A longitudinal analysis of gendered career trajectories and academic efficiency in North American MD/PhD faculty.

Gender disparities in academic medicine persist despite increasing women's representation in higher education. Prior research highlights the underrepresentation of women in senior ranks and leadership roles, yet few studies have assessed these disparities using time-adjusted productivity metrics. This study aims to evaluate gender-based differences in academic rank, scholarly productivity, and leadership representation among MD/PhD faculty in North America, accounting for career length and institutional variability. A secondary analysis was conducted on a dataset of 6,149 MD/PhD faculty from 122 accredited North American medical schools. Time-adjusted measures of productivity, H-index per year and citations per year, were calculated. Gender differences in rank, productivity, and leadership were assessed using Mann-Whitney U tests and descriptive statistics. Institutional-level representation of women in leadership roles was also analyzed. Women held significantly lower academic ranks than males and were underrepresented in departmental leadership roles. Despite achieving assistant and full professorships earlier, women were overall less likely to reach these positions. Males exhibited higher time-adjusted H-index and citation rates (p < .0001), with a compounded 3.5-year publication gap. Institutional analysis revealed stark variability: 38 institutions had no women in MD/PhD leadership roles, while fewer than 20 percent achieved gender parity. Gender disparities in academic medicine cannot be explained by productivity alone. Structural barriers, opaque promotion criteria, and institutional cultures continue to impede women's advancement and leadership. Addressing these inequities requires transparent policies, targeted mentorship, equity audits, and inclusive leadership pathways to support a more equitable academic workforce.