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Abstract
Objective Although medical institutions aim to promote equity within the workplace, gender disparities persist in academic psychiatry. Previous evidence indicates that women in psychiatry encounter gender-based barriers to career advancement, resulting in slower rates of promotion, lower research productivity and less grant funding than men. Here, we investigate gender disparity in Canadian Institutes of Health Research (CIHR) grant funding decisions for researchers from Canadian Departments of Psychiatry.
Method Data since inception from the CIHR funding decision database were searched for awards to applicants affiliated with Canadian psychiatry departments. For each grant, we collected the principal investigator’s (PI) name, conferral year, duration and total funding contribution. PI gender was extracted from an agreement between self-reported gender identity on provincial or territorial physician directories, from an official institutional website biography, and a validated gender application programming interface. Primary analysis was conducted for all recipients from Canadian psychiatry departments (including physician and non-physician scientists), and secondarily within a subgroup of physician scientists alone.
Results Women (both physician and non-physician scientists) consistently received fewer grants (40.75%) and were less likely to obtain multiple awards in a year than men. Most strikingly, women received a total of US$110 658 191 while men received over double this amount, totalling US$253 339 865. Women (both physician and non-physician scientists) also received shorter award durations (p=2.312e-06, rg=0.179), fewer awards per year (p=0.002128, rg=0.662) and less money per grant (p=1.583e-07, rg=0.205). Within the subgroup of physician scientists, women were awarded a total of US$22 901 569 altogether, while men received a total of US$144 451 178. Women also received significantly fewer grants per year than men (p=3.565e-05, rg=0.889).
Conclusions Gender disparity in CIHR funding decisions may pose another barrier to career progression for psychiatrists who are women. Further work is recommended to reduce gender funding gap in medical academia.
- career development
- clinical leadership
- data
- health policy
Data availability statement
Data are available on reasonable request. Data available on reasonable request to the corresponding author.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
There is significant evidence of gender disparity in funding decisions across multiple institutions. However, few external investigations have studied this phenomenon in funding decisions by the Canadian Institutes of Health Research.
WHAT THIS STUDY ADDS
Among applicants from Canadian Departments of Psychiatry, we report insignificant gender-based differences in the superficial total number of awards conferred. However, this study reveals significant gender disparity in the underlying grant metrics (eg, total funding, award durations) awarded to female applicants.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Further investigation and equity efforts are needed to promote gender parity in all aspects of grant funding decisions.
Background
Medicine has historically been a profession dominated by men.1 The proportion of females in medicine has been increasing over the last two decades; reports from the Association of Faculties of Medicine of Canada state that the percentage of females enrolled in Canadian faculties of medicine has steadily risen from 44.4% to 57.9% between 1991 and 2021.2 Despite the increasing number of women pursuing a career in medicine, gender disparity continues to persist in other domains, especially within leadership ranks. In a systematic review of 49 studies examining the gender differences in the physician workforce, women had fewer leadership roles, slower promotion rates from associate to full professorship and earned US$20 000 less annually compared with men.1 Women also have discrepantly fewer journal publications and lower h-indices. Evidence further indicates that women are leaving academic medicine in higher rates than men, due to reports of lacking role models, lower satisfaction with work–life balance, issues with securing research funding and unwelcoming institutional environments.3 In summary, although overall gender representation in medicine has improved in recent decades, entrenched attitudes continue to propagate gender disparity by other metrics.
Although psychiatry has a strong representation of women physicians in its workforce, women continue to face barriers to career progression. For instance, women are significantly under-represented in senior faculty and executive leadership positions. In a study of 23 psychiatry training programmes, although 42% of faculty members were female, only 9% of individuals with higher academic ranks, full professorship or leadership positions (eg, department chair) were female.4 Additionally, in one survey of psychiatry department chairs, female chairs reported 2.75 times more perceived barriers to career progression than males, with the most common obstacles involving family responsibilities, lack of mentorship and outright gender discrimination.5 Among criteria for academic promotion, research productivity is an almost universal measure.6 However, among Canadian psychiatrists, one study reports that women produced significantly fewer peer-reviewed publications and exhibit lower h-indices than men, with the latter metric being associated with lower grant funding success.6 Overall, the under-representation of women in medical and clinical leadership is multifactorial, yet in part, is likely driven by disparate opportunities for research success.
The Canadian Institutes of Health Research (CIHR) is a federal funding agency that invests approximately US$1 billion annually in support of health research.7 In Canadian psychiatry faculties, CIHR-supported faculty has been previously associated with greater scholarly impact, higher h-index and more total citations than counterparts without CIHR funding.8 Unfortunately, current evidence implicates biased assessment against women who apply for CIHR grant funding.9 For instance, women submitting applied science applications received systematically lower application scores than men with equivalent past application success.9 It remains controversial whether these biased assessments also occur broadly within medical CIHR grant applications. However, one study reports a similar trend of gender disparity in CIHR anaesthesiology grant funding decisions.10 The purpose of this study was to determine the extent of gender disparity among psychiatrists awarded CIHR grants.
Methods
Gender terminology statement
In this work, we use the terms ‘woman/women’ and ‘man/men’ for gender identity to acknowledge that individuals may not identify with their biological sex. The terms ‘woman/women’ and ‘man/men’ are also used in accordance with the terminology used in CIHR grant application forms as well as recent CIHR reports.11 When otherwise referencing results from a previous work, we adopt the authors’ terminology whether they used biological sex or gender. Given the binary nature of gender reporting in the collected data, we acknowledge that we are unable to account for the entire spectrum of valid gender identifications in this study.
Search methods and data collection
The CIHR Funding Decision Database was searched from inception to June 2022 for grants awarded to applicants affiliated with Canadian psychiatry departments. These applicants consisted of both licensed psychiatry physicians and dedicated scientists within these departments. To account for potential differences due to spelling and French language, the database was sorted by entering variations of ‘psychiatry’ into the departmental search field. Each grant in this procured shortlist was extracted for the principal investigator’s (PI) name, award year, grant duration, and total contribution (composed of grant and equipment funding). To identify extraneous grants that were not captured in the departmental search, each identified PI name was searched independently in the database. Subsequently, gender identities of awarded PIs were determined systematically from a consensus of sources including (1) self-reported identities from official institutional website profiles; (2) self-reported identities from physician directories of provincial and territorial colleges of physicians and surgeons and (3) a validated gender application programming interface.12–14 For non-physician PIs, we determined their gender identity through agreement from sources (1) and (3). We used a binary classification (woman/man) to describe the gender of recipients who identify as a woman or man. Although this approach does not capture the diverse and complex spectrum of gender identity, our methodology has been previously validated in the literature.10 Sources (1) and (2) were then used to identify licensed psychiatrist physicians from non-physician PIs.
Data analysis
The primary objective of this study was the historical prevalence of grants awarded to women versus men from psychiatry departments (including psychiatrists and non-psychiatrists), calculated as the number of awards to each gender divided by all included grants. Secondary objectives include the gender-wise comparison of multiple grant recipients (defined as receiving two or more grants since all time), grant contribution, award duration and grants awarded per year. All outcomes were additionally analysed in a subgroup of solely psychiatrist PIs. During an a priori review of the CIHR database contents for psychiatry departments, we determined that the population of sole psychiatrist applicants (only since 2008) had a non-negligible risk for lacking sufficient power for our planned analysis. Conservatively, it was decided a priori to include non-clinician applicants to yield a greater sample size and statistical power for revealing potentially subtle gender-based disparities.
As award data were not expected to satisfy the principle of normality a priori, we conducted non-parametric analysis. The Shapiro-Wilk test was used to assess the normality of continuous outcomes, which subsequently reached significance for non-normal distributions. Data are, therefore, presented using proportions and medians (IQR). Additionally, the Mann-Whitney U test and Glass rank biserial correlation (rg) were used to compare the number of awarded grants, award duration and grant amount between genders. The null hypothesis was defined as no difference between recipients who were women or men for a given award metric (such as award contribution and duration). The alternative hypothesis to indicate a statistically significant difference was based on an alpha level of 5%. For results with a significance outcome less than 5%, we rejected the null hypothesis. Otherwise, for results with a non-significant outcome greater than 5%, we failed to reject the null hypothesis. As all data were reported in its entirety from publicly and federal sources, there were no missing data. Thus, all grants were eligible for synthesis across all outcomes. Analysis was performed in RStudio V.2022.02.0+443.
Results
Psychiatry departments (physician and non-physician and scientists)
Psychiatry departments received a total of 908 grants between 2008 (earliest identified) and 2022, of which 370 (40.75%) and 538 (59.25%) were allocated to women and men, respectively. Figure 1 depicts the number of grants awarded per year to psychiatry departments, stratified by gender. Women received a total of US$110 658 191, while men received over double this amount, US$253 339 865. Figure 2 depicts the total contribution per year to psychiatry departments, when stratified by gender. Women received a median contribution of US$105 000 (407 071) per grant, while men received a median contribution of US$200 433.50 (581 969.20) per grant (W=118 648, p=1.583e-07, rg=0.205). There were 449 unique grant recipients composed of 211 women (47%). Since 2008, there were only 72 women awarded multiple grants, compared with 110 men. Women received a median of only 25 (8.5) grants in a year, while men received a median of 37 (8.5) grants in a year (p=0.002128, rg=0.662). Women received a median award duration of only 24 (24) months, while men received a median award duration of 36 (48) months (p=2.312e-06, rg=0.179).
Frequency (%) of awarded grants to Canadian psychiatry departments between 2008 and 2022, stratified by gender. The percentage of total number of awards to males is labelled for each year.
Annual total contribution awarded to Canadian psychiatry departments between 2008 and 2022, stratified by gender. The percentage of total annual contribution awarded to male recipients is labelled for each year.
Psychiatry physician subgroup
The subgroup of psychiatrists received a total of 335 grants between 2008 and 2022, of which 63 (18.81%) and 272 (81.19%) were allocated to women and men, respectively. Figure 3 depicts the number of grants awarded per year to psychiatrists, stratified by gender. Most strikingly, women received a total of US$22 901 569, compared with US$144 451 178 for men. Figure 4 depicts the total contribution per year to psychiatrists, when stratified by gender. Women received a median contribution of US$182 149 (482 916.5) per grant, while men received a median contribution of US$237 500 (605 743.50) per grant (W=9355.5, p=0.2557, rg=0.0919). There were 114 unique grant recipients composed of 23 women (20.18%). Since 2008, there were 15 women awarded multiple grants, compared with 60 men. Women received a median of 4 (3) grants in a year, while men received a median of 19 (4.5) grants in a year (p=3.565e-05, rg=0.889). Finally, women received a median award duration of 24 (48) months, while men received a median award duration of 36 (48) months while (p=0.2822, rg=0.0844).
Frequency (%) of awarded grants to Canadian psychiatrists between 2008 and 2022, stratified by gender. The percentage of total number of awards to males is labelled for each year.
Annual total contribution awarded to Canadian psychiatrists between 2008 and 2022, stratified by gender. The percentage of total annual contribution awarded to male recipients is labelled for each year.
Discussion
We report significant gender-based disparity in the provision of CIHR grants to recipients from psychiatry departments between 2008 and 2022. Most notably, although the number of awarded grants did not widely differ between men and women, men received over twice as much funding. Also, a broader group of women from psychiatry departments received 40.75% of grants, which is commensurate with rates of women applying for CIHR grants.11 However, within the subgroup of psychiatrists, only 18.81% of awards were conferred to women. We also report significant disparity within underlying award metrics, including award duration, monetary contribution and grants awarded per year.
Gender inequity in grant funding decisions may be attributed to implicit bias held by decision-makers when evaluating applicants. Indeed, in one study assessing CIHR grant applications between 2012 and 2014, lower application scores were associated with female applicant status even after controlling for scientific productivity.9 This gender bias in the evaluation of grant applications has also been reported in other grant funding agencies. For instance, one Dutch study evaluated the effect of award committees prioritising the ‘quality of the researcher’, which ultimately resulted in higher rates of grant success among men.15 As a result of this phenomenon, among other factors, the authors quantified that women were under-represented by 4% compared with their rates of applying for such grants.15 However, aside from gender bias among award committees, other factors may contribute to this gender gap in research funding. Indeed, a recent CIHR report on applicant data demonstrated that women requested approximately only two-thirds of the funding amounts requested by men.11 We hypothesise that gender differences in funding be, at least in part, due to social biases and barriers that may discourage women from targeting higher grant funding.
As research productivity remains an important evaluation metric for grant funding, continued effort should be concentrated into initiatives that provide women with equitable opportunities for mentorship and research scholarship. Ongoing modifications to institutional policies may issue greater flexibility to balance family-related and work-related responsibilities, and confer additional bandwidth to engage in research. Another notable initiative involves the mentorship of young women by successful same-gender role models.16 In one systematic review of medical mentorship programmes for and designed by women, metrics such as research productivity improved after implementation among junior faculty.17 Removing research capacity restrains among physicians who are women may also drive their increased representation among medical leadership. Indeed, research productivity is a common metric for career promotion in academic medicine.6 In the context of same-gender mentorship programmes, evidence demonstrates that along with improved scholarly metrics, mentees who were women reported increased rates of job satisfaction, chances for promotion and career retention.17 In summary, narrowing the gender gap in research funding may also advocate for the broader issue of under-representation of women in medical leadership.18
This retrospective analysis has some limitations. First, the CIHR database does not report the ratio of woman-to-man applicants in each year. The gender disparity in grant recipients may reflect that more men than women apply for grants. However, this phenomenon would not account for gender-based discrepancies in other award metrics, such as award duration and total contribution. That said, previous work has demonstrated that women often requested less funding than men, which may reflect ancillary effects of implicit bias.9 Advocating for future transparency on applicant and recipient demographics may help to identify potential sources of bias during grant applicant evaluation. Additionally, our dataset is limited in size as the CIHR funding database only reports funding decisions since 2008, although grant awards have been conferred for many years prior. While we achieved statistical power to reveal significant gender-based differences in the total departmental population, analysis of the psychiatrist subgroup only reached significance for the median number of awards per year. We hypothesise that, over time, a growing dataset on grants awarded to psychiatrists may yield sufficient power to reveal significant gender-based differences on other award metrics, as were revealed in the larger departmental population. Next, our results are limited to investigating binary gender differences in award metrics and do not account for other valid gender identities (eg, transgender and genderfluid) who also encounter significant societal barriers. As well, recent CIHR data does not entirely elucidate the intersection of gender with career stage on variables such as the proportion of early-stage career women out of the total applicant pool.19 20 Likewise, recent data do not stratify by non-professional obligations, such as family planning and its interaction with gender.19 20 That said, in contexts outside of CIHR funding decisions and psychiatry, a recent review asserts that women may submit fewer applications and obtain fewer grants due to barriers including childrearing and non-research activities (eg, teaching and administration).21 Further, especially for women with intersectional identities (eg, simultaneously a person of colour), they may participate in other time-consuming activities such as equity, diversity and inclusion initiatives which can serve as a minority tax and detract from research time.21 More investigation into application rates by gender and its interaction with career stager is needed. Finally, publicly available data from the CIHR do not measure the interaction of gender with ethnicity, institution and research content.21 If at all, these variables are typically reported independently.21 Future work is needed to make these demographic interactions more apparent to improve equity promoting efforts.
Conclusion
In summary, we report significant gender disparity in the provision of CIHR grants to women and men from Canadian departments of psychiatry. Future work should re-evaluate the extent of gender disparity in CIHR grant funding decisions as a growing sample of data accumulates over years. As well, further studies should investigate non-binary gender disparities within psychiatry and departmentally related grant funding decisions. Disparities stratified by demographics other than gender deserve further study. Finally, our results indicate a need to address systems-level barriers to career advancement among women in academic medicine. Promoting equal gender representation among grant funding committees may provide more objective gender-based balance to evaluating CIHR grant applications.
Data availability statement
Data are available on reasonable request. Data available on reasonable request to the corresponding author.
Ethics statements
Patient consent for publication
Ethics approval
This study was exempt from institutional review board approval as the data were extracted in its entirety from publicly available resources. The dissemination of results will not identify any individual or generate new forms of identifiable information.
Footnotes
Contributors BT, FK and SN conceived of this work. BT, FK, SN, TV and VWLT developed the methodology. KM and BT collected the data. BT conducted the analytical methods. All authors reviewed and discussed the results and contributed to the final manuscript. BT and FK had full responsibility over this work, the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The authors did not have any relationship with organisations or individuals that may have influenced this study. Dr. FK is the recipient of the Michael Smith Health Research BC Award (2023–2028); Don Rix Physician Leadership Lifetime Achievement Award (2022); BC Achievement Foundation-Mitchell Award of Distinction (2022); University of British Columbia-Distinguished Achievement Award for Equity, Diversity & Inclusion (2022) and Vancouver Medical Dental & Allied Staff Association-Equity, Diversity & Inclusion Award (2022).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.