Gender Distribution in Pediatric Hospital Medicine Leadership

This study was Institutional Review Board–approved as non–human subjects research through University of Chicago, Chicago, Illinois. From January to March 2020, the authors performed web-based searches for PHM division directors or program leaders in the United States. Because there is no single database of PHM programs in the United States, we used the AAMC list of Liaison Committee on Medical Education (LCME)–accredited US medical schools; medical schools in Puerto Rico were not included, nor were pending and provisional institutions. If an institution had multiple practice sites for its students, the primary site for third-year medical student clerkship rotations was included. If a medical school had multiple branches, each with its own primary inpatient pediatrics site, these sites were included. If there was no PHM division director, a program leader (lead hospitalist) was substituted and counted as long as the role was formally designated. This leadership role is herein referred to under the umbrella term of “division director.”

We searched medical school web pages, affiliated hospital web pages, and Google. All program leadership information (divisional and fellowship, if present) was confirmed through direct communication with the program, most commonly with division directors, and included name, gender, title, and presence of associate/assistant leader, gender, and title. Associate division directors were only included if it was a formal leadership position. Associate directors of research, quality, etc, were not included due to the limited number of formal positions noted on further review. Of note, the terms “associate” and “assistant” are referring to leadership positions and not academic ranks.

Fellowship leadership was included if affiliated with a US medical school in the primary list. Medical schools with multiple PHM fellowships were included as separate observations. The leadership was confirmed using the methods described above and cross-referenced through the PHM Fellowship Program website. PHM fellowship programs starting in 2020 were included if leadership was determined.

All leadership positions were verified by two authors, and all authors reviewed the master list to identify errors.

To determine the overall gender breakdown in the specialty, we used three estimates: 2019 American Board of Pediatrics (ABP) PHM Board Certification Exam applicants, the 2019 American Academy of Pediatrics Section on Hospital Medicine membership, and a random sample of all PHM faculty in 25% of the programs included in this study.⁴

Descriptive statistics using 95% confidence intervals for proportions were used. Differences between proportions were evaluated using a two-proportion z test with the null hypothesis that the two proportions are the same and significance set at P < .05. 

Of the 150 AAMC LCME–accredited medical school departments of pediatrics evaluated, a total of 142 programs were included; eight programs were excluded due to not providing inpatient pediatric services.

Division Leadership

The proportion of women PHM division directors was 55% (95% CI, 47%-63%) in this sample of 146 leaders from 142 programs (4 programs had coleaders). In the 113 programs with standalone PHM divisions or sections, the proportion of women division directors was 56% (95% CI, 47%-64%). In the 29 hospitalist groups that were not standalone (ie, embedded in another division), the proportion of women leaders was similar at 52% (95% CI, 34%-69%). In 24 programs with 27 formally designated associate directors (1 program had 3 associate directors and 1 program had 2), 81% of associate directors were women (95% CI, 63%-92%).