a b s t r a c t

Background: Gender gaps have been described regarding the chairpersons in academic emergency departments, the composition of editorial boards and publications in emergency medicine. The objective of this study was to determine the gender distribution of chairpersons and board members of emergency medicine societies world- wide.

Materials and methods: In this cross-sectional analysis, websites of national emergency medicine societies world- wide were screened for the composition of executive boards and the respective chairpersons. The gender of the board members and chairpersons was obtained either by the profile on the respective web site and/or by internet search and gender identification software. Descriptive statistics were performed and results for national societies were stratified by continent.

Results: A total of 61 boards of national emergency medicine societies were analyzed. Detailed information on the board composition was available for 50 societies, of which 27 were from Europe, 10 from Asia, five from Africa, four from North America, three from South America and one from Australasia. A total of 603 persons were in- cluded in the analysis. 45 (82%) of the listed societies’ presidents were male, while 10 (18%) were female. 385 (70%) of the non-president board members were male. The highest proportion of female board members was seen in Australia/New Zealand with five out of eight persons (62%) followed by South America with 13 out of 29 (45%).

Conclusions: A marked gender disparity was found for emergency medicine societies worldwide in terms of chair functions as well as board composition. Wide regional differences were found between world regions.

(C) 2021

1. Introduction

The importance of gender equality and the continued presence of gender disparity is increasingly under scrutiny in various industries. Companies in the top 25% of gender equality were found to perform bet- ter financially (1). During the last years, diversity and gender equality are also getting more attention in the Healthcare sector. For emergency medicine, only recently a relevant sex disparity among emergency med- ical journals’ editors was found (2). A gender gap was also detected in an analysis of publications in emergency medicine literature (3). In a study from 2006, Cheng and coworkers described a marked gender dis- parity among chair holders in academic emergency medicine depart- ments (4). The authors also found that departments chaired by women had a significantly higher proportion of female faculty members

(4). Moreover, it was described that in emergency medicine, female

* Corresponding author at: Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500 Solothurn, Switzerland.

E-mail address: [email protected] (G. Lindner).

physicians not only held fewer chairs but also less administrative posi- tions and had a significantly lower salary even after adjusting for race, region, rank, years of work experience, clinical hours, administrative roles, board certification and Fellowship training (5). The gender gap in salary was shown to persist over the years in later studies on the issue (6). However, gender diversity in national emergency medicine societies has not been investigated so far to the best of our knowledge. National medical societies fulfill important tasks such as representing the respective Medical specialty in the public, promoting and coordinating education and research as well as issues in profes- sional policies of the specialty. Sex diversity in chair positions and board composition of national medical societies should represent the proportion of female to male physicians of medical specialties in the re-

spective country.

In the present analysis, we aimed to determine whether a gender gap exists in the compositions of emergency medicine societies with a focus on members of the European Society of Emergency Medicine and internationally with a distinction between president/chair positions and board members.

https://doi.org/10.1016/j.ajem.2021.04.042

0735-6757/(C) 2021

1. Materials and methods

A cross sectional analysis was performed in order to assess gender distribution of board members of national emergency medicine socie- ties with a focus on national societies being part of the European Society of Emergency Medicine (EUSEM), as well as worldwide. The informa- tion concerning European emergency medicine societies was obtained from the EUSEM homepage: https://www.eusem.org/membership/ national-society-membership, accessed January 9th and 10th 2021.

The need for review by the institutional review board was waived.

A list of the national emergency medicine societies being members of the EUSEM by December 31st 2020 was prepared. Non-European na- tional emergency medicine societies were searched and identified by using “Google” Search Engine. “Google” Search Engine was used to iden- tify the respective national emergency medicine society and its editorial board. “Emergency medicine” was used as a search term in combination with either “society”, “academy” or “college” together with the respec- tive name of the country.

Identification of board members was based on the online website information.

The respective board members were categorized in either “presi- dent/chair” or “board member”. Specific functions within the board (e.g. treasurer or secretary) were classified as “board member”. Former or honorary presidents were not considered in the analysis. Categoriza- tion into male or female was performed on basis of name with help of a gender identifier (www.genderchecker.com) as well as salutation and pictures on the respective national society homepages.

All data were gathered by the same persons (GL, AR, SR). All national emergency medicine societies’ homepages were accessed on January 09th and 10th 2021.

1. Results

A total of 61 boards of international emergency medicine societies from 60 countries worldwide were analyzed: 35 (57%) from Europe,

10 (16%) from Asia, 6 (10%) from Africa, five (8%) from South America, four (7%) from North America and one (2%) from Australia/ New Zealand. Data on board compositions were available for 27 socie- ties in Europe (six without homepage, two without information on board composition), 10 in Asia (one society only displayed information on the president), five in Africa (one society without information on board composition), four in North America, three in South America (two societies did not show board composition) and one in Australia/ New Zealand. In total, detailed information on board composition was available for 50 national emergency medicine societies and thus, 603 board members from 50 national societies were analyzed.

Fifty-five of the 603 board members were presidents or chairs of the respective boards, five boards had two presidents, respectively. Forty- five (82%) of the listed societies’ presidents were men, while 10 (18%) were women. Of the 10 female presidents listed, five were co- presidents with one additional male president, while 5 were listed as single presidents. The highest proportion of female board presidents was found in Australia/New Zealand with one in two (50%), followed by North America with three in seven (43%), Europe with five in 28 (18%) and Asia with one in 10 (10%). No female president was found in African and South American emergency medicine societies. In the chi-square test, there was no significant difference in gender distribu- tion between groups for presidents of the boards (p = 0.97).

Concerning the remaining 548 non-president board members, 385 (70%) were men. The highest proportion of female board members was seen in Australia/New Zealand with five out of eight persons (62%) followed by South America with 13 of 29 (45%), Africa with 14

of 33 (44%), Europe with 102 of 287 (36%), North America with 14 of

47 (30%) and Asia with 15 of 144 (10%). Table 1 gives a detailed over- view on the board compositions for the respective countries. Comparing different Geographical areas, no significant difference was found in

gender proportion for board members of the national societies. Fig. 1 de- picts the gender distribution within board members and presidents of the national emergency medicine societies.

1. Discussion

In this first investigation on gender distribution in the board composition of emergency medicine national societies, women were underrepresented in most national emergency medicine societies worldwide. The gender gap was even more apparent in the chair func- tion: Of all analyzed national societies in South America or Africa, no sin- gle society had a woman in the president position and only one out of 10 societies in Asia was presided by a woman. In Europe, 23 out of 28 chair positions were held by men. Interestingly, in North America and Aus- tralasia chair functions were quite balanced between men and women. The variety in the constitution of the boards was also huge: in Asia, 129 out of 144 board positions (90%) were held by men, whereas only 38% in Australasia. Non-president board composition appeared balanced in Africa and South America.

Why are these findings important? Gender and racial diversity are increasingly recognized worldwide. Not only are they considered mat- ters of equality and fairness but are known to affect the profit of compa- nies (1). In academic medicine, it was shown that women are underrepresented in editorial boards of scientific journals although im- provements have been achieved in some areas during the last years (7). By the example of a journal in Europe, it was shown that women were less often considered as peer-reviewers, although the quality of their re- views was considered to be higher, and less likely to be invited for edi- torials (8). Furthermore, research results submitted by female authors had longer review periods and were rejected more quickly (9). At least the final editor’s decision showed no difference comparing female and male authors (9).

The gender gap in the board composition of emergency medicine so- cieties as outlined in the current analysis is less studied but seems sim- ilarly explosive: Medical societies fulfill a wide spectrum of highly important tasks ranging from representation in the public to coordina- tion of education and research as well as conference organization and hosting. Moreover, medical societies should be a reflection of their basis, namely the physicians they represent: In member states of the Or- ganization for Economic Co-operation and Development (OECD) the proportion of female physicians has been rising continuously during the last 20 years (10). For example, the proportion of female physicians has risen from 25% in 2000 to 36% in 2018 in the United States compared to the United Kingdrom where it developed from 36% to 49% (10). For 25 member states of the OECD we were able to evaluate information on emergency medicine societies’ board constitutions: only in 6 (24%) of them women were represented in the national emergency medicine boards in a proportion of +/- 10% of the underlying share of female physicians in the respective country (Australia/New Zealand, Czech Republic, Greece, Ireland, Norway and Canada).

These data underline that closing the gender gap is a central and ur- gent issue to be addressed in the future. There already are emergency medicine societies acting as an example for gender equality as for exam- ple in Australasia.

The present study has several limitations: Although more than 60 national societies for emergency medicine were analyzed and detailed data available on as many as 50 of them, many others did not have homepages or otherwise accessible information on the composition of their boards. Moreover, we do not have information on the gender dis- tribution of emergency physicians in the respective countries in order to find out whether board assembly is representative of the country or not. Concerning classification of board members into the respective sex cat- egories, we tried to ensure correctness by intense research using socie- ties’ web sites, available photos as well as gender identifier software. Since the analyses of the present study are based on data published on the web sites of the respective emergency medicine societies, the true

Table 1

Board composition of the respective national emergency medicine societies

National Emergency Medicine Society	Country	President	No. (%) of female board members	Commentary
Europe		female: 5/28 (18%)	102/287 (36%)
Albanian Society of Emergency Medicine Austrian Assoc. Emergency Medicine	Albania Austria	– male	– 1/9 (11%)	No homepage
Belgian Society of Emergency and Disaster Medicine	Belgium	male	1/9 (11%)
Bulgarian Emergency Medical Services Association	Bulgaria	female	3/6 (50%)
Croation Society of Emergency Medicine	Croatia	male	11/12 (92%)
Czech Society for Emergency and Disaster Medicine	Czech Republic	male	4/8 (50%)
Danish Society of Emergency Medicine	Denmark	male	3/8 (38%)
Estonian Society of Emergency Physicians	Estonia	male	3/8 (38%)	Current as of 2017
Finnish Society for Emergency Medicine	Finland	male	7/13 (54%)
French Society for Emergency Medicine	France	male	6/18 (33%)
Georgian College of Emergency Physicians	Georgia	male	1/3 (33%)	Information from Facebook page
German Association for Emergency Medicine	Germany	male	3/9 (33%)
Hellenic Society of Emergency Medicine	Greece	male	5/11 (45%)
Hungarian Society for Emergency Medicine Icelandic Society for Emergency Medicine Irish Association for Emergency Medicine	Hungary Iceland Ireland	male – male	0/6 (0%) – 1/2 (50%)	No homepage
Italian Society for Emergency Medicine Kosovo Society of Emergency Medicine Latvian Association for Emergency Medicine Lithuanian Society for Emergency Medicine Association of Emergency Physicians of Malta Society of Emergency Medicine and Disasters	Italy Kosovo Latvia Lithuania Malta Moldova	male – female – male –	6/19 (32%) – 1/2 (50%) – 3/6 (50%) –	No homepage No homepage No homepage

Medicine

from Republic of Moldova

Dutch Society of Emergency Physicians Netherlands – – No information on board members available Norwegian Society for Emergency Medicine Norway male 2/3 (67%)

Polish Society for Emergency Medicine Poland male 2/8 (25%) Portuguese Association of Emergency Medicine Portugal male 0/1 (0%)

Romanian Society for Emergency an Disaster Medicine Romania – – Information on pre-hospital service only Serbian Society of Emergency Physicians Serbia male 1/4 (25%)

Slovak Society of Disaster and Emergency Medicine Slovakia female 4/9 (44%) Slovenian Emergency Medical Association Slovenia male 3/10 (30%) Spanish Society of Emergency Medicine Spain male 17/42 (40%)

Swedish Society for Emergency Medicine Sweden – – No homepage Swiss Society for Emergency and Disaster Medicine Switzerland female + male 1/7 (14%)

Royal College of Emergency Medicine United Kingdom female 12/39 (31%) Emergency Physicians Association of Turkey Turkey male 1/15 (7%)

Asia female: 1/10 (10%) 15/144 (10%)

Japanese Society for Emergency Medicine Japan male 1/13 (8%)

Taiwan Society of Emergency and Critical Care Medicine

Taiwan male 2/26 (8%) Honorary members not considered

Society for Emergency Medicine India India male 3/10 (30%) Pakistan Society of Emergency Medicine Pakistan male 1/11 (9%) National Institute of Emergency Medicine of Thailand Thailand male 1/18 (6%) Korean Society of Emergency Medicine Korea male 1/33 (3%)

Malaysian College of Emergency Physicians Malaysia male No information on board members available Philippines College of Emergency Physicians Philippines female 2/7 (29%)

Society for Emergency Medicine Singapore Singapore male 2/9 (22%)

Hong Kong Society for Emergency Medicine and Surgery

Hong Kong male 2/17 (12%)

Africa female: 0/5 (0%) 14/33 (44%)

Emergency Medicine Association of Tanzania Tanzania male 6/13 (46%)

Society of Emergency Medicine Practitioners of Nigeria

Nigeria male 2/5 (40%)

Rwanda Emergency Care Association Rwanda male 2/5 (40%) Emergency Medicine Kenya Foundation Kenya male 2/4 (50%)

Emergency Medicine Society of South Africa South Africa – – No information on board members available Societe Marocaine de Medecine Urgence Morocco male 2/6 (33%)

North America female: 3/7 (43%) 14/47 (30%)

Canadian Association of Emergency Physicians Canada female + male 8/14 (57%) American College of Emergency Physicians USA female + male 2/11 (18%) American Academy of Emergency Medicine USA female + male 3/15 (20%) Sociedad mexicana de medicina de emergencia Mexico male 1/7 (14%)

South America female: 0/3 (0%)

Sociedad Argentina de Emergencias Argentina male 5/10 (50%) Associacao Brasileira de Medicina de Ermegencia Brasil male 3/6 (50%)

Asociacion colombiana de especialistas en medicina de urgencias y emergencia

Colombia – – No information on board members available

Sociedad Uruguaya de Emergencia y Trauma	Uruguay	male	5/13 (38%)
Sociedad Chilena de Medicina de Urgencia	Chile	–	–	No information on board members available

Table 1 (continued)

National Emergency Medicine Society Country President No. (%) of female

board members

Commentary

Australia G New Zealand female: 1/2 (50%) 5/8 (63%)

Australasian College Emergency Medicine Australia & New

Zealand

female + male 5/8 (63%)

Fig. 1. Gender distribution in board members and presidents of emergency medicine societies. President composition according to region: Europe (5 female, 23 male), Asia (1 female, 9 male), Africa (0 female, 5 male), South America (0 female, 2 male), North America (3 female, 4 male) and Australasia (1 female, 1 male). Board member composi- tion according to region: Europe (102 female, 185 male), Asia (15 female, 129 male), Africa (14 female, 19 male), South America (13 female, 16 male), North America

(14 female, 33 male), Australasia (5 female, 3 male).

gender distribution of the boards may be given incorrectly if information is outdated.

1. Conclusions

In conclusion, a relevant gender gap was shown for emergency med- icine societies all over the world in terms of chair functions as well as board composition with huge differences between countries and re- gions. We clearly showed for the majority of OECD countries that women are underrepresented in their national societies’ boards com- pared to the proportion of female physicians in the respective countries. Actions to foster female careers in emergency medicine in order to

balance gender inequalities should be taken by national societies as well as their members. Further studies are to be welcomed to compare these findings to other medical specialty societies and investigate the implications of these findings on physicians working in the respective medical field.

Financial support

None.

Conflicts of interest

None in relation to the present work. GL reports personal fees from Bayer, personal fees from Daiichi-Sankyo, personal fees and non- financial support from Otsuka, non-financial support from GSK, non- financial support from Pierre Fabre.

Author contributions

Conceptualization : GL, SR; Data curation: GL, SR, AR; Formal analy- sis: GL, SR; Investigation: GL, SR, AR; Methodology: GL, SR; Project ad- ministration: GL, SR; Supervision: GL; Validation: GL, SR, AR AE; Visualization: GL, SR; Writing – original draft: GL, SR, AR; Writing – re- view & editing: GL, SR, AE.

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