physiatrist members 2017: 16 17 (+6.25%)

17 (+6.25%)

Women physiatrists 2017: 37.5% 47.1% (+9.6%)

47.1% (+9.6%)

Equity indicator 2017: -3.3% +6.4% (+9.7%) NA

Voting Board of Trustees

Voting physiatrist members 2017: 12 12 (No change)

12 (No change)


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Women physiatrists 2017: 25.0% 41.7% (+16.7%) 50% (+25.0%)

Equity indicator 2017: -15.8%

+1.0% (+16.8%) NA

Committee membership

Committee physiatrist

members

2017: 96 100 (+4.2%)

103 9 (+7.3%)

Women physiatrists 2017: 44.8% 44.0% (-0.8%)

45.6% (+0.8%)

Equity indicator 2017: +4.0% 2019: +3.3% (-0.7%) NA

Committee chairs

Committees 2017: 7 7 (No change)

7 (No change)

Women physiatrists 2017: 0% 2.9% (+42.9%)

42.9% (+42.9%)

Equity indicator

2017: -40.8% +2.2% (+43%) NA

Resident Fellow Council chair

Chairs since 2008 2017: 10 12 (+20%)

13 (+30%)

Women chairs since 2008 2017: 20% 25% (+5%)

31% (+11%)

Equity indicator 2017: -20.8% -15.7% (+5.1%) NA

Annual meeting session proposals

Session proposals 2017: 82 171 (+108.5%) 343 (+318.3%)


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Women lead faculty 2017: 40.2% 40.4% (+0.2%) 39.1% (-1.1%)


Annual Meeting presenters

Physiatrist presenters 2017: 100 159 (+59.0%) 324 (+224.0%)

Women physiatrist

presenters

2017: 44.0% 43.4% (-0.6%) 39.8% (-4.2%)

Equity indicator 2017: +3.2% +2.7% (-0.5%) NA

Annual meeting plenary speakers

Physiatrist faculty 2017: 2 1 (-50%) 5 (+150%)

Women physiatrist faculty 2017: 50% 0% (-50%) 60% (+10%)

Equity indicator 2017: +9.2% -40.7% (-49.9%) NA

Recognition award recipients since

2008

Physiatrist recipients 2017: 55 72 (+30.9%) 82 (+49.1%)

Women physiatrist

recipients

2017: 23.6% 31.9% (+8.3%) 32.9% (+9.3%)


Recognition award nominations

since 2014

Nominees 2017: 63 125 (+98.4%) 160 (+154.0%)

Women nominees 2017: 28.6% 36.8% (+8.2%) 36.3% (+7.7%)



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Difference between

women’s and men’s

likelihood of success in

receiving an award

2017: -41.1% -11.5% (+29.6%) -6.5% (+34.6%)

Program for Academic Leadership

candidates

Physiatrist candidates / year 2017: 6 10 (+66.7%) 10 (+66.7%)

Women physiatrist

candidates

2017: 50.0% 40.0% (-10.0%) 40.0% (-10.0%)

Equity indicator 2017: +9.2 -0.7% (-9.9%) NA

Program for Academic Leadership

graduates since 1999

Graduates 2016: 98 108 (+10%) NA

Women graduates 2016: 35% 34% (-1%) NA

Equity indicator 2016: -5.8% -6.7% (-0.9%) NA

Rehabilitation Medicine Scientist

Training Program pre-applicants

Physiatrist pre-applicants /

year

2017: 9 20 (+122.2%) 8 (-11.1%)

Women physiatrist pre-

applicants

2017: 44.4% 55.0% (+10.6%) 25.0% (-19.4%)

Equity indicator 2017: +3.6% +14.3 (+10.7%) NA

Rehabilitation Medicine Scientist

Training Program Graduates since

2006

Graduates 2016: 27 38 (+41%) NA

Women graduates 2016: 41% 37% (-4%) NA


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Equity indicator 2016: +0.2% -3.7% (-3.9%) NA

AJPM&R Editors

US physiatrist editors 2017: 39 48 (+23.1%) 47 (+20.5%)

Women physiatrist editors 2017: 28.2% 37.5% (+9.3%) 37.5% (+9.3%)

Equity indicator 2017: -12.6% 2019: -3.2% (+9.4%) NA

aPresidential leadership was predetermined for the follow-up study period. In contrast to other

study categories, there was no opportunity to make changes either positive or negative to equity

in the representation of women.


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Table 2. Physiatrist Members in the AAP, 2017-2019

Category 2017, No. 2018, No. 2019, No.

Change 2017

to 2019, %

General membership

Physiatrists – All 1438 1464 1595 10.9

Physiatrists – In training 663 672 814 22.8

Physiatrists – Completed training 768 789 781 1.7

Women physiatrist membership



Physiatrists – Completed training 297 303 321 8.1

Men physiatrist membership



Physiatrists – Completed training 465 484 460 -1.1

Women physiatrist proportional

membership

Physiatrists – All 40.8% 40.5% 40.7% -0.1

Physiatrists – In training 43.0% 42.8% 40.3% -2.7

Physiatrists – Completed training 39.0% 38.5% 41.1% 2.1


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Documents

Association of Academic Physiatrists Women’s Task Force