Gender Bias in Medicine: Are We Finally Closing the Gap?

Gender Bias in Medicine: Are We Finally Getting Better?
The Silent Scalpel: Where Are the Women in Surgery?

Let’s not sugarcoat it—surgery has long been a boys' club. From the sterile corridors of orthopedics to the adrenaline-pumping trauma theaters, women have often found themselves underrepresented, undervalued, and, quite frankly, underestimated. Despite decades of progress, the scalpel still seems heavier in the hands of women. But is that finally starting to change?

According to The Lancet Women in Science series published in 2024, female surgeons now represent around 27% of the global surgical workforce. That's a notable jump from previous decades, but when you peel back the data, the disparities are glaring. For example:

• In orthopedic surgery, only 6% of practicing surgeons are women.
  
  
• Cardiothoracic surgery? Roughly 10%.
  
  
• Neurosurgery? About 12%.
  

While the numbers are inching upward, women remain woefully underrepresented in high-paying, high-prestige surgical specialties. And it’s not due to lack of capability—rather, it’s the combination of implicit bias, lack of mentorship, and structural barriers that deter many women early in their training. One female surgical resident featured in The Lancet described it best: “You’re expected to act like one of the guys, but never forget you’re not one of them.”

Clinical Trials: Where Male Is Still the Default

Let’s take a trip back in time to 1993—the year the U.S. National Institutes of Health finally mandated the inclusion of women in federally funded clinical trials. Now fast-forward to today. You’d expect gender parity by now, right? Not quite.

The Lancet’s recent review reveals that:

• Only 39% of participants in cardiovascular drug trials are women.
  
  
• Preclinical studies on animals still default to male models.
  
  
• Analysis by sex is inconsistently applied or completely absent in many published studies.
  

Why does this matter? Because sex-based physiological differences affect pharmacokinetics, drug metabolism, and symptom presentation. For instance, women are 50–75% more likely to experience adverse drug reactions to medications that were never adequately tested on them. A famous case? Zolpidem (Ambien), which had to have its recommended dose for women cut in half—after years of reports of excessive sedation and memory impairment.

The good news is that regulatory agencies like the FDA and EMA are beginning to crack down on this oversight. But progress remains sluggish, especially in privately funded trials where cost and speed often trump diversity.

Leadership in Medicine: Cracking the Stethoscope Ceiling

Here's a fun fact: women make up over 50% of medical school entrants globally. Now here’s the not-so-fun fact: only 18% of deans of medical schools are women, and only about 25% of hospital CEOs.

The numbers show a classic case of the “leaky pipeline.” Women enter the profession in equal or greater numbers but are systematically filtered out as they ascend the ranks. By the time you get to the decision-making boardroom, the gender ratio has flipped.

The Lancet series identified three main culprits:

1. Lack of sponsorship (not just mentorship).
   
   
2. Unconscious bias in promotion criteria.
   
   
3. Work-life integration challenges, disproportionately impacting women with caregiving responsibilities.
   

Interestingly, countries that have implemented transparent promotion policies and childcare support systems—like Sweden and New Zealand—are seeing a significant narrowing of the leadership gender gap. So yes, the problem is solvable. But it requires intention, not just inspiration.

Academic Medicine: Publish and Perish?

Another striking figure from The Lancet: Female authors make up only 34% of first authors and 21% of senior authors in high-impact journals. Worse still, during the COVID-19 pandemic, women’s publication rates dropped significantly, while men’s remained stable or even increased.

Why the drop? Women were more likely to take on caregiving duties, homeschooling, and emotional labor at home during the pandemic, leading to reduced research productivity. This period widened the existing academic gender gap, a phenomenon now referred to in academic circles as the “COVID authorship cliff.”

Even peer review isn’t immune. Papers with female first authors are less likely to be accepted by top journals, according to double-blind review experiments. It’s an uncomfortable truth that even in objective science, subjective biases persist.

The Pay Gap: Still Unwell

Despite doing the same job with the same qualifications, female doctors globally earn 10–25% less than their male colleagues. This isn’t just due to specialty choice. Even within the same specialty, discrepancies exist.

The Lancet shows that:

• Female cardiologists in the U.S. earn approximately $100,000 less annually than male cardiologists.
  
  
• The gap remains after adjusting for hours worked, procedures performed, and years of experience.
  

The common explanations—“They work fewer hours,” “They choose less lucrative roles”—don’t hold up under rigorous analysis. What’s more insidious is the undervaluing of time spent on communication, empathy, and holistic care—areas where women statistically score higher but which are often uncompensated.

Medical Training: Microaggressions in Macro Amounts

The experience of medical training can be subtly brutal for women. Think of the "banter" in the OR, the jokes that toe the line, the “compliments” that undermine, and the evaluations that reward confidence in men but label it “abrasiveness” in women.

Female trainees report:

• Higher rates of burnout and harassment.
  
  
• Lower access to hands-on procedures.
  
  
• Less mentorship from senior physicians.
  

Many internal surveys in Western academic centers show that nearly 1 in 3 female residents has experienced gender-based discrimination. And yet, reporting systems are often inadequate, slow, or—worse—retaliatory.

The cultural shift needed here is profound. It’s not just about enforcing policies; it’s about reprogramming the very social fabric of medical education to be inclusive, not just diverse.

What’s Actually Getting Better?

• Data Transparency: More journals and grant agencies now require gender-disaggregated data. It's not perfect, but it’s a start.
  
  
• Mentorship Networks: Initiatives like Women in Surgery, Women in Cardiology, and institutional Women in Medicine groups are becoming increasingly active and vocal.
  
  
• Representation Matters: We’re seeing more women on editorial boards, speaking panels, and academic promotions committees than ever before.
  
  
• Public Accountability: The power of social media (#MedTwitter, #ILookLikeASurgeon) has given women a platform to call out injustice, share stories, and build solidarity in ways that were previously unthinkable.
  

Are We Finally Getting Better?

Yes—but the slope is still uphill.

Progress is visible but uneven. Surgical fields are evolving slowly. Clinical trials remain stubbornly male-centric. Leadership continues to be male-dominated. And yet, the voices advocating for change have never been louder—or more determined.

The next step isn’t just more women in medicine. It’s more medicine reshaped by the values, experiences, and strengths that women bring. Because true equity doesn’t just benefit female doctors—it elevates the entire profession.