Women now make up over one-third of the physician workforce and more than half of medical school graduates, yet medicine remains shaped by a deeply entrenched culture of inequity. This inequity not only harms the careers and well-being of women physicians, it also jeopardizes patient care and weakens our national health care system.

As a physician and author of the forthcoming book Doctoring While Female: The Personal and National Toll of Gender Inequity in Medicine, I have witnessed firsthand the subtle and not-so-subtle ways gender bias shapes the careers of women physicians. While many celebrate the increasing number of women entering medical schools, the reality of what awaits them once inside the system remains alarmingly skewed.

Gender inequity in medicine does not always take the form of overt discrimination. More often, it is found in the slow, compounding disadvantages: slower career advancement, smaller research grants, fewer leadership opportunities, and persistent pay gaps, even after controlling for specialty and experience. According to a 2021 Health Affairs study, female physicians earn an estimated $2 million less over a forty-year career compared to their male counterparts.

But beyond the toll on individuals, this imbalance has far-reaching consequences for the health care system as a whole.

Burnout among female physicians is on the rise, and they are leaving academic medicine at disproportionately high rates. According to a 2019 report by the Association of American Medical Colleges, forty percent of women either scale back their careers or leave the practice of medicine entirely within six years of completing their training. This trend only worsens the existing physician shortage, which the same organization projects will reach a deficit of 139,000 physicians in the U.S. by 2033.

When women are excluded from leadership, it does not just limit their careers; it shapes the entire culture of health care. Leadership sets the tone for priorities, policies, and values across a hospital or health system. And when the decision-makers do not reflect the workforce or the patient population, the system suffers. Studies show women physicians spend more time with patients and achieve better outcomes across key health metrics. Their absence at the top means institutions risk becoming less patient-centered, less effective, and less adaptable. Without diverse voices shaping policy and institutional norms, the result is not just missed opportunities; it is compromised patient care.

You may wonder why this topic belongs in Forbes. Here is why: Health care is a $4.5 trillion industry in the U.S., employing over twenty-two million people. It is one of the largest and most essential sectors of our economy. When highly trained professionals, such as female physicians, are undervalued, underpaid, or pushed out of the workforce, it is not just a workplace issue. The loss of talent, training investment, and leadership potential weakens hospitals, slows innovation, and ultimately impacts patient care. This inefficiency carries real financial consequences. In fact, it is a business liability.

The cost of replacing a single physician can range from $250,000 to over $1 million when factoring in recruitment, onboarding, and lost revenue during vacancy. Burned-out physicians who remain on the job but are mentally and emotionally depleted are also costly. They may cut back hours, retire early, or practice below their full capability, leading to lower productivity, missed revenue opportunities, and in some cases, medical errors. That is a direct hit to hospital performance and bottom lines.

And this is not just a health care problem. The same patterns show up in law, finance, tech, and other male-dominated industries. When experienced professionals are sidelined or forced out, companies face costly turnover, leadership gaps, stagnation, and diminished momentum. These losses are not abstract; they are expensive, measurable, and avoidable. Addressing these issues is not about politics; it is about smart economics, good management, and long-term sustainability.

One of the most dangerous aspects of this inequity is the culture of silence. Women physicians are routinely discouraged, explicitly or implicitly, from speaking out. They are warned that doing so will make them seem “difficult,” “ungrateful,” or not a “team player.” The unspoken message: Stay quiet, stay agreeable, and stay grateful just to be in the room. Many internalize this, choosing silence over the risk of professional backlash, even as they are passed over for promotions, underpaid, or sidelined.

The numbers reflect this chilling reality. Nearly two-thirds of women physicians report experiencing gender-based discrimination during their careers. Yet only a small fraction report it. Why? Because the consequences of speaking up are real. Retaliation can be subtle, such as being excluded from opportunities, labeled as “hard to work with,” or suddenly receiving poor evaluations. But it can also be direct: loss of leadership roles, stalled advancement, or pressure to leave. In medicine, where reputation is everything, many women feel they must choose between their voice and their career.

My own journey through the medical field has been one of both privilege and pain, navigating spaces where I was often the only woman in the room, or the youngest. I have experienced the quiet cost of calling out bias and the steeper cost of staying silent. My book, Doctoring While Female, is not just a collection of personal anecdotes; it is a call to action, grounded in data and lived experience. Because until we address the culture that silences women, we will continue to lose some of our best minds and most dedicated healers, not to other industries but to burnout, attrition, and disillusionment.

Real change requires institutional accountability. This means transparent salary audits, equitable promotion and mentorship opportunities, gender bias training that is not performative, and leaders, especially male leaders, who are willing to sponsor, not just mentor, talented women.

But perhaps more urgently, we need to normalize the conversation. Because right now, when women in medicine speak up about pay gaps, discrimination, unsafe conditions, or toxic leadership, they too often face retaliation. They are labeled as “difficult,” excluded from key meetings, passed over for promotions, or pushed out altogether. In a profession that claims to value evidence, we still regularly dismiss firsthand accounts from women as emotional or anecdotal. The silencing of women’s voices has real, measurable consequences. It drives talented physicians out of academic medicine, creates hostile work environments, erodes trust in leadership, and ultimately jeopardizes patient care. When the people on the front lines are afraid to speak, errors go unreported, ideas are lost, and innovation stalls.

This is not just about fairness; it is about functionality. A system that penalizes honesty and rewards silence is bound to collapse under its own inefficiency. We do not need more lip service. We need systems-level change. Because equity is not just the right thing to do; it is also the smart thing to do.

Kolleen Dougherty is an anesthesiologist.