To the Editor
In the December 2007 issue of Academic Emergency Medicine, Dr. Li and colleagues1 endeavored to provide the emergency medicine (EM) counterpart to the article by Jagsi et al.2 in the New England Journal of Medicine titled “The ‘gender gap’ in authorship of academic medical literature--a 35 year perspective.”1,2 Li et al. should be congratulated for their enormous undertaking—the review of more than 2,000 publications in four EM journals. Unfortunately, the methodology in this investigation did not mirror that of Jagsi et al., and because of this, the selection and classification criteria are somewhat flawed, leading to questionable results.
Unlike Jagsi et al., who included only physician authors in their review, this investigation included all female authors, irrespective of degree. This is problematic on two fronts. First, in some publications, particularly with earlier periodicals, last authors frequently did not have medical degrees. Rather, the last author was a medical student, nurse, emergency medical technician, or other nonphysician.3 It is difficult to conclude that these last authors consistently served as senior authors for their respective articles. Second, Li et al. juxtapose their data for female authorship to the increasing female physician presence in EM.2 Since their investigation included all female authors, not just female physician authors, one cannot conclude with absolute certainty that female EM faculty are currently publishing at higher rates. First and last authors could again have been represented by nonphysician health care providers as noted above or by PhDs, statisticians, or other female public health professionals with advanced degrees. Finally, female authorship was counted twice (both first and last) in publications with only one author. This deviation from Jagsi et al.’s methodology leads to a form of “double-dipping” in female authorship, further placing the results and conclusions into question.