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Research Christmas 2015: Face Time

Plenty of moustaches but not enough women: cross sectional study of medical leaders

BMJ 2015; 351 doi: (Published 16 December 2015) Cite this as: BMJ 2015;351:h6311
  1. Mackenzie R Wehner, resident physician1,
  2. Kevin T Nead, resident physician2,
  3. Katerina Linos, professor of law3,
  4. Eleni Linos, assistant professor4
  1. 1Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, US
  2. 2Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, US
  3. 3Berkeley Law, University of California Berkeley, CA 94720, US
  4. 4Department of Dermatology, University of California San Francisco, 2340 Sutter Street, San Francisco CA 94143, US
  1. Correspondence to: E Linos linose{at}


Objectives To draw attention to sex related disparities in academic medical leadership by investigating the representation of female leaders compared with leaders with moustaches.

Design Cross sectional analysis.

Setting Academic medical departments in the United States.

Participants Clinical department leaders (n=1018) at the top 50 US medical schools funded by the National Institutes of Health (NIH).

Main outcome measures The proportions of female leaders and moustachioed leaders across institutions and specialties (n=20). Additionally, the moustache index: the proportion of women compared with the proportion of moustaches, analyzed with multinomial logistic regression models.

Results Women accounted for 13% (137/1018) of department leaders at the top 50 NIH funded medical schools in the US. Moustachioed leaders accounted for 19% (190/1018). The proportion of female department leaders ranged from 0% (0/20) to 26% (5/19) across institutions and 0% (0/53) to 36% (19/53) across specialties. Only seven institutions and five specialties had more than 20% of female department leaders. The overall moustache index of all academic medical departments studied was 0.72 (95% confidence interval 0.58 to 0.90; P=0.004). Only six of 20 specialties had more women than moustaches (moustache index >1).

Conclusions Moustachioed individuals significantly outnumber women as leaders of medical departments in the US. We believe that every department and institution should strive for a moustache index ≥1. Known, effective, and evidence based policies to increase the number of women in leadership positions should be prioritized.


  • MRW and KTN contributed equally and are co-first authors. We thank Jon Dyer for use of figure 2, John Boscardin for statistical advice, and Natalie Linos and Elizabeth Linos for content advice and editing. EL thanks the American Academy of Dermatology 2015 Leadership Forum, and KL thanks the Hellman Family Fund.

  • Contributions: MRW, KTN, and EL conceived and designed the project and collected data. MRW and KTN analyzed the data. MRW, KTN, KL, and EL wrote the manuscript. EL is guarantor.

  • Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests: MRW, KL, and EL are women. KTN is a man and does not currently have a moustache. All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study used publicly available data and institutional review board was not required.

  • Transparency: The manuscript’s guarantor affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained

  • Data sharing: Statistical code and dataset are available from the corresponding author.

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