• Mackenzie R Wehner, Kevin T Nead, Katerina Linos, and Eleni Linos.
• Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, US.
• BMJ. 2015 Jan 1;351:h6311.

ObjectivesTo draw attention to sex related disparities in academic medical leadership by investigating the representation of female leaders compared with leaders with moustaches.DesignCross sectional analysis.SettingAcademic medical departments in the United States.ParticipantsClinical department leaders (n=1018) at the top 50 US medical schools funded by the National Institutes of Health (NIH).Main Outcome MeasuresThe 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.ResultsWomen 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).ConclusionsMoustachioed 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.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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