As of 2023, women accounted for over half — 55 percent — of US medical students and 45 percent of medical school faculty members, but only 25 percent of department chairs, according to a 2025 article in JAMA Network Open.A 2024 article in the same journal found that “Compared with men, women [medical school] deans reported having to work harder to advance, while receiving less support and opportunities for leadership positions by their own institutions.”Muto recalls that about a decade ago a surgeon arrived in town who targeted a well-loved female chief of surgery. He saw her “case volume, and wanted it.” What came next, said Muto, was a “sham peer review,” a practice in which a colleague falsely accuses a doctor of misconduct on the job.As a colleague, Muto reviewed the cases in which the chief of surgery was accused of a breach in the standard of care. She said she found there was none. “She just happened to be on call for a couple of complicated patients.”But the ordeal was too much for the chief of surgery. She resigned, then left medicine. Muto once considered becoming chief of surgery at a hospital. When she met resistance from leadership, she started a company instead.Suddenly, she found herself at conferences with other female doctors. “ I started to talk to women, and we started to share our stories. And everyone had the same story.” When the women spoke, she said, they talked about “everything from sexual harassment to personal harassment to sham peer reviews. And then you realized: ‘Oh my God, this problem is national.’”None of this surprises Sarah Temkin, a surgeon and the director of the documentary “1001 Cuts” about challenges facing female surgeons.Temkin once served as a hospital division director, in charge of gynecologic oncology. But she said, “Even though I had a title, I called it ‘responsibility without authority.’” Temkin said that women commonly raise safety concerns, but they are often not listened to.Both peers and mentors advised her to get a man to raise important issues in the hospital. Being a health care leader who lacks authority is “a terrible position to be in because you’re responsible for people’s lives,” said Temkin.Temkin emphasizes that it’s not just men who view men as natural leaders. She has witnessed women bullying other women, but she said talking about it can be “taboo.” Dr. Clara Keegan, a family doctor and associate professor at the University of Vermont’s Larner College of Medicine, notes that more women than men are becoming doctors. But “there is definitely a gap both in compensation and in positions in academic leadership,” she said. “As you move up the leadership, the percentage that are women becomes smaller and smaller.”Keegan notes that “ on chair searches that I’ve been on, one of the things on the rubric that we’re supposed to evaluate people on is their ‘chair presence,’ and I think that that is the sort of place where a bias can come in.”In part, that’s because men are often viewed as better — or more natural — leaders. A 2019 study by researchers at Washington University found that “health care professionals and surgeons hold implicit and explicit biases associating men with careers and surgery, and women with family and family medicine.”Many female physicians believe they are targeted for the sort of assertiveness that would be admired in a man — or at least tolerated. Dr. Pringl Miller, founder of the advocacy group Physician Just Equity, which provides peer support to physicians, frequently works with doctors, particularly women, who fear for their livelihoods because of sham peer reviews.Doctors from across the country turn to Miller’s organization, and the mistreatment that Miller sees takes a variety of forms, she said, including “bullying, harassment, discrimination, retaliation. And it’s pervasive.”There are other issues. Temkin believes that “sexual harassment is ubiquitous,” and, for women on the path to leadership, “it’s another way that women have their confidence undermined. Or it can force women to change jobs.”When Temkin herself was sexually harassed by an operating room technician who leered and made inappropriate comments, she said she wasn’t sure what to do. “You don’t know if you should report it or not, because you don’t know if it’s going to affect patient care. You don’t know if it’s going to affect your own career.”As women gain more power, Temkin believes that the nature of the discrimination they experience changes. “ The sexual harassment and some of the little digs may be worse while women are younger,” she said. “But as women gain expertise and rise into leadership positions, they’re much more likely to experience frank discrimination, which limits their ability to be successful in their leadership position.”Many women end up quitting, resulting in enormous losses for patients, said Miller. She notes that female doctors often have superior results — a 2023 JAMA article found that patients of female surgeons were less likely to die, be readmitted, or have major complications after surgery. She argues that it hurts medical outcomes when women are pushed out or leave because of mistreatment. In 2015, one physician — who asked that some identifying details remain anonymous because of potential repercussions — was the chief of anesthesiology at a community hospital in Massachusetts. She had held the position for about seven years, until her boss approached her one day.“The administration doesn’t like your facial expression,” she remembers him saying. “You’re going to have to step down.”She was shocked. She believed that a man would never have been talked to that way. Before she immigrated to the United States from Europe, the physician said, “I had this vision of America, or the thought of America, that it’s amazing and everything is fair.” But being a woman in medical leadership proved more complicated than she had anticipated.“There are more women going into medicine than men for the first time in history,” noted the anesthesiologist. “So if you discourage or mistreat the women physicians, they’re going to give up, they’re going to go part-time, they’re going to retire early, and then society loses.”It’s important for the health care system to take this issue seriously.In 1970, when fewer than 8 percent of doctors were women, losing a substantial number of them didn’t significantly alter the workforce. But now, Temkin said, “if women make up 50 percent of the physician workforce, and we’re forcing out 20 percent of them because of these issues related to culture and the way that we treat women, then that becomes a real systems problem.”It is the increase in the number of female doctors that makes the bullying and harassment of women in medicine particularly concerning, with ramifications for the environment within hospitals, the quality of care administered, and the doctors available to administer it.Fixing the problem will require attention from leaders in academic medicine, professional organizations, hospitals, and government. It’s a problem that will not solve itself, and that should not depend on women risking their careers to tell their stories.Kara Miller is the host of the podcast It Turns Out. Send comments to kara.miller@globe.com.
