Due to historic underinvestment in women’s health and sex-differences research, women’s health remains understudied in public and private research, inadequately taught in medical schools, and incompletely adopted into clinical care.
Sarah Chew, M.P.H.
Programs Manager, Society for Women’s Health Research
There are significant gaps in the knowledge of how and why diseases, conditions, and treatments impact women differently. Due to historic underinvestment in women’s health and sex-differences research, women’s health remains understudied in public and private research, inadequately taught in medical schools, and incompletely adopted into clinical care. This dearth of information is compounded by the underrepresentation of female clinicians, researchers, and leaders across healthcare. Female clinicians and researchers are key participants in women’s health research and care, meaning that the lack of gender diversity in certain medical specialties directly impacts women’s health outcomes.
The gender gaps in healthcare
Everywhere we look, we can see gender disparities in medical specialties, cascading into women’s health research and clinical care.
In 2023, women represented 38% of the total active physicians in the United States. Despite decades of progress, women remain a minority in almost all of the 20 largest medical specialties and are underrepresented in several key specialties. Consequently, many of these specialties represent fields in which there are significant health differences between men and women.
For example, among U.S. physicians in 2023, only 17% of cardiovascular disease specialists were female, which contributes to a gap in understanding women’s heart health, despite the fact that heart disease is the leading cause of death for women at all ages (as well as men). Women also comprise only 20% of pain medicine and management specialists, despite pain being more common in women and overlooked in healthcare generally. Only 28% of radiologists and diagnostic radiologists are women. In neurological surgery and orthopedic surgery — two of the specialties with the biggest gender discrepancies — males make up 89% and 93% of physicians, respectfully.
Additional gaps can be found in an analysis of 2023 U.S. medical school faculty: While women represented 45% of all medical school faculty, they only represented 22% of orthopedic surgery faculty and 30% of radiology faculty. Women also only represented 32% of physiology faculty, 31% of biochemistry faculty, and 33% of pharmacology faculty. Our limited understanding of sex differences in neurosurgical outcomes, adverse drug reactions, and disease mechanisms are likely impacted by the underrepresentation of female clinicians and faculty in these related specialties.
Disparities by the numbers
When women participate at the clinical level, it improves care for patients. Female physicians are more likely to see female patients, engage in preventive care with women, utilize patient-centered care, and have better health outcomes with female patients. Supporting female clinicians means healthier lives for us all.
Behind the research itself, there also remains a fundamental problem with gender gaps. Women are less likely than men to be credited with research authorship, and their work is less likely to be recognized. In biomedical research from 2014–2020, women represented only 16% of highly cited researchers. From 2015–2020, women represented only 22% of first authors in surgical research. Further, fewer women than men are principal investigators of clinical trials, including in areas relevant to women’s health.
For example, in cardiovascular clinical trials published in major medical journals from 2014–2018, women comprised only 10% of clinical trial leadership committees. But again, when women are present and supported in pursuing research, the outcomes have a positive ripple effect: female authors are more likely to include female participants in their studies, and female researchers are more likely to recruit women as participants to their clinical trials. Diverse research teams are also more likely to confront biases, investigate understudied topics, and uncover sex differences in their research.
Finally, women are also underrepresented in health leadership roles. Overall, women hold only around 25% of leadership roles within healthcare. For example, in U.S. academic medical institutions, in 2023, only 34% of division and section chiefs were women and 32% of center and institute directors were women. Disparities are even greater in certain specialties like surgery. Across 165 medical school and affiliated hospital surgical departments in 2022, women comprised only 14% of chairs, 32% of vice chairs, and 13% of division chiefs.
A call for the future
To fully reach equity in women’s healthcare and research, there needs to be a multifaceted approach to address women’s underrepresentation in medical specialties. Academic institutions, medical societies, healthcare systems, and funders need to confront the systemic and institutional barriers that prevent women from pursuing certain specialties and limit their growth. Such barriers may include pay inequities, reduced promotional pathways, sexual harassment, bullying, gender biases, and higher burnout.
Institutions also need to prioritize women’s health research and the value of sex-differences research, funding more research and investing in the women doing this work. Moving forward, universities and care providers alike should consider increasing sex- and gender-specific medical education, improving mentoring and sponsorship in medical specialties with a minority of women, improving leadership pipelines for women, and offering education for current leaders on the importance of workforce gender diversity.
The inclusion of women across all fields of medicine is crucial to progress, innovation, and the future of healthcare. It is also critical to the future health and medicine workforce. When young girls and women see women in the medical field, they can more easily envision themselves in these roles. Representation matters; increasing the visibility of women in medicine and research encourages the next generation to enter these fields, bringing new perspectives and fresh ideas. And when more women are present in healthcare — providing care, conducting research, educating future providers, and leading health systems — health outcomes improve for everyone, and women will live healthier lives.
