Although it is assumed that female physicians are underrepresented on critical care task forces, the gender balance of these task forces has not been formally assessed. Because expertise is cited as the main criterion to receive an invitation to participate on a critical care task force, we assert that authors of high impact critical care articles are a proxy for the pool of experts from which task force participants are selected. We sought to determine whether the proportion of female physicians on recent major critical care task forces was similar to the proportion of female physicians who authored critical care literature during the years 2011 to 2017.

We selected critical care articles published from 2011–17 from four high-impact journals: The New England Journal of Medicine, The Journal of the American Medical Association, The American Journal of Respiratory and Critical Care Medicine, and The Lancet Respiratory Medicine. We restricted our analysis to original clinical critical care articles in adult populations, and to authors with an MD or equivalent degree. We excluded articles that were authored by a writing committee, basic science articles, editorials, perspectives, and clinical reviews. For each article, we determined both the first and last authors' gender, graduate degree, and institutional affiliation. We determined gender by initial inspection of the author's first name. In cases when gender was not clear, we accessed the author's institutional faculty profile page, searched for their name using Google search, or both.

Table Critical care task force participants Year task force met Total participants (n) Female MDs (adult critical care; n) Women with other degrees * * Including BS, RN, PhD, PharmD, and MS degrees. (n) Male MDs (n) Men with other degrees * * Including BS, RN, PhD, PharmD, and MS degrees. (n) Female MDs (%) Multisociety Task Force for Critical Care Research January, 2012 25 4 2 17 2 16% Consensus statement of the European Society for Intensive Care Medicine (ESICM) task force on colloid volume therapy in critically ill patients February, 2012 8 1 0 6 1 13% Acute Respiratory Distress Syndrome Task Force June, 2012 17 0 0 17 0 0% Surviving Sepsis 2012 (adult group) June, 2012 63 6 5 52 0 10% Statement from the Society of Critical Care Medicine Taskforce on ICU staffing February, 2013 12 0 1 10 1 0% Consensus statement of the ESICM task force on circulatory shock and haemodynamic monitoring December, 2014 12 0 0 12 0 0% Third international consensus definitions for sepsis and septic shock February, 2016 19 0 0 19 0 0% End-of-life care in the intensive care unit: report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine August, 2016 16 0 2 14 0 0% Triage decisions for ICU admission: report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine December, 2016 41 5 0 36 0 12% What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine February, 2017 21 1 2 18 0 5% Total 234 17 12 201 4 7% We identified ten critical care task forces that met between 2011 and 2017 ( table ). We determined the gender of task force participants with an MD or equivalent degree using the same process described above.

We compared the gender distributions of the task force participants to the authors of high impact critical care articles using a two-population sample test of proportions (z-test). We determined the gender for all authors and task force participants. We identified 333 adult clinical critical care articles from 2011 to 2017. Of these 333 articles, 101 female physicians were either the first or last author (ie, 101 [15%] of 666 authorship opportunities). Women were the first author on 59 (18%) of 333 articles, and senior author on 42 (13%) articles.

Of the included critical care task forces that met between 2011 and 2017, there were 234 participants. Female physicians who practiced adult critical care accounted for 17 (7%; range 0–16%) of these participants. Notably, five of the task forces had no female physician participants ( table ). The proportion of women serving on critical task forces was significantly lower than the proportion of women serving as first or senior authors in high-impact critical care publications (7% vs 15%; p=0·001).

The proportion of women serving on critical care task forces was less than half of what would be expected had the gender distribution of these task forces been representative of the authors of high-impact critical care journal articles. Our results suggest that the disproportionately small number of women on critical care task forces isn't simply due to a lack of eligible female candidates, but could be due to bias in task force participant selection.

Although the mechanisms underpinning this gender imbalance cannot be identified using our methods, the task force selection process offers many opportunities for bias to operate. Typically, when a task force is convened, sponsoring societies select a chair or an executive committee, who then selects members for the task force. Criteria for task force membership is often vague, and not published in the task force document. Critical care societies will often list diversity as an important criterion for task forces, but there is often little-to-no penalty for an absence of women or other traditionally underrepresented groups. One possibility is that the chair or executive committee members select friends or colleagues rather than ensuring the task force best represents the pool of experts for the given topic.

Our analysis is limited in that we only examined participants on the task forces, not those who were invited. Therefore, we cannot rule out the possibility that women were invited but declined to participate more often than men. Another limitation is that we included only four high-impact journals in our analysis. The New England Journal of Medicine and Journal of the American Medical Association typically publish large, randomised controlled trials, and women are less likely to be principal investigators on these large studies, so our estimate of female authors is probably conservative. If this is the case, the discrepancy between authorship by female physicians and task force participation might be even greater than what we identified.

To increase the number of female physician participants on task forces, we suggest that critical care societies should mandate more gender parity on task force panels. Societies should provide more transparency in their task force selection process by clearly stating the criteria for task force participant selection. Societies should also solicit applications for participation on task force panels and then choose from these applicants. Finally, societies should publish the methods for task force participant selection, and also include a list of people who were invited and those who declined.

For more on the numbers of women in critical care in 1980 see American Medical Association. Physician characteristics and distribution. 1981 AMA Data Workforce Report. Chicago: AMA, Division of Data and Resources, 1981

PBB reports grants from Kaiser Permanente, Laura and John Arnold Foundation, and the National Institutes of Health ( core grant P30 CA 008748 ). PBB also reports personal fees from the American Society for Health-System Pharmacists, Gilead Pharmaceuticals, WebMD, Goldman Sachs, Defined Health, Vizient, Anthem, Excellus Health Plan, the Hematology Oncology Pharmacy Association, Novartis Pharmaceuticals, Janssen Pharmaceuticals, Third Rock Ventures, JMP Securities, Genentech, Mercer, and United Rheumatology; and consulting fees from Foundation Medicine and Grail, outside of the submitted work. The other authors declare no competing interests.