On the surface, the outlook is promising for women in healthcare.

Women and men are enrolling in medical school at similar rates and women hold a wide range of positions in the healthcare industry.

They’re inspiring a new generation of women in a field once thought to be the domain of men.

However, women are still being held back from attaining positions of influence in the medical world.

They also regularly contend with sexism and discrimination before hitting the proverbial glass ceiling.

What healthcare consumers may not realize is that unfair treatment of women has repercussions. Medical communities lose out on crucial perspectives.

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Unequal representation

Women make up about one-third of the physicians in the United States, most in areas such as family medicine, obstetrics and gynecology, and pediatrics.

How about chief executives, medical school deans, and department chairs?

According to data from the Association of American Medical Colleges (AAMC), just 15 percent of department chairs are women and only 16 percent are deans. By 2012, just 18 percent of women were hospital CEOs.

“When you’re talking about the positions of authority in healthcare, people who can really make systemic changes to address healthcare needs …  women are not in these positions to enact policy changes,” said Diana Lautenberger, director of Women in Medicine and Science for the AAMC.

Pharmacology is one area of healthcare in which women are thriving, but they are still grappling with policies and norms rooted in sexism.

On the whole, pharmacology is a rewarding field for women, allowing for flexibility and yielding relatively high earnings. However, few women own pharmacies, which may restrict their opportunities and authority.

Part of the problem lies in the handoff of independent pharmacies, according to Eden Sulzer, director of Women in Pharmacy at Cardinal Health.

Male pharmacy owners who don’t have successors often get their businesses snapped up by chain pharmacies because women with all of the right qualifications may still not feel comfortable taking the leap into business ownership.

“Women are essentially talking themselves out of business ownership because of fear. Fear of risk, fear of not being able to have a personal life and a family life, so they’re going into other fields,” Sulzer said.

In hospitals and other healthcare settings, the imbalance in power is also visible.

“When you look at these subspecialties that really have authority … that’s where we see the underrepresentation,” Lautenberger said.

Take surgeons, for example. Research shows that women and minorities in general surgical training programs are less likely than males to attain board certification. The reasons why are not fully understood, but surgery can be an unwelcoming environment for women.

Dr. Yvette Canaba, a podiatric surgeon and physician at St. John's Episcopal Hospital in New York, is familiar with the dilemma.

“It’s always had that belief that females are unable to withstand the pressures that one experiences in the operating room,” Canaba said. “You have a patient’s life at stake and, depending on the surgery, there’s the belief that women are the weaker sex and are unable to withstand the emotional and physical stressors that accompany that kind of a setting.”

Last year’s #ILookLikeASurgeon campaign sought to highlight women surgeons, shaking up notions of who a surgeon can be. Still, some outdated views of women in surgery persist.

“We go through the same schooling, the same training as our male counterparts. We took the same examinations as our male counterparts. There’s no reason to believe that we can’t deliver equal quality care as our male counterparts,” Canaba said.

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Hardships facing women in healthcare

As a medical student at the University of Illinois at Chicago, Karishma Bhatt is not naive to the challenges she faces as she pursues a career as a surgeon.

Bhatt wanted to get a better sense of what sexism looks like in medicine, so she asked users on Reddit’s medical schools subreddit about their experiences.

Respondents told her about how female physicians are regularly mistaken for other roles, which Bhatt called “relatively innocuous” in an article for in-Training.

But some stories eclipsed the condescending, run-of-the-mill comments. Reddit users discussed how being pregnant can threaten career prospects and the ways sexual harassment permeates healthcare.

Bhatt wasn’t completely surprised by what she learned.

“Sexism is really pervasive in a really stressful field such as medicine,” making it “easy to fall back on stereotypes,” Bhatt said.

An emergency room physician once told Bhatt about a related phenomenon. Throughout the course of their residencies, some emergency room doctors may succumb to the pressures of the job, becoming more racist and sexist by the end of the year. In such a demanding environment, Bhatt said, confirmation bias can reinforce negative stereotypes.

And women may already be forced to tread lightly for fear of giving any credence to unfair depictions.

“More often than not an assertive female is looked at is someone who’s bitchy or moody or not friendly. It still happens and I’m already a senior in my program,” Cabana said.

“It’s very interesting,” she noted, “how even in this day and age when you’re an assertive female it’s not something that’s applauded. It’s something that’s automatically attributed to a woman’s emotional state.”

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Trickle-down effect

For the first two years in her residency, Canaba was the only woman.

“It was very easy for the male counterparts in my group to kind of set me aside when it came to making decisions for the plan of care for patients,” she said.

Canaba’s experience is just one sliver of a widespread matter. When women are left out of the conversation, so are their insights and expertise.

“In the end it’s the patient that loses,” Canaba said. “Our patient population as a whole definitely benefits from a more diverse group of physicians that is in charge of their care.”

Female patients may also benefit from providers with a more personal stake in their health. They may also feel more comfortable discussing their medical issues.

“We need people in these rooms treating people that look like them and someone they can identify with,” Lautenberg said.

That’s also true of interactions that take place outside of the hospital.

“The reason why I feel so passionately about this beyond empowering women … is patient care is going to be delivered outside the hospital,” Sulzer said. “Pharmacists really are that first line of healthcare in many communities.”

To Sulzer, it makes sense to have women at the forefront.

“Women make [most of the] healthcare purchasing decisions, so I say who better to serve them than female pharmacists in their communities,” she said.

The loss of women’s perspectives is notable in academic medicine as well. One study found that female biomedical researchers receive significantly less financial support early in their careers compared with their male counterparts

Lautenberger also points to the National Institutes of Health (NIH) policy on the Consideration of Sex as a Biological Variable, which was spurred by the high volume of research that uses only male patients, stem cells, and even mice in clinical and biomedical trials.

“That’s a perfect example of what we lose as a society when we leave out half of the population,” Lautenberger said.

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What can be done?

The issues affecting healthcare have plagued numerous other industries and experts say reform is needed at all levels of healthcare to turn the tide.

From an administrative standpoint, hospitals and healthcare systems need to step up their standards of parity, with fair pay being one part of the equation.

A recent study from Glassdoor found that the pay gap between men and women is especially pronounced in healthcare.

Bhatt proposes a cultural shift in hospitals, emphasizing the need for fair hiring standards and women-friendly policies such as maternity leave. That also includes creating a safe work environment in which even the most well respected, tenured physicians are subject to scrutiny for complaints of sexual harassment.

“It doesn’t matter that you have tenure, you’re harassing the future of medicine,” Bhatt said.

Helping patients and healthcare consumers become more aware of the ways in which they contribute to sexist behavior is another hurdle for equity.

“Very often we find the patients have their own biases toward these women [providers],” Lautenberg said.

According to Bhatt, the stressful environment of a hospital may serve as the catalyst for sexist behavior.

“When we see patients it’s everyday for us, for a patient it might be the worst day of their life,” she said.

Patients may lash out with sexist comments without meaning to, making an already tense situation more difficult.

Lautenberger suggests that patients examine their unconscious biases not only to show more respect toward female providers but also to open themselves up to the best possible care, which may just happen to be administered by a woman.

“As a patient and as a consumer, becoming more aware of your biases and what you are preferential to may allow you to make more informed decisions in terms of providers,” Lautenberg said.

To push back against sexism in healthcare, women are turning to one another for support through mentoring and educational programs led by other women in the field.

AAMC’s Women in Medicine, Cardinal Health’s Women in Pharmacy, and SEIU Healthcare’s Women in Medicine group, all offer various programs and tools to help women navigate their careers in healthcare.

Topics like salary negotiation, leadership, and promotion reflect the challenges that women in medicine face every day on the job.

“The additional mentoring and education you need to … make it as a woman in science is really quite substantial,” Lautenberg said.

As women in healthcare embark on their careers, they need as much support as they can get.

Canaba wants women in medicine to know that “they’re not alone.”

“There’s always going to be someone out there who has not been afraid to speak out and move forward despite these things,” she said. “Seek them out for mentorship and support because they’re out there.”