Discussion

This study investigated trends and predictors of female authorship in a high-impact Canadian medical journal over a 10-year period. Women were less likely to be last versus first authors. The annual proportion of female authors increased by 18% for first authors and 11% for last authors over the study period, and women constituted a slight majority of first authors in recent years. Higher proportions of female first and last authors were observed during the tenure of female editors-in-chief. Odds of female first and last authors were higher with female editors-in-chief and higher proportion of female authors on the team. Moreover, having a female last author was associated with higher odds of having a female first author, highlighting potential benefits of mentorship or support networks.

We identified a lower proportion of female first and last authors overall, but crucially, temporal analyses showed increasing representation over time. The proportion of female first authors increased by 18% and female last authors by 11% over the study period, with females making up a slight majority of first authors and nearly half of last authors since 2022. This trend aligns with broader efforts to improve gender equity in academia and mirrors increases reported in high-impact US and British journals, though the magnitude of change in CMAJ appears greater than in prior studies of general medical journals.9 15 However, improved gender parity was observed in more recent years in this contemporary CMAJ cohort; updated analyses of other medical journals would therefore be needed to examine whether these positive changes in gender balances were isolated or more widespread. Importantly, we found no significant decline in female authorship from the onset of the COVID-19 pandemic, despite early studies showing lower submission and authorship rates for female scientists during the pandemic.34–37 However, female last authorship remained lower than first authorship, suggesting persistent barriers to senior authorship, which has been reported in other studies. Additionally, female authors were under-represented in more impactful publications, such as practice guidelines, RCTs and comparative studies, which are more likely to be highly cited and influence clinical practice and policy.38 These imbalances may reflect ongoing gender disparities at senior levels of the workforce and could reinforce barriers to academic promotion by skewing citation metrics. At the same time, a 2018 US study found that publication-related productivity helped mitigate gendered differences in achieving full professor rank but not senior leadership positions.1 Multifaceted approaches are clearly needed to target these intertwined domains.

The increased odds of female first authorship when the last author was female highlight the role of mentorship and sponsorship in fostering gender equity in academic publishing. Our study also found that a higher proportion of female coauthors was associated with greater odds of both female first and last authorship, suggesting that diverse authorship teams may create more supportive environments for female researchers. Prior research shows that gender-diverse teams produce more novel, high-impact work, reinforcing the broader benefits of diversity in academia.39 A 2019 systematic review reported that mentorship programmes for women led to high satisfaction, increased publications, promotions and retention in medicine.40 Strong female networks and diverse external connections are also associated with higher leadership success for women.41 However, the gender imbalance among senior academics in Canada limits access to female mentors, particularly in fields where women remain under-represented.42 43 Establishing an independent research programme often overlaps with childbearing years, and limited grant funding for female researchers further restricts their ability to mentor junior trainees.2 3 23 44 Female trainees may also struggle to develop effective mentor-mentee relationships due to fears of male mentors in the #MeToo era.45 A Canadian training programme with a gender-balanced award selection committee and structured mentorship has shown benefits in promoting gender diversity and equity for early researchers.44 Having observed real-world improved gender parity for female authors in CMAJ, these findings support the need for future studies examining the identified factors associated with increased female authorship. Implementation studies should also explore potential roles of formal mentorship structures and diverse research teams to promote equitable opportunities for women in academic medicine.

The significant influence of female journal editors on female authorship underscores the importance of leadership in fostering gender equity. Our findings align with prior research showing that female peer reviewers and editors are associated with increased female authorship. However, editorial leadership remains predominantly male across academia. Despite some progress, women still comprise less than one-third of journal editors, with even smaller proportions serving as editors-in-chief, particularly in male-dominated fields like surgery.17 46–50 This lack of representation in editorial leadership may contribute to the slower progression of female authors to senior authorship roles. CMAJ’s single-blind peer review process, where reviewers know the authors’ identities, creates the opportunity to potentially introduce gender bias, as replicated by our study’s gender prediction software. A 2022 systematic review found mixed results on the impact of double-blind versus single-blind peer review on publication decisions by perceived author gender.51 Studies on gender balance would benefit from transparent reporting by journals of author gender at all stages from submission to publication; ideally, studies such as this would not be needed. A recent Canadian review called for collecting and reporting gendered data, promoting voluntary gender disclosure during manuscript submission and advocating for funding bodies to disclose funding success rates by gender.52 Strengthening gender diversity in editorial leadership, alongside transparent peer review and authorship reporting practices, could help advance gender equity in academic publishing.

This study has several strengths. It provides a unique examination of gender disparities in academic authorship within the Canadian context, covering a decade-long period. The use of validated software for gender prediction enhances the reliability of our findings, enabling a robust analysis of trends and predictors of female authorship. However, there are also notable limitations. While the gender prediction software is validated, it is inherently limited and may not accurately identify gender, particularly for gender-neutral names or across different cultures. Additionally, it may not reflect an individual’s self-identified gender or account for non-binary identities. This study also did not examine the intersection of gender and race or ethnicity. Our analysis was restricted to published articles, and we could not assess gendered differences at the submission stage. Article types were classified based on PubMed indexing, which was not uniformly available and may not comprehensively capture all nuances, though we highlighted significant gender differences in first and last authorship as per available data. This study did not analyse manuscript content, which may be an important factor influencing publication patterns. Women are more likely to conduct research on female-focused health issues, which have historically received less recognition and funding. If such research is perceived as lower priority by journals or reviewers, it could partially explain disparities in authorship representation and impact. Future research should explore whether topic selection plays a role in gendered differences in academic publishing. Statistical models are susceptible to residual unmeasured confounding; however, the nature of the dataset precluded broad adjustment for potential confounders. The structure of the data precluded the use of individual fixed effects, which may limit the ability to account for unmeasured author characteristics such as writing style, field of expertise or reputation, that could contribute to observed gender differences in authorship. Finally, we assumed a traditional first versus last author distinction of seniority, which may not always apply, potentially overlooking other collaborative dynamics within author teams.

In conclusion, women were under-represented as first and last authors overall, but we observed increasing female authorship in CMAJ over the past decade, with female first authors surpassing parity in recent years and female last authors achieving near-equal representation. Female journal editors were associated with greater female last authorship, underscoring the role of leadership in shaping authorship patterns. Additionally, a higher proportion of female coauthors was linked to increased odds of both female first and last authorship, while female last authors were associated with higher odds of female first authors, reinforcing the importance of diverse research teams and mentorship in supporting female career progression. These findings suggest that editorial leadership, team composition and mentorship networks play a crucial role in advancing gender equity in academic publishing. Strengthening policies that promote gender-inclusive editorial boards, transparent authorship tracking and structured mentorship programmes may help sustain progress towards equitable representation in medical research.