FEMALE PHYSICIANS IN
THE WORKPLACE
ARE WE AT A TIPPING POINT?
ARE WE AT A TIPPING POINT?
By Aekta Malhotra, MD MS, and Aparna Iyer, MD
Female physicians in the workforce
seem to be at the brink of
a tipping point. An ever-growing
body of data demonstrates the
clear benefits of having a diverse
employee population, with clear evidence
supporting women as effective and motivated
leaders, allies, and employees. However,
many female physicians are struggling to
remain in the workforce, citing burnout and
opting to either demote their roles or leave
the workplace entirely. The pandemic made
these inequities and challenges worse; over
25% of female physicians have since reduced
their work hours, as compared to 2.6% of
male physicians. As a result, hospital systems
and medical communities worldwide risk
losing some of their most valuable talent,
and the retention of female physicians will
be contingent upon understanding complex
contributing stressors as well as making
shifts that make the workplace culture more
sustainable.
Women have become an essential part
of the physician workforce, both due to
the sheer number of female physicians as
well as the essential and unique contributions
of female physicians to patient care,
research, clinical outcomes, leadership,
and more. Females constitute 50% of the
medical student class, and female physicians
constitute over 41% of full-time academic
medical school faculty. Females accounted
for 36.3% of the physician workforce in an
article cited in 2019, a sharp increase from
28.3% in 2007. Women in all areas of medical
and corporate leadership were shown
to have strengths of increased allyship with
minorities, concerns for the well-being of
their employees and peers, and an emphasis
on inclusion and anti-discrimination. Female
physicians fare equally well and, in many
cases, better in inpatient care situations: an
increasing body of data demonstrates that
female physicians provide improved quality
of patient communication, team collaboration,
and clinical outcomes.
If female physicians in the workplace are
clearly strengths for the medical community,
why are we at risk of a sharp decline of
female physicians altogether? While females
account for a large part of the physician
workforce, inequities and other significant
hurdles make the choice to remain in the
workplace simply unsustainable for many.
This is particularly true for several subgroups,
such as women physicians in leadership,
women of color, bisexual and lesbian women,
and mothers. Female physicians describe
feeling the workplace pressures of microaggressions,
8 | DALLAS MEDICAL JOURNAL • May 2022
under-representation, and difficulty
with being promoted at a lesser frequency
than their male peers. The data shows that,
when compared to their male peers, female
physicians are not promoted at the same
frequency, do not obtain research funding
to the same extent, and are not paid
equitably. A 2021 report from the Association
of American Medical Colleges found that
female physicians are paid a mere $0.67 to
$0.77 on the dollar when compared to their
white male peers. When adjusting for others
factors (including hours worked, clinical revenue,
practice type, and specialty), female
physicians earned on average $2,043,881 less
than their male colleagues over the course of
a 40-year career. Further, in academic medical
centers, females only account for 18% of
academic chairs, 18% of deans, and 25% of
full professors. Female physicians have also
reported experiencing discrimination largely
around pregnancy and maternity leave.
With many describing the candle burning
at both ends, female physicians often
have to balance their work challenges and
responsibilities with experiencing a greater
proportion of the responsibilities for their
home duties as well — and preexisting
gender inequities for home responsibilities
widened greatly during the pandemic. The
childcare crisis of 2020 left working parents in
a bind to balance employment with housework,
education of children, and aroundthe
clock childcare — although women,
and particularly single mothers and mothers
of color, disproportionately shouldered this
responsibility. For physicians, these statistics
were staggering: approximately 45% of
women physicians stated they were primarily
responsible for the household tasks compared
with approximately 5% of their male
peers. The disparity is even greater in physician
couples, with 28% of female physicians
primarily managing house and childcare responsibilities
compared to none of their male
counterparts reporting the same. Pandemic
stressors have necessitated greater work-life
integration, with 65% of female physicians
working from home compared to 25% of
their male peers.
In the post-2020 era, the stressors on
female physicians have taken a toll on wellbeing
and mental health. Although there
was no clear difference in risk for depressive
symptoms pre-pandemic, female physicians
are currently at a higher risk for depression
symptoms when compared to their male
colleagues. Female physicians have also selfreported
a higher level of overall stress and
burnout symptoms.
It should be noted that a limitation of
many of these studies was a focus on heterosexual
households; there are many other
kinds of families that face similar (and often
greater) challenges, including same-sex
households, single-parent households, and
those with gender minorities.
An Approach That Works
It is unquestionable that gender equity
and the physician workforce shortage are
inextricably linked. Given that over 50% of
medical school matriculants constitute
women and other gender minorities, it is
critical that we rebuild our healthcare system
to encourage these marginalized groups to
not just stay in medicine, but also realize long
and fulfilling careers. These goals will not be
possible without institutional, cultural, and
public policy efforts focused on intentional
equity and inclusion specifically targeted at
abolishing systemic barriers. Below we outline
several measures for consideration.
1. Normalizing Well-being
Neglecting well-being and self-care is a
chief driver of burnout, depression, anxiety,
and other morbidities. This is particularly
challenging for women, gender minorities,
and people of color because of the stigma
associated with help-seeking. These groups
can perceive seeking support and prioritizing
personal well-being as signs of inferiority or
personal shortcoming. Therefore, it is unsurprising
that 40% of female physicians either
choose to go part-time or leave medicine
altogether within six years of completing
their residency. This is a staggering loss to a
healthcare system already faced with a criti-
HOUSE CALL