Abstract

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.

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