Women are entering medical school in greater numbers and constitute half of all classes. There are many reasons to keep women in the medical workforce. Women physicians provide more preventative services and devote more time to psychosocial/family medical history. Studies show that patient satisfaction with women physicians is significantly higher than with men physicians. Elderly patients who received care from women general internists had lower 30-day mortality and readmission rates than those cared for by men internists.

Women enter academic medicine at higher rates than men but are less likely to advance to senior ranks. Early-career women who left academia reported a lack of support, lack of role models, and a noncollaborative work environment seeming to favor men faculty.

Westring et al. identified four facets conducive to women’s success in academic medicine settings: equal access to opportunities and resources, encouragement of work-life balance, eliminating gender biases, and a supportive chair/chief.

After spending a decade caring for medical students, I delved into the world of physician burnout. Medical students put themselves through a grueling four years and are a cohort of hard-working, dedicated, resilient people. Both men and women have a tough road ahead of them after medical school graduation. Post-pandemic and in an ever-changing health care system, physician burnout numbers are high. Lyuabarova et al. wrote a brief report stating that there is a dramatic gender difference in physician burnout rates: in 2020, 51 percent of U.S. women physicians reported burnout versus 36 percent of men physicians. In 2021, burnout increased among both women and men physicians to 56 percent and 41 percent respectively. A study published in JAMA Psychiatry found that female physicians in the U.S. died by suicide at more than 1.5 times (specifically, 53 percent higher) the rate of women in the general population between 2017 and 2021.

I spent the last year interviewing female physicians about burnout. The narratives they shared had common themes of anger, frustration, disappointment, and loneliness. Women felt they either had to adapt in a way that crushed them or exit (either academic medicine or medicine altogether). People who devoted their lives to helping others no longer felt they had the bandwidth to help themselves. Certainly, some of what I heard applies to male physicians too. But some does not, like caring for patients while also being the default parent. Vocal women leaders were looked down upon, at times torn down by others (men and women!) at each juncture that they celebrated another success in their professional journeys.

There was a common thread of fear. Don’t speak up. Don’t be the problem child. Don’t make waves. These toxic patterns persisted across specialties and universities. Hearing other women’s lived experiences led me to want to offer guidance to those entering into (or currently in) academic medicine.

• Control the controllables.
• Know what your peers do within your institution and within other institutions.
• Identify your value to the institution (research, supervision, or some other niche).
• Delineate your current priorities.
• Consider how you can maintain your integrity as a physician. What type of physician do you strive to be in a constantly shifting health care system with competing demands? Mardi Horowitz writes about how intimacy, integrity, and integration lead to happiness. All three of these were threatened in the women I spoke with.
• Be ready to pivot in all areas of your life.
• Don’t get lost in fairness/justice. Focus on what is going to work for you, your patients, and others who rely on you.
• Think about how you can be a role model for the next generation of female physicians. There are many!
• Get guidance from someone outside of your life, like a supervisor or therapist. This person can help foster change in line with your goals and values (instead of their own motives, needs, and wants).

Elina Maymind is a psychiatrist.