When Dr. Cornelia Griggs, a pediatric surgeon at Massachusetts General Hospital, was in training, she got lots of advice: Be careful what specialty you go into. Consider what life is going to be like when you’re a parent.
Her husband — who is also a surgeon — “didn’t get that advice,” says Griggs, 43. “ Our profession and how we train was structured and designed in an era where it was mostly men going through residency. They mostly had partners who could follow them wherever they landed in the match, and the makeup of our profession looks very different now.”
Griggs, who spoke personally and not for her employer, says, “We are experiencing a backlash to a surge of women who entered procedural fields” — including gastroenterology, interventional radiology, and surgery. And she has chronicled explicit and implicit bias that female surgeons across the country experience. “Now we represent a real economic threat to the boys.”
But the problems for female doctors aren’t confined to a few fields. A recent paper published in The Journal of General Internal Medicine finds that women are significantly more likely to quit practicing medicine than men, a disparity that holds true at every age, and across specialties.
Among doctors who leave the profession, women exit at age 49, on average, while men leave at 64. And women tend to be about 40 percent more likely to leave medicine than men at any point in their careers.
Lisa Rotenstein, the lead author of the paper and the director of the Center for Physician Experience and Practice Excellence at Brigham and Women’s Hospital, emphasizes that “we have really good research that female physicians have better outcomes than male physicians in many circumstances,” including for hospitalized and surgical patients. But, she notes, female physicians also have higher rates of burnout.
“It’s not just an epidemic. It’s a pandemic,” says Dr. Amy S. Gottlieb, a Boston-based consultant specializing in fair pay strategy.
And Rotenstein says it’s important to remember that many women have been in residency until their early or mid 30s, so “that’s many years of care provision that we are losing from really, really good doctors.” It also means that many women are missing out on what could be their most powerful — and lucrative — years in medicine.
So what’s driving them away?
Gottlieb, who has advised hundreds of female physicians during her career, says a chunk of it is about pay. Lots of women have told her that “the guy coming out of the same residency program — or maybe the same speciality in a different residency program — into the same job is being paid more. Literally, there’s no justification for it.” Often, says Gottlieb, the woman is making 10 or 20 percent less than the equally qualified man.
A 2021 study found that during the course of a 40-year career, a female physician could expect to earn about $2 million less than a male physician. The largest earnings gap was in surgery (a $2.5 million gap), while primary care physicians had just under a $1 million gap.
Meanwhile, as more women have entered pediatrics over the last few decades, compensation for pediatricians has declined, relative to many other areas of medicine. Some of this, Gottlieb says, is because our compensation structure tends to reward specific procedures, while pediatricians tend to spend more time talking to their patients and trying to understand their lives holistically.
But the inequities are not just financial. Every doctor I interviewed says both colleagues and patients expect more of women than they do of men.
“I’ve always been aware that there is gender bias in medicine, specifically in surgery,” says Dr. Andrea Merrill, a breast surgeon in Charlottesville, Va., who collaborated on a recent paper with Griggs. “But I didn’t quite realize it could profoundly affect and even threaten my career.”
When she was an attending physician, Merrill got “some criticism from some of the nurses that I worked with. And it was, I think, taken to the extreme by my leadership. I feel like the criticism was mainly because I’m a woman.” She says she was described as condescending and bossy — “the things that women who are strong and assertive often get told.” Since then, she has counseled many women who have had similar experiences, some of which have threatened or ended their careers.
“Historically,” says Griggs, “if a male surgeon is operating and someone has brought out the wrong set of instruments, or they don’t have one of the tools that he asked for, and he’s grumpy and critical of the team, then [the team is] going to make damn sure that they have it right the next time. That dynamic doesn’t always play out the same way for women surgeons. Really demanding women surgeons often get mean labels.”
Female doctors report feeling that both their patients and their co-workers expect more from them. “We sort of have to bend over backwards to be super friendly,” says Merrill.
Gottlieb points out that “there’s so much data and research on how women doing the exact same thing are evaluated more harshly than their male colleagues.”
Apart from money and double standards, there’s also the issue of flexibility. Griggs says she sees some doctors working 80-hour weeks, which contributes to burnout. “I have a friend who is a pediatric endocrinologist, and she went to work for a pharma. And she’s making more, working fewer hours, and has the flexibility to say: ‘OK, I need to go pick my kid up.’ . . . She went from feeling like she was pulling her hair out every week to feeling sane and valued and respected.”
In Greater Boston, particularly, a high concentration of biotech and pharmaceutical jobs can offer an attractive alternative pathway for physicians.
Karen Leitner, a primary care physician and pediatrician, largely left the practice of medicine in 2014 because of burnout. After having children — including one with a health issue — she tried to balance caretaking and a demanding job. “I just felt like it was too much for me to manage. I was thinking about work when I was home. I was thinking about home when I was at work.”
Leitner saw large numbers of patients, tried to respond to their electronic messages, and faced “different expectations” than a man, she says. She subsequently founded a coaching firm to help women physicians weather the medical system.
Female doctors describe a culture that to them feels broken. Few people are actively trying to do the wrong thing, but the cumulative effect of the system is to squeeze women out. Within medicine, this offers a real — and urgent — opportunity for reform.
“I think we have to build systems and environments where women are seen and heard and respected and feel they have support,” says Dr. Olivia Liao, president of the Massachusetts Medical Society.
In some environments, Liao has seen doctors wear special tags noting that they’re physicians. “So that we’re not mistaken for nurses. And I don’t think that happens to the males.”
At the end of the day, Liao says, " We are seeing more women in leadership positions. And that’s what’s going to drive this [reform] forward."
Gottlieb, who frequently works with medical leadership teams, says there’s no easy fix to such a multidimensional problem. But she exhorts leaders to just “start somewhere and do something. Look at starting salaries out of training. Look at how you’re incentivizing the workforce.”
Griggs, the pediatric surgeon, said she loves her job, but cautions, “if we want to continue to recruit some of the brightest minds, the most talented, empathetic, altruistic individuals into this field, we have to convince young people that it’s still a wonderful field to go into.”
Kara Miller is the host of the podcast It Turns Out. Send comments to kara.miller@globe.com.