Background

Academic medicine often struggles to balance leadership duties with maintaining research productivity. The impact of holding a position of power on authorship practices in a hierarchical environment remains underexplored. We addressed this gap by examining how leadership roles influence publication and collaboration patterns in Lithuanian medical academia.

Methods

We performed a bibliometric analysis of ten-year publication records for 633 Lithuanian medical researchers in formal leadership positions (department heads, center directors, and similar formal roles), comparing their output and authorship patterns to those of peers without such roles. Publication data were collected from PubMed and a national academic library, capturing total publications, author order (first/middle/last author positions), and co-authorship counts. We used statistical tests to compare groups and applied the Gini coefficient to assess inequality in research output.

Results

Leaders showed distinct authorship roles and collaboration patterns. Compared to equally productive non-leaders, leaders had significantly fewer first-authored papers (10.79% vs 36.31%) and more last-authored (36.42% vs 23.57%) and middle-authored contributions (52.78% vs 40.12%). Leaders published more papers (average 78.42 vs 49.41), in Web of Science–indexed journals (average 49.44 vs 27.68), and had higher h-indices (19.66 vs 12.59) (all p < 0.001). They also more frequently co-authored in larger teams (>5 co-authors: 58.76% vs 51.79%, p < 0.001). Output inequality among leaders was high (Gini = 0.718). Gender trends differed: prolific leaders were mostly men, while prolific non-leaders were mostly women. Importantly, these authorship patterns remained consistent across leader subgroups with varying productivity levels.

Conclusions

Leadership position significantly impacts authorship practices and research productivity in Lithuanian medical academia -leaders display different patterns of collaboration and authorship positions, along with considerable institutional and gender disparities. The results illustrate how hierarchical power dynamics shape academic publishing in Lithuanian medical institutions. This evaluation could lead to important changes for organizational development and policies that ensure authorship credit accurately reflects actual contributions to research. From a research ethics perspective, authorship involves both accountability and recognition. The leadership-related shifts we observe require ethical scrutiny; our bibliometric analysis reveals structural patterns but cannot determine whether specific papers meet ICMJE authorship criteria.