Gender Differences in X (Formerly Twitter) Use Among Oncology Physicians at National Cancer Institute–Designated Cancer Centers: Cross-Sectional Study

Introduction

In 2023-2024, women comprised 55% of matriculating US medical students but continue to be underrepresented in academic medicine [1,2]. This is particularly true in the workforce and leadership of oncology disciplines [2]. Social media platforms have gained popularity for professional development [3], though data characterizing gender parity in the social media oncology workforce are lacking and studied herein.

Methods

Overview

Twenty regionally distinct National Cancer Institute (NCI)–designated cancer center websites were accessed from December 2023 to July 2024 (Table 1) and physician demographic information was collected. Apparent gender (binary) was assigned by a single researcher (VT) using names, pronouns, and/or public profile images. Among physicians on X, publicly available data were manually collected. Physicians with missing numbers of “likes” (public reporting discontinued June 12, 2024) were excluded. Statistical analysis by X use and gender was performed using Wilcoxon rank sum and chi-square (or Fisher exact) tests for continuous and categorical variables, respectively. Analyses were performed using R (version 4.0.5; The R Foundation) with 2-sided tests with P≤.05.

Ethical Considerations

This cross-sectional study used publicly available data and was therefore exempt from ethical approval per the Cedars-Sinai Medical Center institutional review board (STUDY00003292). STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines were followed (Multimedia Appendix 1).

Results

In total, 2908 physicians’ profiles were analyzed, of which 37% (n=1068) were on X (Table 2). There was a greater proportion of women (vs men) physicians on X in the Northeast (35.1% vs 27.1%) but a smaller proportion in the Midwest (32.2% vs 39.6%; P=.03; Table 2). X users accounted for a higher proportion of women (39% vs 35%; P=.05), were more likely to hold leadership titles (P<.001), and had an advanced dual degree (33% vs 25%; P<.001) than non–X users. Among those on X, women (vs men) were less likely to have “professor” status (25% vs 41%; P<.001) and leadership titles (P=.006) but more likely to have a master’s in public health (9% vs 5%; P=.03).

Overall, women (vs men) had significantly fewer followers (mean 305 vs 390, P=.002) and tweets (mean 131 vs 169, P=.02). Adjusting for fewer years on X, women showed similar influence as men (mean 48 vs 55 followers per X-year, P=.12) but a higher rate of liking posts (mean 77 vs 46 per X-year, P=.02). Women (vs men) were more likely to mention being a parent in their biography (17% vs 10%, P=.002), but no differences were noted in other content variables (P>.05).

Discussion

Principal Results

In this cross-sectional study evaluating gender parity in the oncology workforce on social media, we observed women physicians on X being less likely to hold professor status and leadership titles. As seen on X, particularly in male-dominated fields of radiation and surgical oncology, the proportion of women was significantly higher than published workforce estimates (radiation oncology: 42% vs 31%, P=.04; surgical oncology: 51% vs 39%, P=.03) [2]. These data are suggestive of motivational and/or behavioral differences in X use by gender.

Comparisons With Prior Work

We observed that women were more likely to mention being a parent, consistent with studies describing higher engagement in fostering support and community [3]. Further, women “liked” more posts, which perhaps parallels the expected levels of “friendliness” and tone softening in women’s professional communications, which has been associated with increased emotional labor. Indeed, content language analyses have demonstrated that women use exclamation points more frequently than men and as markers of “friendly interaction” [4]. Behavioral psychology studies report that women have higher engagement in emotional labor practices, which may drain resources without equitable rewards, contributing toward the underrepresentation of women in leadership positions [5]. These findings support continued evaluation of motivational and/or behavioral differences in professional social media use.

Men physicians are more likely to hold “verified” X accounts (verification is thought to add a degree of validity) [6] and report professional benefits from social media use, such as invited talks [7], consistent with studies reporting that women X users face challenges in popularity and influence at academic meetings despite comparable activity [8]. Thus, while social media offers a platform for connection and visibility [9], these findings underscore the need for ensuring equitable opportunities moving forward.

Limitations

Institutional websites may be inaccurate, incomplete, and/or outdated. Gender classification may be inaccurate and impart classification bias. Publicly available X data are more limited than prior studies [10]. Verified status was not analyzed due to low occurrence (0.2% of accounts).

Conclusions

Women oncologists are enriched on X, with higher self-engagement, suggestive of a heightened motivation for professional X use. Future longitudinal studies examining the role of emotional labor and network support in motives for social media use are warranted.