We all saw the report on early clinical departure. Women are leaving medicine at age 45.8. A senator immediately replied that we needed to be more selective and implied that medical school applicants should accept 30 plus years in a career that is crumbling under our feet.

We know the data. Women physicians have higher burnout than male physicians, and we also know that women physicians have double the suicide risk. Meanwhile, as the baby boomers require more medical care, we are facing a dire physician shortage.

More and more data continues to demonstrate that women physicians provide equal or better care when compared with male physicians (surgical outcomes, heart attack outcomes in emergency room settings, readmission rates, adherence to guidelines). We also know that women physicians carry more of the invisible labor at home and work (7.5 more hours of domestic work in equal employed partnership).

This week, Melinda French Gates vowed to donate $215 million to menopausal research. These items are related, and this is a wonderful time for health care organizations to examine what is under their control to retain these highly qualified, highly experienced physicians at the prime of their productivity.

Men and women are different. We easily accept this fact in medicine and in society. We even accept this fact in the actuary world. We grudgingly and knowingly pay higher premiums for our teen boys to drive. We understand that teen pregnancy will disproportionately negatively impact our girls much more than our boys’ future. However, when it comes to women needing to take off more time from work in our 20s, 30s, 40s, and 50s due to fertility, pregnancy, cancer screening, and menopause, we ignorantly turn the other way.

Expectations for women to be the nurturers remain persistent. Women are the caregiver at 80 percent of appointments for children and the elderly. The health care system did not account for physicians possibly being sons, daughters, or parents. The system assumes we have a wife to provide these services for a physician’s family.

The number one reason people cited for leaving medicine was the hassle factor. Women are asked to clarify their orders and recommendations 25 percent more often than male physicians. We all should stop the line and provide clarifications for patient safety, but women getting 23 percent more messages from patients and 26 percent more messages from their own support staff is not a close the loop issue, but a bias issue. Women often request a woman physician to provide their medical care, but women rarely provide women with the highest subjective ratings of scores.

85 percent of women will have a pregnancy, and women physicians have lower fertility and more miscarriages than non-physicians. Health care leadership cannot change women’s bodies, prevent pregnancy, or change societal bias, but it can evolve with the times. The health care system changed overnight in April 2020. If there is enough pressure, we can do these hard, new, unexpected, and correct things.

• Give more medical time off: Let women care for themselves and their families. How do you pay for this? Easy, we use math. Now this woman stays working for you until 59 instead of 45, no loss of continuity, no clinical disruption, no extra recruitment, no extra signing bonus, and no lag in production during onboarding. With retention, did you make more money from her to justify the extra 5 days a year? The AMA cites $500,000 to $1,000,000 in cost for a single departing physician.
• Add support for the hassle work: Women currently do 25 percent more uncompensated work, pajama charting time, longer appointments due to more complex patient mix, disparities of portal messages, more staff interruptions. Give women 25 percent more support staff or AI resources to sift through this extra hassle work.
• Adjust the Press Ganey scoring: Women should get a handicapped feature on their scores of 15 percent improvement in the scores submitted by women patients (ironically, male patients are less biased against high scores for women physicians).
• Audit for disparities: Regular audits of retention of women physicians, salaries, promotions, and initial offer letters should be conducted to look for blatant and subtle disparities.
• Offer flexible schedules and childcare: All physicians should regularly be offered proportionate part-time or flexible schedules (0.8 FTE while reducing pay and benefits by 20 percent). On-site childcare, sick care, or backup childcare solutions can be explored as a bonus point section.
• Build communities of women: Support groups such as Women in Medicine have been proven to be a cost-effective strategy to improve retention, burnout, and engagement.
• Provide cohort coaching: Small group, cohort coaching has been shown to provide cost-effective improvements in retention, burnout, and engagement.
• Run bystander training: Bystander training and sexual harassment and discrimination awareness campaigns can be enlisted as needs assessments dictate.
• Hold zero tolerance for the boys’ club: End the mentality of women doing the housekeeping pre-op and post-op visits while the male physician does the RVU-rich surgery. Equal endoscopy, cardiac catheterization, bronchoscopy, and OR time should be provided and audited for between the genders.
• Create a re-entry program after pregnancy: A re-entry program sets the whole team up for success. A woman who returns at 70 percent postpartum provides 70 percent more care for patients and call sharing than a woman physician who quits medicine postpartum.

In the coaching world, we use the phrase, “When you argue with reality, you always lose.” The reality is these proposals will not be seen as fair. It is expected that the opposite gender will initially protest. After some careful consideration, our male colleagues will certainly acknowledge that their bodies do not have as many medical needs during their 20s to 50s, that their families simply do not have the same expectations, and that they are lucky enough not to suffer through monthly periods for decades, undergo invasive cancer screening on the most personal of parts every 1 to 3 years, followed by years of perimenopause and menopause symptoms impacting their sleep, focus, and very well-being. Wise health care leaders will simply acknowledge these differences and provide the right solutions to retain some of their best partners. Our children deserve this, our current and future patients deserve this, and your health care system deserves this. We cannot afford to lose any more physicians. Please run your numbers.

Dawn Sears is a board-certified gastroenterologist and hepatologist, a clinical professor at UT Southwestern, and the founder of GutGirlMD Consulting. She currently serves in the gastroenterology division at the North Texas Veterans Administration, where she works as an instructor, gastroenterologist, and coach.

Much of her career and research has focused on the well-being of her colleagues, with a stated goal of stopping the loss of women physicians from health care. She spearheaded the Women Leaders in Medicine program, serving more than 300 women physicians and moving the needle on engagement, retention, and burnout, and she hosts the ACE and Emerge women physician empowerment conferences. As an ICF Certified Executive Coach, she works regularly with both private and institutionally based physicians. She has served as chief of well-being, program director, and chief of gastroenterology at multiple institutions, and has sat on boards of directors. Her work has been recognized with grants and awards from the American Medical Association, the American Medical Women’s Association, the Texas Medical Association, and the Physicians Foundation.

She has authored numerous peer-reviewed publications spanning physician burnout, women in medicine, hepatitis screening, and gastrointestinal disease, with work appearing in PLOS One, Clinical Gastroenterology and Hepatology, Gastroenterology, and The Lancet Gastroenterology and Hepatology. She shares updates on LinkedIn, Facebook, X, and YouTube.