Clin Colon Rectal Surg 2023; 36(05): 309-314
DOI: 10.1055/s-0043-1763518
Review Article

Gender Inequity in the Clinical Setting

Erin B. Fennern
1   Department of Surgery, University Hospitals–Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
Sharon L. Stein
1   Department of Surgery, University Hospitals–Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
› Author Affiliations


Women in surgery continue to face inequitable treatment from surgical leadership, their peers, hospital staff, and even from their patients. Despite this, women surgeons continue to produce equal, or improved, clinical outcomes for their patients, with their work being given less remuneration than that of their male peers. The cultural stereotypes and biases that drive these inequities are implicit and subtle; however, they have dramatic effects on the lives and careers of women surgeons.

Publication History

Article published online:
08 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Barnes KL, McGuire L, Dunivan G, Sussman AL, McKee R. Gender bias experiences of female surgical trainees. J Surg Educ 2019; 76 (06) e1-e14
  • 2 Brubaker L. Women physicians and the COVID-19 pandemic. JAMA 2020; 324 (09) 835-836
  • 3 Torres MB, Salles A, Cochran A. Recognizing and reacting to microaggressions in medicine and surgery. JAMA Surg 2019; 154 (09) 868-872
  • 4 Abelson JS, Chartrand G, Moo TA, Moore M, Yeo H. The climb to break the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. Am J Surg 2016; 212 (04) 566-572.e1
  • 5 Davids JS, Lyu HG, Hoang CM. et al. Female representation and implicit gender bias at the 2017 American society of colon and rectal surgeons' annual scientific and tripartite meeting. Dis Colon Rectum 2019; 62 (03) 357-362
  • 6 Zhang B, Westfal ML, Griggs CL, Hung YC, Chang DC, Kelleher CM. Practice patterns and work environments that influence gender inequality among academic surgeons. Am J Surg 2020; 220 (01) 69-75
  • 7 Chen YW, Westfal ML, Chang DC, Kelleher CM. Underemployment of female surgeons?. Ann Surg 2021; 273 (02) 197-201
  • 8 Zeltzer D. Gender homophily in referral networks: consequences for the Medicare physician earnings gap. Am Econ J Appl Econ 2020; 12 (02) 169-197
  • 9 Dossa F, Zeltzer D, Sutradhar R, Simpson AN, Baxter NN. Sex differences in the pattern of patient referrals to ma_le and female surgeons. JAMA Surg 2022; 157 (02) 95-103
  • 10 Sarsons H, Akhtari M, Barron K. et al. Interpreting signals in the labor market: evidence from medical referrals. Accessed February 18, 2023 at:
  • 11 Etherington C, Kitto S, Burns JK. et al. How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis. BMC Health Serv Res 2021; 21 (01) 1357
  • 12 Gjerberg E, Kjølsrød L. The doctor-nurse relationship: how easy is it to be a female doctor co-operating with a female nurse?. Soc Sci Med 2001; 52 (02) 189-202
  • 13 Durand F, Bourgeault IL, Hebert RL, Fleury MJ. The role of gender, profession and informational role self-efficacy in physician-nurse knowledge sharing and decision-making. J Interprof Care 2022; 36 (01) 34-43
  • 14 Cleveland Manchanda EC, Chary AN, Zanial N. et al. The role of gender in nurse-resident interactions: a mixed-methods study. West J Emerg Med 2021; 22 (04) 919-930
  • 15 Sudol NT, Guaderrama NM, Honsberger P, Weiss J, Li Q, Whitcomb EL. Prevalence and nature of sexist and racial/ethnic microaggressions against surgeons and anesthesiologists. JAMA Surg 2021; 156 (05) e210265
  • 16 AAMC. More women than men enrolled in U.S. medical schools in 2017. Published 2017. Accessed September 19, 2022 at:
  • 17 Slomski A. Few Black individuals are becoming surgeons. JAMA 2022; 327 (13) 1218
  • 18 Keshinro A, Butler P, Fayanju O. et al. Examination of intersectionality and the pipeline for Black academic surgeons. JAMA Surg 2022; 157 (04) 327-334
  • 19 Wallis CJD, Jerath A, Coburn N. et al. Association of surgeon-patient sex concordance with postoperative outcomes. JAMA Surg 2022; 157 (02) 146-156
  • 20 Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ 2017; 359: j4366
  • 21 Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA 2002; 288 (07) 756-764
  • 22 Dossa F, Simpson AN, Sutradhar R. et al. Sex-based disparities in the hourly earnings of surgeons in the fee-for-service system in Ontario, Canada. JAMA Surg 2019; 154 (12) 1134-1142
  • 23 Gupta VK, Turban DB, Bhawe NM. The effect of gender stereotype activation on entrepreneurial intentions. J Appl Psychol 2008; 93 (05) 1053-1061
  • 24 Heilman ME, Okimoto TG. Why are women penalized for success at male tasks?: the implied communality deficit. J Appl Psychol 2007; 92 (01) 81-92
  • 25 Okimoto TG, Brescoll VL. The price of power: power seeking and backlash against female politicians. Pers Soc Psychol Bull 2010; 36 (07) 923-936
  • 26 Calka A. Why Do Female Faculty Members Still Earn Less? Gender Pay Gap in Higher Education in Science, Health and Engineering Fields [dissertation]. South Orange, NJ: Seton Hall University; 2020
  • 27 Vagins DJ, Miller K. The simple truth about the gender pay gap. 2018 Accessed at: www.aauw.orgconnect@aauw.org202.785.7700
  • 28 Proctor BD, Semega JL, Kollar MA. Income and poverty in the United States: 2015. U.S. Census Bureau, Current Population Reports, P60-256(RV). Washington, DC: U.S. Government Printing Office; 2016
  • 29 Jena AB, Olenski AR, Blumenthal DM. Sex differences in physician salary in US public medical schools. JAMA Intern Med 2016; 176 (09) 1294-1304
  • 30 Hoops HE, Brasel KJ, Dewey E. et al. Analysis of gender-based differences in surgery faculty compensation, promotion, and retention: establishing equity. Ann Surg 2018; 268 (03) 479-487
  • 31 Peters WR, Ramamoorthy S. Healthcare Economics Committee of The American Society of Colon and Rectal Surgeons. Delivery of colorectal surgical care in 2018: results from the 2018 ASCRS compensation survey. Dis Colon Rectum 2020; 63 (07) 887-889
  • 32 Whaley CM, Koo T, Arora VM, Ganguli I, Gross N, Jena AB. Female physicians earn an estimated $2 million less than male physicians over a simulated 40-year career. Health Aff (Millwood) 2021; 40 (12) 1856-1864
  • 33 2018 Medscape General Surgery Compensation Report. Accessed February 18, 2023 at:
  • 34 Chen YW, Westfal ML, Cauley CE, Chang DC, Kelleher CM. Do surgeons adjust clinical productivity after maternity leave?. Am J Surg 2022; 223 (05) 900-904
  • 35 Delman K, Chen H, Clarke C. et al. Addressing compensation inequities. AIS Channel. Published 2021. Accessed October 19, 2022 at:
  • 36 AAPC. Work RVU Calculator. Accessed February 18, 2023 at:
  • 37 Goff BA, Muntz HG, Cain JM. Is Adam worth more than Eve? The financial impact of gender bias in the federal reimbursement of gynecological procedures. Gynecol Oncol 1997; 64 (03) 372-377
  • 38 Zhu K, Das P, Karimuddin A, Tiwana S, Siddiqi J, Khosa F. equity, diversity, and inclusion in academic American surgery faculty: an elusive dream. J Surg Res 2021; 258: 179-186
  • 39 Lemak CH. Knowing better and doing better to advance women in academic surgery. JAMA Netw Open 2019; 2 (08) e1910211
  • 40 Morris-Wiseman LF, Cañez C, Romero Arenas MA, Hsu CH, Nfonsam VN. Race, gender, and international medical graduates: leadership trends in academic surgical societies. J Surg Res 2022; 270: 430-436
  • 41 Sullivan BG, Al-Khouja F, Herre M. et al. Assessment of medical industry compensation to US physicians by gender. JAMA Surg 2022; 157 (11) 1017-1022
  • 42 Zhuge Y, Kaufman J, Simeone DM, Chen H, Velazquez OC. Is there still a glass ceiling for women in academic surgery?. Ann Surg 2011; 253 (04) 637-643
  • 43 Davids JS. Building gender equity in surgery. Dis Colon Rectum 2021; 64 (03) 256-258
  • 44 Tannenbaum E, Farrugia M. The road to gender equity in surgery is long. Can J Surg 2019; 62 (03) E4-E4
  • 45 Miller L, Budd J. The development of occupational sex-role stereotypes, occupational preferences and academic subject preferences in children at ages 8, 12 and 16. Educ Psychol (Lond) 1999; 19: 17-35
  • 46 Heilman ME. Sex bias in work settings: the lack of fit model. Res Organ Behav 1983; 5: 269-298
  • 47 Nosek BA, Banaji MR, Greenwald AG. Harvesting implicit group attitudes and beliefs from a demonstration web site. Group Dyn 2002; 6: 101-115
  • 48 Devine PG. Stereotypes and prejudice: their automatic and controlled components. J Pers Soc Psychol 1989; 56: 5-18
  • 49 Brown RP, Josephs RA. A burden of proof: stereotype relevance and gender differences in math performance. J Pers Soc Psychol 1999; 76: 246-257
  • 50 Keller J, Dauenheimer D. Stereotype threat in the classroom: dejection mediates the disrupting threat effect on women's math performance. Pers Soc Psychol Bull 2003; 29 (03) 371-381
  • 51 Kray LJ, Thompson L, Galinsky A. Battle of the sexes: gender stereotype confirmation and reactance in negotiations. J Pers Soc Psychol 2001; 80 (06) 942-958
  • 52 Inzlicht M, Ben-Zeev T. Do high-achieving female students underperform in private? The implications of threatening environments on intellectual processing. J Educ Psychol 2003; 95: 796-805
  • 53 Hughes F, Bernstein PS. Sexism in obstetrics and gynecology: not just a “women's issue”. Am J Obstet Gynecol 2018; 219 (04) 364.e1-364.e4