Key Points Question Are women, who in 2015 made up 61.9% of pediatricians and 53.0% of full-time physician pediatric faculty, underrepresented among physician first authors of perspective-type articles published in the 4 highest-impact general pediatric journals? Findings In this cross-sectional study, women were underrepresented among physician first authors (140 of 336 [41.7%]). Underrepresentation was more pronounced in article categories described as more scholarly (range, 15.4%-44.1%) vs narrative (range, 52.9%-65.6%). Meaning Because women are underrepresented among physician first authors of perspective-type articles, they are less likely to have opportunities to express their opinions and provide insights that may influence the field.