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SURF  |   February 2019
Medical Degree Disparity Among Authors in Obstetrics and Gynecology Journals
Author Notes
  • From the Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania (Student Doctor Merritt); the Department of Research at Conemaugh Memorial Medical Center in Johnstown, Pennsylvania (Mr Simunich); and the Department of Emergency Medicine at Kingman Regional Medical Center in Arizona (Dr Ashurst).  
  • Financial Disclosures: None reported.  
  • Support: The study was partially funded by a Lake Erie College of Osteopathic Medicine/Lake Erie Consortium for Osteopathic Medical Training research support grant.  
  •  *Address correspondence to John Ashurst, DO, MSc, Kingman Regional Medical Center, Department of Emergency Medicine, 3269 Stockton Hill Rd, Kingman, AZ 86409-3619. Email: ashurst.john.32.research@gmail.com
     
Article Information
SURF   |   February 2019
Medical Degree Disparity Among Authors in Obstetrics and Gynecology Journals
The Journal of the American Osteopathic Association, February 2019, Vol. 119, e1-e8. doi:https://doi.org/10.7556/jaoa.2019.020
The Journal of the American Osteopathic Association, February 2019, Vol. 119, e1-e8. doi:https://doi.org/10.7556/jaoa.2019.020
Web of Science® Times Cited: 2
Abstract

Context: With the transition to a single accreditation system for graduate medical education, the scholarly activity among core faculty in osteopathic and allopathic residency programs has come under scrutiny. Currently, major differences in scholarly activity requirements exist between core faculty in obstetrics and gynecology residencies accredited by the Accreditation Council for Graduate Medical Education and those accredited by the American Osteopathic Association.

Objective: To determine whether there is a disparity between osteopathic and allopathic physicians among authors with original research published in 4 high-impact obstetrics and gynecology journals during 4 select years.

Methods: The authors reviewed Obstetrics & Gynecology (Obstet Gynecol), the American Journal of Obstetrics and Gynecology (Am J Obstet Gynecol), Fertility and Sterility (Fertil Steril), and Menopause for the degree designation of the first and senior (last) author of each original manuscript for the years of 2000, 2005, 2010, and 2015. Data were analyzed using simple descriptive statistics and linear regression.

Results: In total, 3311 articles and 5909 authors were reviewed. Of these authors, 0.80% (47) had a DO degree. Of 1692 authors with dual advanced degrees, only 0.53% (9) had a DO degree. On subgroup analysis of each journal, 0.87% (13 of 1494) of identified authors in Obstet Gynecol, 1.03% (21 of 2038) in Am J Obstet Gynecol, 0.44% (9 of 2030) in Fertil Steril, and 2.20% (4 of 347) in Menopause were osteopathic physicians. During the years studied, no statistically significant trend could be established for first or senior author publication by osteopathic physicians over time, for all 4 journals or for any individual journal.

Conclusion: Very few osteopathic physicians have served as either the first or the senior author in articles published in Obstet Gynecol, Am J Obstet Gynecol, Fertil Steril, or Menopause during the years studied, and no trend was seen for increased publication by osteopathic physicians in these journals over time.

As graduate medical education moves toward a single accreditation system, growing attention has been paid to the scholarly activity of the residents and core faculty of residency programs. Currently, the Accreditation Council for Graduate Medical Education notes that core faculty in obstetrics and gynecology… 

… should also demonstrate scholarship by one or more of the following: peer-reviewed funding; publication of original research or review articles in peer-reviewed journals, or chapters in textbooks; publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; or, participation in national committees or educational organizations.1

 
Conversely, the Basics Standards for Residency Training in Obstetrics and Gynecology from the American Osteopathic Association (AOA) requires only that all residents in AOA-accredited obstetrics and gynecology programs complete a research project before graduation.2 
A disparity between osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) in emergency medicine has recently been demonstrated among those listed as first or senior (last) authors in PubMed-indexed journals, recipients of R01 grant funding from the National Institutes of Health, and those serving on editorial boards for medical journals.3-5 In the field of obstetrics and gynecology, a similar medical degree disparity was seen among those serving on the editorial board for the journal Obstetrics & Gynecology.5 In the current study, we sought to determine whether there was a medical degree disparity among physicians with articles published in 4 high-impact obstetrics and gynecology journals in 2000, 2005, 2010, and 2015. 
Methods
This study was a retrospective analysis of medical degree (DO vs MD) trends in publications from the journals Obstetrics & Gynecology (Obstet Gynecol), the American Journal of Obstetrics and Gynecology (Am J Obstet Gynecol), Fertility and Sterility (Fertil Steril), and Menopause. These 4 journals were chosen based on their having a minimum impact factor of 3.0 (range, 3.172-5.656) and 5-year impact factor of 3.0 (range, 3.019-5.488) according to the 2015 Journal Citation Reports, as well as a citation half-life of at least 15 years according to their websites. The senior author (J.A.) trained the other study authors (B.M. and T.S.) in proper abstracting technique by identifying the authors and degrees for the first 2 months of Obstet Gynecol. 
Each research article was reviewed to determine the medical degree held by its first and senior authors. This determination was accomplished by inspecting either the abstract or the article that was publicly available on the journal's website. For authors with more than 1 advanced degree, both the medical degree and the second advanced degree (eg, MPH, MSc, PhD) were tallied for analysis. Each publication by a given author was tallied independently, and authors were not excluded if they had multiple publications or served in multiple author roles during the years studied. Only original research articles for the years 2000, 2005, 2010 and 2015 were included in the final analysis. Media reviews, editorials, book reviews, letters to the editor, review articles, and case reports were excluded, as were articles in which the first or senior author was not a physician. 
The proportions of DO and MD authors across the years were compared using simple descriptive statistics. The proportions of those holding both a medical degree and a second advanced degree were also analyzed using descriptive statistics. Overall comparison of authorship by DOs and MDs was performed using trends in authorship and simple linear regression analyses. Statistical significance was defined as P≤.05. 
Results
A total of 3311 articles and 5909 authors were reviewed for the years included in analysis. A total of 3311 authors were considered first authors, 832 of whom held dual degrees, and 2598 were considered senior authors, 860 of whom held dual degrees. 
Overall, 0.80% of authors (47 of 5909) held a DO degree, and 99.20% (5862 of 5909) held an MD degree. Among first authors, 1.10% (36 of 3311) were DOs, compared with 0.42% (11 of 2598) among senior authors (Table 1). Similarly, 0.72% of first authors (6 of 832) and 0.35% of senior authors (3 of 860) with dual advanced degrees had a DO degree. Further subgroup analysis by journal revealed that 0.87% of all authors (13 of 1494) in Obstet Gynecol, 1.03% (21 of 2038) in Am J Obstet Gynecol, 0.44% (9 of 2030) in Fertil Steril, and 2.20% (4 of 347) in Menopause were DOs (Table 1). For all analyses of authorship by DOs compared with MDs, both overall and for individual journals, results were statistically significant (all P<.05). 
Table 1.
Proportions of DOs and MDs Serving as First or Senior Author During All 4 Years Studieda
DO or MD as First Author, % (No./All First Authors) DO or MD as Senior Author, % (No./All Senior Authors)
Journal DO MD DO MD
Overall 1.16 (36/3111) 98.94 (3275/3311) 0.42 (11/2598) 99.58 (2587/2598)
Obstet Gynecol 1.33 (11/828) 98.67 (817/828) 0.30 (2/666) 99.70 (664/666)
Am J Obstet Gynecol 1.30 (15/1151) 98.70 (1136/1151) 0.68 (6/887) 99.32 (881/887)
Fertil Steril 0.62 (7/1132) 99.38 (1125/1132) 0.22 (2/898) 99.78 (896/898)
Menopause 1.5 (3/200) 98.5 (197/200) 0.68 (1/147) 99.32 (146/147)

a Years studied were 200, 2005, 2010, and 2015. All comparisons between osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) were statistically significant at P<.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; Fertil Steril, Fertility and Sterility; Obstet Gynecol, Obstetrics & Gynecology.

Table 1.
Proportions of DOs and MDs Serving as First or Senior Author During All 4 Years Studieda
DO or MD as First Author, % (No./All First Authors) DO or MD as Senior Author, % (No./All Senior Authors)
Journal DO MD DO MD
Overall 1.16 (36/3111) 98.94 (3275/3311) 0.42 (11/2598) 99.58 (2587/2598)
Obstet Gynecol 1.33 (11/828) 98.67 (817/828) 0.30 (2/666) 99.70 (664/666)
Am J Obstet Gynecol 1.30 (15/1151) 98.70 (1136/1151) 0.68 (6/887) 99.32 (881/887)
Fertil Steril 0.62 (7/1132) 99.38 (1125/1132) 0.22 (2/898) 99.78 (896/898)
Menopause 1.5 (3/200) 98.5 (197/200) 0.68 (1/147) 99.32 (146/147)

a Years studied were 200, 2005, 2010, and 2015. All comparisons between osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) were statistically significant at P<.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; Fertil Steril, Fertility and Sterility; Obstet Gynecol, Obstetrics & Gynecology.

×
In 2000, DOs accounted for 0.74% (7 of 994) in the first author and 0.52% (4 of 772) in the senior author role; in 2015, the equivalent numbers were 2.20% (14 of 635) and 0.79% (4 of 507). However, no statistically significant trend was found for either first (P=.35) or senior (P=.80) authorship by DOs over time (Table 2). Likewise, among first authors with dual advanced degrees, 0.61% (1 of 165) were DOs in 2000, compared with 1.46% (3 of 205) in 2015; for the senior author role, the percentages were 0% (0 of 144) in 2000 and 0.84% (2 of 237) in 2015 (Table 3). No statistically significant trend in authorship was found for either first (P=.20) or senior (P=.06) authors with dual degrees who were DOs over time. 
Table 2.
Proportions of DOs and MDs Serving as First or Senior Author by Journal and Year
DO or MD as First or Senior Author, % (No./All First or Senior Authors)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.74 (7/944) 1.10 (9/815) 0.65 (6/917) 2.20 (14/635) .35
  Senior 0.52 (4/722) 0 (0/628) 0.40 (3/741) 0.79 (4/507) .80
 MD authors
  First 99.26 (937/944) 98.90 (806/815) 99.35 (911/917) 87.80 (621/635) .24
  Senior 99.45 (718/722) 100 (628/628) 99.60 (738/741) 99.21 (503/507) .36
Obstet Gynecol
 DO authors
  First 1.15 (3/262) 0.88 (2/227) 1.11 (2/179) 2.50 (4/160) .60
  Senior 0 (0/207) 0 (0/183) 0.70 (1/143) 0.75 (1/133) .11
 MD authors
  First 98.85 (259/262) 99.12 (225/227) 98.88 (177/179) 97.50 (156/160) .01
  Senior 100 (207/207) 100 (183/183) 99.30(142/143) 99.25 (132/133) .02
Am J Obstet Gynecol
 DO authors
  First 0.96 (4/415) 1.69 (5/296) 0.86 (2/232) 1.92 (4/208) .69
  Senior 0.99 (3/304) 0 (0/213) 1.0 (2/201) 0.59 (1/169) .60
 MD authors
  First 99.04 (411/415) 98.31 (291/296) 99.14 (230/232) 98.08 (204/208) .05
  Senior 99.01(301/304) 100 (213/213) 99.00 (199/201) 99.41 (168/169) .07
Fertil Steril
 DO authors
  First 0 (0/243) 0.40 (1/250) 0.23 (1/442) 2.54 (5/197) .13
  Senior 0.52 (1/194) 0 (0/202) 0 (0/348) 0.65 (1/154) ??
 MD authors
  First 100 (243/243) 99.60 (249/250) 99.77 (441/442) 97.46 (192/197) .95
  Senior 99.48 (193/194) 100 (202/202) 100 (348/348 99.35 (153/154) .96
Menopause
 DO authors
  First 0 (0/24) 2.38 (1/42) 1.56 (1/64) 1.43 (1/70) .23
  Senior 0 (0/17) 0 (0/30) 0 (0/49) 1.96 (1/51) .23
 MD authors
  First 100 (24/24) 97.62 (41/42) 98.44 (63/64) 98.57 (69/70) .02
  Senior 100 (17/17) 100 (30/30) 100 (49/49) 98.04 (50/51) .04

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; Obstet Gynecol, Obstetrics & Gynecology.

Table 2.
Proportions of DOs and MDs Serving as First or Senior Author by Journal and Year
DO or MD as First or Senior Author, % (No./All First or Senior Authors)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.74 (7/944) 1.10 (9/815) 0.65 (6/917) 2.20 (14/635) .35
  Senior 0.52 (4/722) 0 (0/628) 0.40 (3/741) 0.79 (4/507) .80
 MD authors
  First 99.26 (937/944) 98.90 (806/815) 99.35 (911/917) 87.80 (621/635) .24
  Senior 99.45 (718/722) 100 (628/628) 99.60 (738/741) 99.21 (503/507) .36
Obstet Gynecol
 DO authors
  First 1.15 (3/262) 0.88 (2/227) 1.11 (2/179) 2.50 (4/160) .60
  Senior 0 (0/207) 0 (0/183) 0.70 (1/143) 0.75 (1/133) .11
 MD authors
  First 98.85 (259/262) 99.12 (225/227) 98.88 (177/179) 97.50 (156/160) .01
  Senior 100 (207/207) 100 (183/183) 99.30(142/143) 99.25 (132/133) .02
Am J Obstet Gynecol
 DO authors
  First 0.96 (4/415) 1.69 (5/296) 0.86 (2/232) 1.92 (4/208) .69
  Senior 0.99 (3/304) 0 (0/213) 1.0 (2/201) 0.59 (1/169) .60
 MD authors
  First 99.04 (411/415) 98.31 (291/296) 99.14 (230/232) 98.08 (204/208) .05
  Senior 99.01(301/304) 100 (213/213) 99.00 (199/201) 99.41 (168/169) .07
Fertil Steril
 DO authors
  First 0 (0/243) 0.40 (1/250) 0.23 (1/442) 2.54 (5/197) .13
  Senior 0.52 (1/194) 0 (0/202) 0 (0/348) 0.65 (1/154) ??
 MD authors
  First 100 (243/243) 99.60 (249/250) 99.77 (441/442) 97.46 (192/197) .95
  Senior 99.48 (193/194) 100 (202/202) 100 (348/348 99.35 (153/154) .96
Menopause
 DO authors
  First 0 (0/24) 2.38 (1/42) 1.56 (1/64) 1.43 (1/70) .23
  Senior 0 (0/17) 0 (0/30) 0 (0/49) 1.96 (1/51) .23
 MD authors
  First 100 (24/24) 97.62 (41/42) 98.44 (63/64) 98.57 (69/70) .02
  Senior 100 (17/17) 100 (30/30) 100 (49/49) 98.04 (50/51) .04

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; Obstet Gynecol, Obstetrics & Gynecology.

×
Table 3.
Proportions of DOs and MDs With Dual Degrees Serving as First or Senior Author by Journal and Year
DO or MD With Dual Degrees as First or Senior Author, %
(No./All First or Senior Authors With Dual Degrees)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.61 (1/165) 0 (0/211) 0.80 (2/251) 1.46 (3/205) .20
  Senior 0 (0/144) 0 (0/186) 0.34 (1/293) 0.84 (2/237) .06
 MD authors
  First 99.39 (164/165) 100 (211/211) 99.20 (249/251) 98.54 (202/205) .44
  Senior 100 (144/144) 100 (186/186) 99.66 (292/293) 99.16 (235/237 .23
Obstet Gynecol
 DO authors
  First 2.08 (1/48) 0 (0/79) 0 (0/60) 1.96 (1/51) NA
  Senior 0 (0/38) 0 (0/59) 0 (0/66) 100 (0/58) NA
 MD authors
  First 97.92 (47/48) 100 (79/79) 100 (60/60) 98.04 (50/51) .91
  Senior 100 (38/38) 100 (59/59) 100 (66/66) 100 (58/58) .28
Am J Obstet Gynecol
 DO authors
  First 0 (0/67) 0 (0/59) 1.64 (1/61) 1.43 (1/70) .11
  Senior 0 (0/62) 0 (0/50) 1.32 (1/76) 1.23 (1/81) .11
 MD authors
  First 100 (67/67) 100 (59/59) 98.36 (60/61) 98.57 (69/70) .82
  Senior 100 (62/62) 100 (50/50) 98.68 (75/76) 98.77 (80/81) .25
Fertil Steril
 DO authors
  First 0 (0/41) 0 (0/53) 0 (0/103) 0 (0/59) NA
  Senior 0 (0/41) 0 (0/62) 0 (0/122) 0 (0/70) NA
 MD authors
  First 100 (41/41) 100 (53/53) 100 (103/103) 100 (59/59) .50
  Senior 100 (41/41) 100 (62/62) 100 (122/122) 100 (70/70) .45
Menopause
 DO authors
  First 0 (0/9) 0 (0/20) 3.70 (1/27) 4 (1/25) .11
  Senior 0 (0/3) 0 (0/15) 0 (0/29) 3.57 (1/28) .23
 MD authors
  First 100 (9/9) 100 (20/20) 96.30 (26/27) 96.00 (24/25) .13
  Senior 100 (3/3) 100 (15/15) 100 (29/29) 96.43 (27/28) .08

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; NA, not applicable; Obstet Gynecol, Obstetrics & Gynecology.

Table 3.
Proportions of DOs and MDs With Dual Degrees Serving as First or Senior Author by Journal and Year
DO or MD With Dual Degrees as First or Senior Author, %
(No./All First or Senior Authors With Dual Degrees)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.61 (1/165) 0 (0/211) 0.80 (2/251) 1.46 (3/205) .20
  Senior 0 (0/144) 0 (0/186) 0.34 (1/293) 0.84 (2/237) .06
 MD authors
  First 99.39 (164/165) 100 (211/211) 99.20 (249/251) 98.54 (202/205) .44
  Senior 100 (144/144) 100 (186/186) 99.66 (292/293) 99.16 (235/237 .23
Obstet Gynecol
 DO authors
  First 2.08 (1/48) 0 (0/79) 0 (0/60) 1.96 (1/51) NA
  Senior 0 (0/38) 0 (0/59) 0 (0/66) 100 (0/58) NA
 MD authors
  First 97.92 (47/48) 100 (79/79) 100 (60/60) 98.04 (50/51) .91
  Senior 100 (38/38) 100 (59/59) 100 (66/66) 100 (58/58) .28
Am J Obstet Gynecol
 DO authors
  First 0 (0/67) 0 (0/59) 1.64 (1/61) 1.43 (1/70) .11
  Senior 0 (0/62) 0 (0/50) 1.32 (1/76) 1.23 (1/81) .11
 MD authors
  First 100 (67/67) 100 (59/59) 98.36 (60/61) 98.57 (69/70) .82
  Senior 100 (62/62) 100 (50/50) 98.68 (75/76) 98.77 (80/81) .25
Fertil Steril
 DO authors
  First 0 (0/41) 0 (0/53) 0 (0/103) 0 (0/59) NA
  Senior 0 (0/41) 0 (0/62) 0 (0/122) 0 (0/70) NA
 MD authors
  First 100 (41/41) 100 (53/53) 100 (103/103) 100 (59/59) .50
  Senior 100 (41/41) 100 (62/62) 100 (122/122) 100 (70/70) .45
Menopause
 DO authors
  First 0 (0/9) 0 (0/20) 3.70 (1/27) 4 (1/25) .11
  Senior 0 (0/3) 0 (0/15) 0 (0/29) 3.57 (1/28) .23
 MD authors
  First 100 (9/9) 100 (20/20) 96.30 (26/27) 96.00 (24/25) .13
  Senior 100 (3/3) 100 (15/15) 100 (29/29) 96.43 (27/28) .08

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; NA, not applicable; Obstet Gynecol, Obstetrics & Gynecology.

×
Although we found no statistically significant trends for publication by DOs (including those with dual advanced degrees) as first or senior authors in any journal we reviewed, for MDs as first authors we found significant negative linear trends in Obstet Gynecol (P=.01) and Am J Obstet Gynecol (P=.05), and a significant positive linear trend in Menopause (P=.02), and as senior authors in Obstet Gynecol (negative linear trend, P=.02) and Menopause (positive linear trend, P=.04) (Table 2). For MDs with dual degrees, no statistically significant trends could be established for either first or senior authors (Table 3). 
Discussion
The results of the current study indicate that DOs served as first or senior authors of published original research articles in obstetrics and gynecology journals less frequently than their MD counterparts in the years studied. To our knowledge, this study is the first to highlight the medical degree disparity among physician authors in obstetrics and gynecology journals, but our findings resemble those of previous research. In emergency medicine, Lammers et al3 found that osteopathic emergency physicians had significantly fewer published articles than their allopathic counterparts when the roles of first and senior author were considered during a 2-decade period in high-impact journals. However, the exact reasons for the medical degree disparity remain unclear. 
One reason for the disparity in publications between DOs and MDs could be the difference in training that allopathic and osteopathic medical students receive with regard to research. Historically, the osteopathic curriculum has not been research oriented, despite medical students’ expressed desire for increased clinical research electives.6,7 According to a 2011 survey, osteopathic medical students reported devoting only 2% of their time during clerkship to research, and a large number of those graduating believe that not enough time is spent on learning research techniques.8 In a 2016 study, Smith et al9 found that senior medical students understand only about half of evidence-based medicine question topics, with the most poorly understood subjects being number needed to treat, CIs, 2-by-2 grids, magnitude, internal validity, relevance, and study design. Without acquiring proficiency with foundational techniques during medical school, it may be difficult for a novice researcher to break into publication. 
In 2015, Muffly et al10 reported that it takes an average of 25.6 months for an abstract presented at an obstetrics and gynecology meeting to become a published article and that 54% of all abstracts presented at major obstetrics and gynecology conferences in 2005 had been published. Although many abstracts are transitioned to articles in obstetrics and gynecology journals, DOs rarely serve as first or senior authors, based on the data from the current study. This finding could be related to the fact that few published articles are authored or coauthored by DOs with dual degrees. 
Physician-scientists, or those holding dual degrees, are integral to the continued development of medical knowledge and produce an average of 4 or more publications during their training.11 However, several factors, including financial and family obligations, the time it takes to obtain dual degrees, and the “publish or perish” mentality, may discourage young physicians from pursuing careers as physician-scientists.12-14 For the academic year 2018-2019, a total of 77 dual-degree programs were offered by osteopathic medical schools.15 However, these physician-scientist trainees are years away from being academically productive in their specialties. 
Another suggested reason for the degree disparity in academic medicine is that there are many more MDs than DOs in practice. According to data from the American Congress of Obstetricians and Gynecologists for 2010, there were 33,624 practicing general obstetrician-gynecologists in the United States.16 An AOA workforce analysis for the same year stated that there were 2170 DOs practicing obstetrics and gynecology.17 Based on these data, it can be inferred that 6.45% of all practicing obstetrician-gynecologists in 2010 were DOs. However, despite this percentage, only 0.66% (11 of 1666) of original research articles published that same year in obstetrics and gynecology journals we studied featured a DO as first or senior author. 
Since the announcement of the single accreditation system, the AOA and The Journal of the American Osteopathic Association have made strides not only to aid the novice physician researcher but also to lay the groundwork for increased numbers of DO researchers. In 2013, the AOA published a strategic plan for research that focused on increased production, collaboration, and funding for research in the osteopathic medical profession.18 Although the groundwork is being laid for current physicians, future studies need to focus on how residencies are coping with the need for heightened academic productivity and the resources that may be needed to fulfill this requirement. 
Limitations
The current study had several limitations. We are unable to comment on the years that we did not directly review, but we established trend lines based on 4 data points over a 16-year span. By not reviewing each year individually, however, we may have missed peaks and valleys for publication. Furthermore, we tallied only the degree designation provided in the journal abstract or article for the first and senior authors and made no attempts to determine authors’ degrees beyond the information presented. If the publisher or author designated a degree inappropriately, the results may have been altered. We also considered only the first and senior authors for the articles we reviewed, not DOs listed in other author positions. 
Another limitation is that we reviewed only 4 high-impact journals. These journals were chosen based on impact factor and because they generally reject a high proportion of manuscripts each year. Future studies could consider publication in other journals. We also cannot comment on the total numbers of manuscripts submitted to each journal by DOs and MDs because we considered only published articles. 
In addition, in attempting to include only original research in our study, we reviewed each journal for specific sections labeled as original research, but we may have missed original research studies published in other sections, which were not reviewed. We also reviewed each abstract to determine whether the article actually described original research. Finally, from a statistical standpoint, we did not conduct a power analysis before the study and did not perform a κ analysis to assess interrater reliability. 
Conclusion
Compared with MDs, DOs rarely served as first or senior authors of articles published in 4 high-impact obstetrics and gynecology journals from 2000 to 2015. No trend over time could be established for publication of articles with DO first or senior authors, including those with dual degrees. 
Author Contributions
All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 
References
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Table 1.
Proportions of DOs and MDs Serving as First or Senior Author During All 4 Years Studieda
DO or MD as First Author, % (No./All First Authors) DO or MD as Senior Author, % (No./All Senior Authors)
Journal DO MD DO MD
Overall 1.16 (36/3111) 98.94 (3275/3311) 0.42 (11/2598) 99.58 (2587/2598)
Obstet Gynecol 1.33 (11/828) 98.67 (817/828) 0.30 (2/666) 99.70 (664/666)
Am J Obstet Gynecol 1.30 (15/1151) 98.70 (1136/1151) 0.68 (6/887) 99.32 (881/887)
Fertil Steril 0.62 (7/1132) 99.38 (1125/1132) 0.22 (2/898) 99.78 (896/898)
Menopause 1.5 (3/200) 98.5 (197/200) 0.68 (1/147) 99.32 (146/147)

a Years studied were 200, 2005, 2010, and 2015. All comparisons between osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) were statistically significant at P<.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; Fertil Steril, Fertility and Sterility; Obstet Gynecol, Obstetrics & Gynecology.

Table 1.
Proportions of DOs and MDs Serving as First or Senior Author During All 4 Years Studieda
DO or MD as First Author, % (No./All First Authors) DO or MD as Senior Author, % (No./All Senior Authors)
Journal DO MD DO MD
Overall 1.16 (36/3111) 98.94 (3275/3311) 0.42 (11/2598) 99.58 (2587/2598)
Obstet Gynecol 1.33 (11/828) 98.67 (817/828) 0.30 (2/666) 99.70 (664/666)
Am J Obstet Gynecol 1.30 (15/1151) 98.70 (1136/1151) 0.68 (6/887) 99.32 (881/887)
Fertil Steril 0.62 (7/1132) 99.38 (1125/1132) 0.22 (2/898) 99.78 (896/898)
Menopause 1.5 (3/200) 98.5 (197/200) 0.68 (1/147) 99.32 (146/147)

a Years studied were 200, 2005, 2010, and 2015. All comparisons between osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) were statistically significant at P<.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; Fertil Steril, Fertility and Sterility; Obstet Gynecol, Obstetrics & Gynecology.

×
Table 2.
Proportions of DOs and MDs Serving as First or Senior Author by Journal and Year
DO or MD as First or Senior Author, % (No./All First or Senior Authors)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.74 (7/944) 1.10 (9/815) 0.65 (6/917) 2.20 (14/635) .35
  Senior 0.52 (4/722) 0 (0/628) 0.40 (3/741) 0.79 (4/507) .80
 MD authors
  First 99.26 (937/944) 98.90 (806/815) 99.35 (911/917) 87.80 (621/635) .24
  Senior 99.45 (718/722) 100 (628/628) 99.60 (738/741) 99.21 (503/507) .36
Obstet Gynecol
 DO authors
  First 1.15 (3/262) 0.88 (2/227) 1.11 (2/179) 2.50 (4/160) .60
  Senior 0 (0/207) 0 (0/183) 0.70 (1/143) 0.75 (1/133) .11
 MD authors
  First 98.85 (259/262) 99.12 (225/227) 98.88 (177/179) 97.50 (156/160) .01
  Senior 100 (207/207) 100 (183/183) 99.30(142/143) 99.25 (132/133) .02
Am J Obstet Gynecol
 DO authors
  First 0.96 (4/415) 1.69 (5/296) 0.86 (2/232) 1.92 (4/208) .69
  Senior 0.99 (3/304) 0 (0/213) 1.0 (2/201) 0.59 (1/169) .60
 MD authors
  First 99.04 (411/415) 98.31 (291/296) 99.14 (230/232) 98.08 (204/208) .05
  Senior 99.01(301/304) 100 (213/213) 99.00 (199/201) 99.41 (168/169) .07
Fertil Steril
 DO authors
  First 0 (0/243) 0.40 (1/250) 0.23 (1/442) 2.54 (5/197) .13
  Senior 0.52 (1/194) 0 (0/202) 0 (0/348) 0.65 (1/154) ??
 MD authors
  First 100 (243/243) 99.60 (249/250) 99.77 (441/442) 97.46 (192/197) .95
  Senior 99.48 (193/194) 100 (202/202) 100 (348/348 99.35 (153/154) .96
Menopause
 DO authors
  First 0 (0/24) 2.38 (1/42) 1.56 (1/64) 1.43 (1/70) .23
  Senior 0 (0/17) 0 (0/30) 0 (0/49) 1.96 (1/51) .23
 MD authors
  First 100 (24/24) 97.62 (41/42) 98.44 (63/64) 98.57 (69/70) .02
  Senior 100 (17/17) 100 (30/30) 100 (49/49) 98.04 (50/51) .04

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; Obstet Gynecol, Obstetrics & Gynecology.

Table 2.
Proportions of DOs and MDs Serving as First or Senior Author by Journal and Year
DO or MD as First or Senior Author, % (No./All First or Senior Authors)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.74 (7/944) 1.10 (9/815) 0.65 (6/917) 2.20 (14/635) .35
  Senior 0.52 (4/722) 0 (0/628) 0.40 (3/741) 0.79 (4/507) .80
 MD authors
  First 99.26 (937/944) 98.90 (806/815) 99.35 (911/917) 87.80 (621/635) .24
  Senior 99.45 (718/722) 100 (628/628) 99.60 (738/741) 99.21 (503/507) .36
Obstet Gynecol
 DO authors
  First 1.15 (3/262) 0.88 (2/227) 1.11 (2/179) 2.50 (4/160) .60
  Senior 0 (0/207) 0 (0/183) 0.70 (1/143) 0.75 (1/133) .11
 MD authors
  First 98.85 (259/262) 99.12 (225/227) 98.88 (177/179) 97.50 (156/160) .01
  Senior 100 (207/207) 100 (183/183) 99.30(142/143) 99.25 (132/133) .02
Am J Obstet Gynecol
 DO authors
  First 0.96 (4/415) 1.69 (5/296) 0.86 (2/232) 1.92 (4/208) .69
  Senior 0.99 (3/304) 0 (0/213) 1.0 (2/201) 0.59 (1/169) .60
 MD authors
  First 99.04 (411/415) 98.31 (291/296) 99.14 (230/232) 98.08 (204/208) .05
  Senior 99.01(301/304) 100 (213/213) 99.00 (199/201) 99.41 (168/169) .07
Fertil Steril
 DO authors
  First 0 (0/243) 0.40 (1/250) 0.23 (1/442) 2.54 (5/197) .13
  Senior 0.52 (1/194) 0 (0/202) 0 (0/348) 0.65 (1/154) ??
 MD authors
  First 100 (243/243) 99.60 (249/250) 99.77 (441/442) 97.46 (192/197) .95
  Senior 99.48 (193/194) 100 (202/202) 100 (348/348 99.35 (153/154) .96
Menopause
 DO authors
  First 0 (0/24) 2.38 (1/42) 1.56 (1/64) 1.43 (1/70) .23
  Senior 0 (0/17) 0 (0/30) 0 (0/49) 1.96 (1/51) .23
 MD authors
  First 100 (24/24) 97.62 (41/42) 98.44 (63/64) 98.57 (69/70) .02
  Senior 100 (17/17) 100 (30/30) 100 (49/49) 98.04 (50/51) .04

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; Obstet Gynecol, Obstetrics & Gynecology.

×
Table 3.
Proportions of DOs and MDs With Dual Degrees Serving as First or Senior Author by Journal and Year
DO or MD With Dual Degrees as First or Senior Author, %
(No./All First or Senior Authors With Dual Degrees)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.61 (1/165) 0 (0/211) 0.80 (2/251) 1.46 (3/205) .20
  Senior 0 (0/144) 0 (0/186) 0.34 (1/293) 0.84 (2/237) .06
 MD authors
  First 99.39 (164/165) 100 (211/211) 99.20 (249/251) 98.54 (202/205) .44
  Senior 100 (144/144) 100 (186/186) 99.66 (292/293) 99.16 (235/237 .23
Obstet Gynecol
 DO authors
  First 2.08 (1/48) 0 (0/79) 0 (0/60) 1.96 (1/51) NA
  Senior 0 (0/38) 0 (0/59) 0 (0/66) 100 (0/58) NA
 MD authors
  First 97.92 (47/48) 100 (79/79) 100 (60/60) 98.04 (50/51) .91
  Senior 100 (38/38) 100 (59/59) 100 (66/66) 100 (58/58) .28
Am J Obstet Gynecol
 DO authors
  First 0 (0/67) 0 (0/59) 1.64 (1/61) 1.43 (1/70) .11
  Senior 0 (0/62) 0 (0/50) 1.32 (1/76) 1.23 (1/81) .11
 MD authors
  First 100 (67/67) 100 (59/59) 98.36 (60/61) 98.57 (69/70) .82
  Senior 100 (62/62) 100 (50/50) 98.68 (75/76) 98.77 (80/81) .25
Fertil Steril
 DO authors
  First 0 (0/41) 0 (0/53) 0 (0/103) 0 (0/59) NA
  Senior 0 (0/41) 0 (0/62) 0 (0/122) 0 (0/70) NA
 MD authors
  First 100 (41/41) 100 (53/53) 100 (103/103) 100 (59/59) .50
  Senior 100 (41/41) 100 (62/62) 100 (122/122) 100 (70/70) .45
Menopause
 DO authors
  First 0 (0/9) 0 (0/20) 3.70 (1/27) 4 (1/25) .11
  Senior 0 (0/3) 0 (0/15) 0 (0/29) 3.57 (1/28) .23
 MD authors
  First 100 (9/9) 100 (20/20) 96.30 (26/27) 96.00 (24/25) .13
  Senior 100 (3/3) 100 (15/15) 100 (29/29) 96.43 (27/28) .08

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; NA, not applicable; Obstet Gynecol, Obstetrics & Gynecology.

Table 3.
Proportions of DOs and MDs With Dual Degrees Serving as First or Senior Author by Journal and Year
DO or MD With Dual Degrees as First or Senior Author, %
(No./All First or Senior Authors With Dual Degrees)
Authorship by Journal 2000 2005 2010 2015 P Valuea
Overall
 DO authors
  First 0.61 (1/165) 0 (0/211) 0.80 (2/251) 1.46 (3/205) .20
  Senior 0 (0/144) 0 (0/186) 0.34 (1/293) 0.84 (2/237) .06
 MD authors
  First 99.39 (164/165) 100 (211/211) 99.20 (249/251) 98.54 (202/205) .44
  Senior 100 (144/144) 100 (186/186) 99.66 (292/293) 99.16 (235/237 .23
Obstet Gynecol
 DO authors
  First 2.08 (1/48) 0 (0/79) 0 (0/60) 1.96 (1/51) NA
  Senior 0 (0/38) 0 (0/59) 0 (0/66) 100 (0/58) NA
 MD authors
  First 97.92 (47/48) 100 (79/79) 100 (60/60) 98.04 (50/51) .91
  Senior 100 (38/38) 100 (59/59) 100 (66/66) 100 (58/58) .28
Am J Obstet Gynecol
 DO authors
  First 0 (0/67) 0 (0/59) 1.64 (1/61) 1.43 (1/70) .11
  Senior 0 (0/62) 0 (0/50) 1.32 (1/76) 1.23 (1/81) .11
 MD authors
  First 100 (67/67) 100 (59/59) 98.36 (60/61) 98.57 (69/70) .82
  Senior 100 (62/62) 100 (50/50) 98.68 (75/76) 98.77 (80/81) .25
Fertil Steril
 DO authors
  First 0 (0/41) 0 (0/53) 0 (0/103) 0 (0/59) NA
  Senior 0 (0/41) 0 (0/62) 0 (0/122) 0 (0/70) NA
 MD authors
  First 100 (41/41) 100 (53/53) 100 (103/103) 100 (59/59) .50
  Senior 100 (41/41) 100 (62/62) 100 (122/122) 100 (70/70) .45
Menopause
 DO authors
  First 0 (0/9) 0 (0/20) 3.70 (1/27) 4 (1/25) .11
  Senior 0 (0/3) 0 (0/15) 0 (0/29) 3.57 (1/28) .23
 MD authors
  First 100 (9/9) 100 (20/20) 96.30 (26/27) 96.00 (24/25) .13
  Senior 100 (3/3) 100 (15/15) 100 (29/29) 96.43 (27/28) .08

a P values were calculated using linear regression analyses. Findings were statistically significant at P≤.05.

Abbreviations: Am J Obstet Gynecol, American Journal of Obstetrics and Gynecology; DO, osteopathic physician; Fertil Steril, Fertility and Sterility; MD, allopathic physician; NA, not applicable; Obstet Gynecol, Obstetrics & Gynecology.

×