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.

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).

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.

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.

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).

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.