A Commitment to Gender Equity in Medicine: An American Medical Women’s Association Position Paper

Abstract

Background:

The American Medical Women’s Association (AMWA) highlights the ongoing gender inequities in the medical profession, particularly in pay, leadership roles, workplace treatment, and work–life integration.

Objective:

To present evidence of gender disparities in medicine, analyze their root causes, and propose strategies for fostering a more equitable and inclusive environment.

Findings:

Despite progress, women physicians continue to face significant disparities, including lower salaries, underrepresentation in leadership roles, and discrimination. These issues are particularly pronounced among minority women and physician mothers.

Recommendations:

AMWA advocates for transparent pay structures, robust antidiscrimination policies, comprehensive support for physician mothers, and a shift toward work–life integration to ensure that all physicians can thrive professionally and contribute fully to patient care.

Conclusion:

By addressing these inequities, the medical profession can create an environment where all physicians thrive professionally and contribute fully to patient care.

Introduction

The American Medical Women’s Association (AMWA) steadfastly champions the cause of gender equity in the medical profession. Despite notable strides forward, persistent disparities in pay, leadership representation, workplace treatment, and work–life integration starkly illustrate that gender equity remains an elusive goal. This position paper outlines the current state of gender inequity in medicine, highlighting key areas where improvements are necessary to create a more equitable and inclusive environment for all physicians.

Position Statement

The AMWA urgently calls for immediate and sustained action to address gender inequity in medicine. Despite significant progress, pervasive disparities in pay, leadership representation, workplace treatment, and work–life integration remain pervasive, with women physicians consistently earning less, holding fewer leadership roles, and facing greater workplace discrimination and burnout than their male counterparts. These inequities are further exacerbated for minority women physicians. AMWA advocates for transparent pay structures, robust antidiscrimination policies, comprehensive support for physician mothers, enhanced mentorship and leadership programs, and a cultural shift toward prioritizing work–life integration. Achieving gender equity is imperative not only for the well-being of women physicians but also for the advancement of the medical profession and the quality of patient care.

Inclusivity Statement

Our overarching mission is to create an inclusive space that fosters leadership and participation among all physicians, doctors-in-training, researchers, students, and health practitioners, including those who identify as women or gender-diverse. We respect the rights of all individuals and are deeply committed to advocating for underrepresented groups, including Black, Indigenous, and people of color, LGBTQIA+ individuals, those who identify as transgender or nonbinary, women physicians serving in the military, international medical graduates, and people with disabilities.

We recognize the significance of embracing diversity in our organization and within the broader medical community. It is important to acknowledge that not every individual who identifies as a woman may see themselves as a mother, and not every person assigned female at birth identifies as a woman. When we use terms such as female, women, minority, and other related terms, we aim to be inclusive of all individuals who identify with these terms, regardless of their identity or expression, and to acknowledge the wide range of experiences and identities that exist within these groups. This includes recognizing the varied gender identities, expressions, sexual orientations, ethnic backgrounds, underrepresented and marginalized status’, and experiences within each of these terms.

We aim to approach the subject of gender equity with a deep commitment to inclusivity and a recognition of the multifaceted identities and purposes within our community. We are dedicated to ensuring that every voice is heard and every perspective is valued.

Gender Inequity in Pay

Gender inequity in pay is a persistent and significant issue in the medical profession, impacting women physicians across various specialties and career stages. Women physicians still consistently earn less than their male counterparts, a discrepancy that undermines the principles of fairness and equity in the workplace.

Evidence of pay inequity

The pay gap between male and female physicians is well-documented. Male primary care physicians earn $229,000 annually, while female primary care physicians earn $197,000, reflecting a 16% gap. This disparity is even more pronounced among specialists, with men earning $345,000 annually compared with $251,000 for women, resulting in a 37% gap.¹ This difference is further exacerbated for minority women, who often face compounded disadvantages due to both gender and racial biases.² In academic medicine, even when adjusting for factors such as faculty rank, age, years since residency, specialty, funding from the National Institutes of Health, clinical trial participation, publication count, total Medicare payment, and hours worked, women physicians still earn $227,783 annually compared with $247,661 for male physicians, a difference of $19,878.¹ The most recent Doximity physician compensation report showed a 23% gender pay disparity. These figures highlight the systemic nature of pay inequity in medicine.

Causes of pay inequity

Several factors contribute to the gender pay gap in medicine, including but not limited to:

Bias in compensation practices and negotiation: Implicit biases can influence salary negotiations and compensation decisions, often disadvantaging women. Additionally, studies have shown that women are less likely to negotiate salaries and are often penalized when they do.³

Occupational segregation: Women are underrepresented in higher-paying specialties and overrepresented in lower-paying ones. Importantly, even in specialty practices where women are the majority, such as obstetrics and pediatrics, men still hold the majority of higher-paid leadership positions.⁴

Career interruptions: Women physicians are more likely to take time off for caregiving responsibilities, which can impact their career progression and earning potential.⁵

Lack of transparency: Opaque salary structures can obscure pay disparities, making it difficult to address inequities.⁶

Mentorship: Women, particularly minority women, often have fewer mentorship opportunities, which can hinder their career development and access to higher-paying positions.⁷

Strategies for addressing pay inequity

To alleviate gender pay inequity in medicine, several strategies should be considered:

Transparent salary structures: Establishing clear and transparent salary structures can help ensure equitable pay. Regular salary audits should be conducted to identify and rectify disparities.

Standardized pay scales: Implementing standardized pay scales based on experience, specialization, and role can minimize subjective biases in compensation.

Support for career advancement: Providing mentorship and sponsorship programs for women physicians can help them navigate career advancements and salary negotiations effectively.

Bias training: Instituting bias training for those involved in hiring and compensation decisions can raise awareness of implicit biases and promote fairer salary practices.

Summary

Addressing gender pay inequity in medicine is essential for fostering a fair and inclusive professional environment. By implementing transparent and standardized compensation practices, supporting career advancement for women, and promoting flexible work policies, the medical community can move toward closing the gender pay gap. The AMWA is committed to advocating for these changes to ensure that all physicians are compensated fairly and equitably.

Gender Inequity in Leadership

Gender inequity in leadership within the medical profession is a noteworthy issue, with women physicians significantly underrepresented in senior roles despite making up a substantial portion of the workforce. This underrepresentation not only limits the career advancement of women physicians, but also deprives the medical field of diverse perspectives and leadership styles.

Evidence of leadership inequity

Statistics reveal a stark underrepresentation of women in leadership positions. Women physicians constitute 38% of full-time medical school faculty, yet they account for only 21% of full professors, 15% of department chairs, and 16% of deans. These figures are particularly concerning given that women have comprised roughly half of medical school graduates for several years.⁸ Promotion rates for first-time assistant professors further highlight this disparity, with 37% of men being promoted over a 10-year period compared with only 31% of women.⁹ These data points underscore the systemic barriers that impede women’s advancement into leadership roles.

Causes of leadership inequity

Several factors contribute to the gender gap in leadership within the medical profession, including but not limited to:

Implicit bias: Gender biases, both conscious and unconscious, often affect hiring and promotion decisions, disadvantaging female candidates.¹⁰

Lack of mentorship and sponsorship: Women often have fewer opportunities for mentorship and sponsorship, which are crucial for career advancement.¹¹

Cultural and institutional barriers: Organizational cultures and institutional policies can inadvertently favor male physicians, creating additional hurdles for women.¹²

Strategies for addressing leadership inequity

To address gender inequity in leadership, the following strategies should be considered:

Mentorship and sponsorship programs: Establish robust mentorship and sponsorship initiatives to support the professional growth of women physicians and prepare them for leadership roles.

Bias training: Implement comprehensive bias training programs to raise awareness and mitigate the impact of implicit biases in hiring and promotion processes.

Transparent promotion criteria: Ensure that promotion criteria are clear, objective, and consistently applied, reducing the potential for biased decision-making.

Leadership development programs: Create targeted leadership development programs that equip women physicians with the skills and networks necessary to advance into senior positions.

Institutional accountability: Hold institutions accountable for gender diversity in leadership through regular reporting and incentives for achieving diversity goals.

Recognition of unpaid work: Institutions should account for all the unpaid work that women physicians do, such as community-centered work and participation on advocacy committees. This work, often driven by a commitment to advocacy, should be recognized and included in promotion criteria.

Summary

Achieving gender equity in leadership within the medical profession is crucial for fostering an inclusive and dynamic health care environment. By implementing mentorship programs, comprehensive bias training, flexible work policies, and transparent promotion criteria, we can dismantle the barriers that prevent women from ascending to leadership roles. The AMWA is dedicated to promoting these changes, advocating for a medical community where leadership opportunities are equally accessible to all, regardless of gender.

Workplace Discrimination

Workplace discrimination is a pervasive issue in the medical profession, disproportionately affecting women physicians. This discrimination manifests in various forms, including career advancement obstacles, disrespectful or punitive actions, and inequitable treatment based on gender and caregiving responsibilities. These discriminatory practices not only hinder the professional growth of women physicians but also contribute to a toxic work environment that affects overall job satisfaction and patient care.

Evidence of workplace discrimination

The prevalence of workplace discrimination against women physicians is alarmingly high. A significant 51.3% of female physicians report experiencing workplace discrimination, compared with 31.2% of their male counterparts. Women physicians are five times more likely to face career advancement obstacles and more than three times more likely to encounter disrespectful or punitive actions. Additionally, 15.2% of women physicians have filed discrimination complaints with their employers, and 27.6% of these individuals reported worsening conditions following their complaint, compared with 8.2% and 5.6%, respectively, for male physicians.¹³ Among physician mothers, four out of five report perceived discrimination, with two-thirds experiencing active discrimination based on gender and over one-third facing maternal discrimination.¹⁴

Causes of workplace discrimination

Several factors contribute to the high incidence of workplace discrimination against women physicians, including but not limited to:

Gender bias and stereotypes: Deep-seated gender biases and stereotypes can influence how women physicians are perceived and treated in the workplace.¹⁵

Institutional culture: Organizational cultures that do not prioritize diversity and inclusion can perpetuate discriminatory practices.¹⁶

Inadequate reporting mechanisms: Insufficient or ineffective mechanisms for reporting and addressing discrimination can deter women physicians from coming forward and exacerbate existing issue.¹⁷

Retaliation: The fear of retaliation or actual retaliatory actions against those who file discrimination complaints can discourage reporting and perpetuate a culture of silence.¹⁸

Strategies for addressing workplace discrimination

To mitigate workplace discrimination and foster a more inclusive environment, the following strategies can be considered:

Implement antidiscrimination policies: Establish and enforce comprehensive antidiscrimination policies that clearly define unacceptable behaviors and outline consequences for violations.

Develop robust reporting mechanisms: Create safe, confidential, and effective channels for reporting discrimination, and ensure timely and fair investigation and resolution of complaints.

Provide bias training: Conduct regular training programs on unconscious bias, cultural competency, and inclusive practices for all employees, particularly those in leadership and decision-making roles.

Promote gender equity initiatives: Establish gender equity committees or task forces to monitor progress, develop initiatives, and promote a culture of inclusion within the organization.

Protect against retaliation: Implement strict antiretaliation policies to protect individuals who report discrimination from any form of retribution.

Summary

Addressing workplace discrimination is essential for creating a fair and supportive environment for all physicians. By implementing strong antidiscrimination policies, developing effective reporting mechanisms, providing comprehensive bias training, supporting caregivers, promoting gender equity initiatives, and protecting against retaliation, the medical profession can move toward a more inclusive and equitable workplace. The AMWA is committed to advocating for these changes, ensuring that all physicians can thrive in their careers free from discrimination.

Discrimination Against Mothers/Caregivers

Discrimination against mothers and caregivers within the medical profession is a significant barrier to gender equity. Women physicians who are mothers or caregivers face unique challenges, including financial penalties, insufficient support during maternity leave, and systemic biases that impede their professional advancement. This discrimination not only affects the careers and well-being of these physicians but also contributes to broader workplace inequities.

Evidence of discrimination against mothers/caregivers

The financial and professional impacts of discrimination against mothers and caregivers are substantial. In a survey of physician mothers, 52.9% reported losing more than $10,000 in income during maternity leave.¹⁹ Additionally, only 28.9% of women physicians’ most recent contracts included maternity leave provisions, highlighting a lack of institutional support.²⁰ A significant 36% of physician mothers reported experiencing maternal discrimination, with 90% attributing it to being pregnant or taking maternity leave, and 48% to breastfeeding on the job.¹⁴ These statistics underscore the systemic issues that disproportionately affect women physicians with caregiving responsibilities.

Causes of discrimination against mothers/caregivers

Several factors contribute to the discrimination faced by mothers and caregivers in the medical profession, including:

Workplace culture: Women physicians often shoulder the majority of caregiving duties, including childcare and eldercare, which can conflict with demanding work schedules. Prevailing workplace norms often undervalue caregiving responsibilities and stigmatize those who prioritize family obligations.²¹

Lack of supportive policies: Inadequate maternity leave policies and a lack of flexible working arrangements place additional burdens on physician mothers. Many residency programs require extension if full maternity leave is taken, delaying entry into the workforce and further impacting job prospects and fellowship options.²²

Implicit bias: Gender biases and stereotypes about women’s roles as caregivers can influence hiring, promotion, and compensation decisions. Assumptions about career commitment based on maternity leave can unfairly limit advancement opportunities.²³

Career penalties: Taking maternity leave or needing flexible work arrangements can be perceived as a lack of commitment, leading to fewer opportunities for career advancement.²⁴

Structural barriers: Institutional policies and practices may not accommodate the needs of physician mothers, leading to systemic inequities.²⁵

Strategies for addressing discrimination against mothers/caregivers

To address discrimination against mothers and caregivers, the following strategies should be considered:

Comprehensive maternity leave policies: Ensure that all physician contracts include adequate maternity leave provisions, reflecting the needs of new mothers. Policies should allow for maximum time off without requiring program extension.

Flexible work arrangements: Develop and promote policies that allow for flexible working hours, part-time roles, and remote work options to accommodate caregiving responsibilities.

Supportive workplace culture: Foster a workplace culture that values and supports caregiving, recognizing it as a legitimate and important aspect of employees’ lives.

Childcare support: Provide on-site childcare facilities or subsidies for childcare to help physician mothers manage their dual responsibilities.

Bias training: Implement regular training on implicit bias and inclusive practices to mitigate the impact of stereotypes and biases in the workplace. Ensure that all staff, especially those in leadership roles, are aware of and actively combat biases against mothers and caregivers.

Mentorship and sponsorship: Establish mentorship and sponsorship programs specifically for physician mothers to support their career development and advancement.

Legal protections and enforcement: Strengthen legal protections against discrimination based on gender, pregnancy, and caregiving responsibilities. Ensure robust enforcement of these protections to safeguard the rights of physician mothers and caregivers.

Summary

Addressing discrimination against mothers and caregivers is crucial for achieving gender equity in the medical profession. By implementing comprehensive maternity leave policies, promoting flexible work arrangements, fostering a supportive workplace culture, providing childcare support, and combating biases, we can create an environment where physician mothers are valued and supported. The AMWA is dedicated to advocating for these changes, ensuring that all physicians can thrive professionally while fulfilling their caregiving responsibilities.

Work–Life Integration

Achieving work–life integration is a critical issue for physicians, particularly for women physicians who often juggle demanding professional responsibilities with substantial caregiving duties. Imbalances in work and personal life can lead to increased burnout, decreased job satisfaction, and ultimately, adverse effects on patient care and physician well-being.

Evidence of work–life imbalance

The struggle for work–life integration is more pronounced among women physicians. A higher percentage of female physicians (55%) report experiencing burnout compared with their male counterparts (44%).²⁶ Women physician–researchers with partners who are employed full-time are more likely to take time off when childcare is disrupted (42.6% versus 12.4%) and are often burdened with greater domestic responsibilities.²⁰ These figures highlight the disproportionate impact of work–life imbalance on women physicians, exacerbating stress and limiting their professional growth.

Causes of work–life imbalance

Several factors contribute to the work–life imbalance experienced by women physicians, including but not limited to:

Rigid work schedules: The inflexible nature of many medical roles makes it difficult for physicians to balance professional and personal responsibilities.²⁷

Lack of institutional support: Furthermore, many medical institutions lack supportive policies such as flexible working hours, part-time positions, and sufficient parental leave.

Burnout and stress: High levels of stress and burnout, exacerbated by work–life²⁷ imbalance, can negatively impact both personal well-being and professional performance.²⁶

Strategies for improving work–life integration

To improve work–life integration for physicians, especially women physicians, the following strategies can be considered:

Flexible work arrangements: Develop and promote policies that allow for flexible working hours, part-time roles, and remote work options to accommodate caregiving responsibilities.

Promote work–life integration: Encourage a culture that supports work–life integration, recognizing and respecting the personal lives and caregiving duties of physicians.

Address burnout: Implement wellness programs and initiatives to address and mitigate burnout, including mental health support, stress management resources, and regular wellness check-ins.

Mentorship and support networks: Establish mentorship programs and support networks specifically for physician parents to share experiences, advice, and strategies for achieving balance.

Role modeling: Encourage senior leaders and role models within the institution to demonstrate and advocate for work–life integration, setting a positive example for all staff.

Summary

Promoting work–life integration is essential for the well-being and professional success of physicians, particularly women physicians who often face disproportionate challenges. By implementing flexible work policies, ensuring equitable parental leave, providing on-site childcare, promoting a culture of work–life integration, addressing burnout, and supporting physician parents through mentorship and support networks, the medical profession can foster a more balanced and inclusive environment. The AMWA is dedicated to advocating for these changes, recognizing that achieving work–life integration is crucial for the health and productivity of physicians and the quality of patient care.

Recommendations

Address pay disparities: Implement transparent pay structures and regular salary audits to ensure equitable compensation for all physicians, regardless of gender.

Promote women to leadership positions: Develop targeted leadership training programs and mentorship opportunities to prepare and support women for senior roles in academic medicine and health care organizations.

Combat workplace discrimination: Enforce strict antidiscrimination policies and provide robust support systems for those who report discrimination, ensuring no retaliation occurs.

Support physician mothers/caregivers: Include comprehensive maternity leave and flexible working arrangements in all physician contracts. Provide on-site childcare facilities and support breastfeeding mothers.

Enhance work/life integration: Foster a culture that prioritizes work–life integration through policies that support flexible working hours, part-time positions, and mental health resources.

Mentorship and sponsorship programs: Establish formal mentorship and sponsorship programs to guide and support women physicians throughout their careers.

Focus on minority women physicians: Implement specific initiatives to address the compounded barriers faced by minority women physicians, ensuring intersectional approaches to equity.

Conclusion

Achieving gender equity in medicine is not only a moral imperative but also essential for the advancement of the medical profession. Women physicians often bring unique perspectives, including a greater focus on women’s health and preventive care, which can significantly enhance patient outcomes. Discrimination against women physicians not only undermines these contributions but also negatively impacts patient care. By addressing these disparities through targeted actions and policies, we can create a more inclusive and equitable environment that benefits all physicians and ultimately improves patient care. The AMWA GETF is dedicated to leading this change and calls on all stakeholders in the medical community to join us in this critical endeavor.

Footnotes

Acknowledgments

The authors extend their sincerest gratitude to the authors of the previous AMWA gender equity position paper, Joyce Braak, Linda Brodsky, Ryan Smith, and Vanessa Coleman, for their foundational contributions in September 2010. Their pioneering efforts have shaped their understanding and commitment to gender equity in medicine. The authors also honor the memory of those listed who have passed away, recognizing their enduring legacy and profound impact on our collective journey toward equality. Inspired by their dedication, the authors remain steadfast in our resolve to advance the cause of gender equity in medicine for generations to come.

Authors’ Contributions

The authors, D.P., V.J.P., B.C., R.T., J.G., M.A.S.D., A.M., and R.G. collectively confirm their contributions to this article. All authors contributed to the conceptualization, drafting, and critical revision of the article. All authors provided significant contributions to the research supporting the article’s arguments. All authors participated in the writing process and in reviewing and editing the final article. All authors have approved the submitted version of the article and agree to be accountable for all aspects of the work.

Author Disclosure Statement

All authors of this article declare no conflicts of interest.

Funding Information

No external funding was received for the drafting of this position statement.

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