Breaking Down Barriers for Women in Emergency Medicine

Gender bias affects women medical students and professionals alike, undermining their performance and longevity. Removing barriers in the structure of training leads to stronger outcomes.

Sydney DeAngelis, M.D., FACEP

Chair-Elect, American Association of Women Emergency Physicians

In 2003, I matched in a well-respected emergency medicine (EM) residency. Surprisingly, 11 of the 17 interns in my class were women! Yet over two decades later, only 5.6% of EM residencies are majority female. My EM training was challenging and fun. We supported each other — women and men alike. I was thrilled to work in this field, but I didn’t know how much EM residency differed from the “real world.”

Overall, women are 37% of EM residents; we’re only 29% of emergency medicine attendings. In our first 5 years out of residency, 10% of us leave. We retire 12 years earlier than our male colleagues. Multiple studies show patients fare better when treated by women EM docs.  So why do we leave a profession in which we do well? The answer lies behind barriers that drive us away. Removing these barriers would help our patients, our specialty, and other women in emergency medicine. 

Engrained in the system 

One barrier is bias against women emergency physicians, starting in our second year of training. Faculty rate us lower than male co-residents. Women displaying “leadership qualities” are graded negatively, while men receive positive reviews. This gendering bias continues after graduation.

As new attendings, we face scrutiny from nurses, patients, and consultants. Our treatment decisions and credentials are questioned every shift. Male co-workers don’t face this. We are expected to endure this lack of respect. It is demoralizing, leading to burnout. This destructive bias needs to end.

A second barrier is lower pay and promotion of women EM physicians. In academic emergency medicine, 42% of chief residents are female, yet women make up only 22% of faculty. Women chair 11% of academic emergency departments, with no increase over the past decade. This provides women fewer mentors and research projects and less leadership training.

Surveys repeatedly show a negative association with female gender and full professorship or leadership position at the same level of seniority.  We are paid 10% to 13% less than male coworkers. Training about this disparity paired with hiring and promotion policies aimed at women candidates would bring it to an end. Reviews of physician pay would ensure equal compensation for doing the same work. 

A path forward

Societal demands pose another barrier for women EM physicians. We spend 8.5 more hours a week on domestic chores than male physicians (citation). During our childrearing years, we’re often excluded from the leadership pipeline. Opportunities for advancement would encourage us to stay. Insufficient childcare is a major obstacle for women continuing in EM — Flexible scheduling and employer investment in childcare prevents experienced physicians from leaving when work conflicts with our family responsibilities. 

Women emergency physicians excel at communication, patient-centered treatment, and guideline-based therapy. Our presence on ED staff fosters better outcomes for our male colleagues. Despite this, we are denied promotion and leadership. We face discrimination and hostility in the workplace. Removing these barriers would benefit not only women in emergency medicine, but our society overall, especially patients who are cared for by these empathetic and highly skilled professionals. 

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