during the past 50 years , the number of women enrolling in medical school has increased almost nine - fold . in particular , the figures published by the association of medical colleges   showed that , in 2005 , women in the united states ( us ) represented 49% of all medical students , compared to 6% in 1960 . similarly in the united kingdom ( uk ) , women composed 59% of the yearly intake of medical schools in 2009 , in contrast to 32% in 1977 . despite this encouraging influx , there is considerable evidence that women are still under - represented in the higher echelons of academic medicine [ 3 - 5 ] . studies on surrogate markers of academic productivity , like the authorship of scientific publications   and the presence on the editorial board of biomedical journals , clearly demonstrate that female representation in these areas is still scanty despite recent increases . the lowest numbers are recorded in the specialty journals of surgery and orthopaedics ( where the proportion of female first authors is only 16.7% and 6.5% , respectively ) , while in obstetric and paediatric journals the percentage is closer to 40% . this inequality between the two genders is also evident in other fields of academic medicine , such as rank attainment , leadership roles and salaries . the percentage of female principal investigators for the national institute of health ( nih ) was 24.6% in 2003 , with female investigators achieving , on average , smaller grants . only 12% of department chairs , 17% of full professors and 11% of medical school deans in the us are female . in the uk , the council of heads of medical schools annual census has shown that , in 2006 , female doctors accounted for only 11% of all professorships and only 36% of clinical lecturers ' posts . interestingly , the proportion of women steadily decreases as they progress from assistant to associate and full professor both in ' traditionally male ' ( 21% , 12% , 6% in surgery ) and ' traditionally female ' ( 53% , 40% , 22% in paediatrics ) specialties . could this kind of disparity exist only in the aforementioned fields of academia ( authorship , editorial board members , professoriate ) ? is gender imbalance more prominent in certain countries or specific ' traditionally male ' specialties ? four international intensive care medicine ( icm ) congresses from three continents were evaluated in terms of female faculty members and speakers . the organizers were the european society of intensive care medicine ( esicm ) , the department of intensive care medicine of erasme university hospital in brussels , in association with the belgian society of intensive care and emergency medicine ( isicem ) , the society of critical care medicine ( sccm ) and the australian and new zealand intensive care society / australian college and critical care nurses ( anzics / acccn ) . using the scientific programmes of the congresses , the proportion of female faculty members was calculated to be 6% in the 32nd isicem and 15% in the 24th esicm meetings that took place in march 2012 and october 2011 , respectively . the percentage was higher in the united states 41st sccm congress ( 25% ) , whereas in the upcoming 37th anzics / acccn women account for 35% of all invited speakers . interestingly , when the non - medical participants were excluded ( mainly nurses and pharmacists ) , the medical female representation amounted to a disappointing 10% , 15% and 16% in the esicm , sccm and anzics / acccn meetings , respectively . the numbers are , at least , disheartening . as advancement in academic medicine is tightly correlated to the external influence of one 's scholarly work and the invitations to present that work publicly , the under - representation of women in the most esteemed intensive care meetings globally poses a significant question : why are women so minimally represented ? surely it can not be the pipeline effect , the notion that an insufficient number of women have been in medicine long enough in order to advance to the top tiers of academia . women have occupied at least 50% of the medical positions for the past 25 years in several fields , without ever assuming the same proportion of leadership roles as their male colleagues . equally unsupported is the explanation that women are less committed to their careers because of family and other personal responsibilities . recent studies have suggested that a balance between work and other activities is as important to men as it is to women , at least among the younger physicians [ 14 - 16 ] , and that there is no significant gender difference in the reported importance of career advancement or in the extent to which work and personal life conflicted . another proposed explanation , the lack of quality in the work produced by women , has been dismissed by housri and colleagues , who showed an increased frequency with which female authors are cited as well as an increased rate of publication in the journals with higher impact factors . most likely , the paucity of women speakers in icm congresses is another manifestation of the ' glass ceiling effect ' : that is , the observation that despite increased entry of women into the fields traditionally held by men , their advancement into the most prestigious , highest - paying , and leadership positions is still limited . several explanations have been proposed : traditional gender roles imposed historically , gender discrimination with many , subtle manifestations , and a lack of same - sex mentors and role models . the resulting scarcity of women at higher ranks may explain their under - representation in icm meetings , since the candidate pool of potential speakers remains small . however , another explanation that has been proposed , albeit in a different setting , is that the ' homogeneity and concentration of power may have contributed to certain unintended biases ' . it is suggestive that out of the 23 scientific advisors and collaborators that contributed to the 32nd isicem meeting , none were female ( interestingly , all managerial and secretarial staff were women ) . the numbers were marginally better across the atlantic , with 6 out of 38 ( 16% ) members of the planning committee of the 41st sccm congress being female medical doctors . could the observed gender imbalance be partly due to the small number of women in decision - making posts ? in conclusion , the scarcity of female speakers and faculty members in icm congresses strongly suggests the existence of a ' glass ceiling ' in the field of critical care . clearly , these results constitute solely a snapshot of each society 's annual congress and , even if every attempt was made to correctly identify the gender of faculty members , there is always room for error . it is also possible that the balance would be somewhat different in icm conferences of other , ' traditionally female ' , sub - specialties ( for example , in paediatric icm ) . however , the exceptionally low female representation in the congresses validates the perception that although women have made remarkable strides in the last decades , a gender gap still remains . it is present in a specialty that was not , up to now , considered to be gender - biased , and appears to be a global phenomenon . simply acknowledging the problem will bring us a step closer to its resolution . after all , wasting ' half our genetic pool of intelligence , creativity and experience ' will only hinder the improvement of health care for all , a loss that medicine simply ' ca n't afford ' . anzics / acccn : australian and new zealand intensive care society / australian college and critical care nurses ; esicm : european society of intensive care medicine ; icm : intensive care medicine ; isicem : belgian society of intensive care and emergency medicine ; sccm : society of critical care medicine .