Background: There is an attrition of women physicians in academic medicine hierarchy. Scholarship in medical journals plays a direct role in career advancement, promotion, and authoritative recognition, and women physician authors are underrepresented in original research articles. Objectives: We sought to determine if women physician authors are similarly underrepresented in commentary articles within high impact journals. Design/Setting/Participants: In this observational study, we abstracted gender, degree, and authorship position from January 1, 2014 to October 16, 2018 among commentary articles in three high impact journals: 1) JAMA Viewpoint; 2) NEJM Perspective; and 3) Annals of Internal Medicine Ideas and Opinions. Primary Outcome Measure: To compare the percentages of authors by gender, degree, authorship position, and journal in commentary articles, and assess for trends over a five-year period. Secondary Outcome Measures: To compare the proportion of men and women physician authorship of commentaries relative to the proportion of men and women physician faculty within academic medicine. To examine the gender concordance between last and first authors. Results: Of the 2,087 articles during the study period, 48% were men physician first authors compared to 17% women physician first authors (p<0.0001). Of the 1,477 articles with more than one author, similar distributions were found with regard to last authors: 55% were men physicians compared to only 12% of women physicians (p<0.0001). The proportion of women physician first authors increased over time, however the proportion of women physician last authors remained stagnant. Women authors in the first and last position were concordant in 9% of articles, men authors in the first and last author position were concordant in 55% of articles. Conclusions: Women physician authors remain underrepresented in commentary articles compared to men physician authors in the first and last author position. The proportion of women first authors was lowest with a women last author.