A 20-Year Spatio-Temporal Analysis of Gender Workforce in Medical Departments of Psychiatry/Psychotherapy and Neurology in Germany.

Background

Although almost two-thirds of medical students in Germany are female, medical leadership positions remain predominantly held by men. This study investigated gender-specific career progression in psychiatry/psychotherapy and neurology, two closely related clinical specialties, using spatio-temporal analyses over a 20-year period.

Methods

The study analyzed five time points (2004, 2009, 2014, 2019, and 2024) to evaluate the temporal and spatial distribution of gender representation across Germany. Data on medical students, hospital-based specialists in psychiatry/psychotherapy and neurology, and department chairs were obtained from the Federal Statistical Office, the Federal Chamber of Physicians, and the medical faculties of 38 universities. Female-to-male ratios (f:m) were calculated for each career stage and applied to the established academic Brüggmann-Groneberg (BG) Index and to a newly developed clinical leadership version introduced in this study (BGclin Index).

Results

In 2024, 64.9% of German medical students were female. Gender parity was reached among hospital-based specialists in psychiatry/psychotherapy and neurology, with f:m ratios increasing from 0.71 (2004) to 1.17 (2024) and from 0.40 (2004) to 1.00 (2024), respectively. Women remained markedly underrepresented in clinical leadership roles (2024 psychiatry/psychotherapy: 0.48; neurology: 0.23) and among department chairs (2024 psychiatry/psychotherapy: 0.15; neurology: 0.14). BG Indices reflected these disparities, with the highest academic BG Index observed in psychiatry/psychotherapy in 2019 (0.112) and in neurology in 2019 (0.091), while BGclin values remained higher, around 0.199 in psychiatry/psychotherapy and around 0.120 in neurology. Spatial analysis revealed substantial regional variation across Germany, with persistent gender disparities across federal states.

Conclusions

Despite achieving gender parity at the specialist level, substantial gender disparities persist in both academic and clinical leadership in the examined specialties. The BG Indices highlighted a sustained disparity in women's advancement, which was more pronounced in neurology than in psychiatry/psychotherapy.