Photograph by Catherine Viox
Amelia Wiggins, D.O., sits cross-legged on the couch in my suburban home. Her long hair flows down around her shoulders, and there’s an open bottle of wine between us. We’re in socks and sweatshirts, our combined four young boys finally asleep for the night.
We’re two women, two moms, two neighbors, and two friends tonight, but in a few hours Wiggins will be elbow-deep in a patient’s muscle and bone. Every inch of her body will be covered in surgical gear: gown, ventilated helmet, shoe booties. Her latex gloves will be splattered in blood, and she’ll be wielding power tools that could moonlight in a carpenter’s garage: drills, saws, hammers, pliers.
She will complete three total knee replacements and one total hip replacement before dinner. Then she’ll head to the football game at Anderson High School, where she serves as team doctor. Just another typical Friday.
I haven’t yet begun recording our couch conversation when Wiggins’s eyes turn misty. She says something to the effect of, “I’m sorry if I cry.” I wonder if she’s gotten used to apologizing for showing emotion in her male-dominated subspecialty, where women represent just 6 percent of the workforce. I grab tissues and place them on the coffee table just in case.
Over the next two hours, Wiggins explains the long, uphill road it took to become—and also to stay—a female orthopedic surgeon. She recounts stories of sexism, gender bias, and discrimination, realities she still faces weekly. Sometimes daily.
Wiggins’s experience is fairly common among female physicians. I hear iterations of her story over and over as I interview a pediatric ophthalmologist, an anesthesiologist, and a pediatric neurosurgeon. They share the discouragement they faced in their early medical training, the subtle (and-not-so-subtle) insinuations that their gender disqualifies them for the highest levels of medicine, and the ways they still have to work twice as hard to be taken as seriously as male counterparts. More importantly, though, they share hope that the tide is turning.
These women offer insight into how we—as patients and as a society—can help facilitate a more hospitable environment for female physicians. It’s vital to the nation’s literal health that we understand the ramifications of their experiences, because their story isn’t just about their own lives—it’s about every one of ours.
The impact of a woman’s early journey into medicine cannot be overstated, for better or worse. Of the physicians I interviewed, almost all experienced some level of gender-based discouragement during their early medical training. For some, it was veiled: Mothers concerned their daughters would waste prime child-bearing years in medical training or they’d struggle to “juggle it all” between a medical career and a family.
For others, the discouragement was overt. In her undergrad college program, Leah Owen, M.D., Ph.D., chief of ophthalmology at Cincinnati Children’s Hospital, was told she needed “special permission” to enroll in a pre-med organic chemistry course despite having a 4.0 grade point average and completing the prerequisite classes. The professor warned her the course was “very hard” and likely not important for her. Owen’s male friends didn’t have to jump through such hoops for the same class.
“It’s not an unusual story, to be honest,” says Owen. “Some of these challenges, yes, you can overcome, but I hope we’re moving toward a future where you don’t have to.”
Wiggins experienced both early empowerment and deep-scarring barriers. On a mission trip in college, two male physicians planted the idea that she could become a surgeon. From that point on, she recalls, “I always knew I wanted to be an orthopedic surgeon. There was never any other option.”
It wasn’t until her third year of medical school that she realized she was an anomaly. “I called a residency program, and they flat out said, We’ve never taken a woman. We won’t take a woman. You shouldn’t rotate here,” she says. That was in 2008, not 1950. And it wasn’t the last time Wiggins would hear that sentiment.
Further into her training, the bias against female orthopedists reared its head in other ways. During surgical instrument training—mallets, hammers, screwdrivers—Wiggins was judged more harshly. “It was very apparent in talking to my male colleagues that they were handed the tools faster and got to keep them longer, even if they were kind of not getting it quite perfect,” she says. “They would still get a second try. I wasn’t awarded that opportunity. Instructors were slower to give me the instruments and much faster to take them away if I faltered. So I had to come in 100 percent perfect.”
Once, she was required to do pushups alongside a male colleague in order to “prove her strength.” It’s hard to believe such chauvinistic chest-bumping behavior still exists in this century, especially within the highly educated and presumably evolved sphere of medicine, but it does.
Anesthesiologist Suzanne Loh, M.D., is the fortunate outlier of this group. She was drawn to the sciences as a young girl, and her mother heartily encouraged her dream of becoming a doctor. “I credit her for understanding who I was and who I was becoming a little more than I did as an 18-year-old,” she says.
To give credit where it’s due, all four physicians speak glowingly about their current colleagues and employers—among them OrthoCincy (formerly Wellington Orthopaedics & Sports Medicine), Cincinnati Children’s, and Seven Hills Anesthesia. They report overarching respect from colleagues and administrations. Their experiences might not have been so positive in less progressive systems, practices, or regions of the country.
About her fellowship at Wellington, Wiggins says, “It was the first time I felt mutual respect with the majority of attendings. The group was absolutely amazing.”
Pediatric neurosurgeon Smruti K. Patel, M.D., notes that Cincinnati Children’s is particularly mindful of physicians’ mental health and offers support to lessen burnout. Owen says Children’s is impressively forward-thinking about encouraging diversity in its leadership.
That said, when it comes to the treatment of female physicians, patients often need the most help. When Loh walks into the preoperative holding area, she’s met with surprise “pretty much every day.” Sometimes, it’s good surprise. Patients, usually female, express excitement to have a female anesthesiologist—a welcomed situation in which Loh feels honored to help disrupt gender assumptions.
Other times, patients’ surprise is less than positive. “I do get comments on either being a woman or my size, which is odd,” says the petite 34-year-old. “I realized quickly that I had to introduce myself as Dr. Loh, because the assumption was that I was not a doctor if I didn’t introduce myself that way.”
Owen reports similar experiences at hospitals she’s worked at across the country. “I have been asked so many times by my patients’ parents, ‘How many of these [surgeries] have you done?’ ” she says.
She looks young, so maybe it’s a fair question. No parent wants his or her child to be a surgeon’s guinea pig, after all. But Owen says her male peers confide—maybe sheepishly—they’ve never had to endure the “How many surgeries have you done” question. “If it was an equally asked question, it wouldn’t be so stigmatizing,” she says.
From the perspective of neurosurgery, which has one of the highest gender gaps in surgical residencies, Patel describes patient skepticism as a “raise of the eyebrow” moment—that knee-jerk unfiltered reaction when patients express some version of surprise or discomfort when realizing their neurosurgeon is a woman. Patel says she first noticed it during residency when she was partnered with male colleagues for rounds. “If you’re walking in with someone who’s your junior resident and a male, people automatically assume he’s the doctor and you’re the assistant, not the other way around,” she says.
A candidate for knee replacement once told Wiggins point-blank that he refused to be treated by a female surgeon. Just three months ago, a different patient told her, “You don’t look like a surgeon.” When asked what a surgeon looks like, he responded, “You should have a beard.” Wiggins sent him to see her bearded male partner in the practice.
Just today, hours before our interview, the parents of a patient asked if Wiggins was “qualified” to do their surgery. “I love what I do, and I love the majority of my patients,” she adds quickly, noting that many of them seek her out because she’s female. She is encouraged by those who sing her praises and who intentionally bring their daughters to see her. One patient even wrote her a poem of gratitude.
The praise is “super rewarding,” she says, and the changed lives are fuel for her passion. At the same time, the casual discrimination can feel disproportionately heavy. “It becomes so exhausting at times,” says Wiggins.
What exactly does a physician look like? And why do we assume it’s a white, middle-aged man with glasses and a beard? More importantly, how much more power and energy could women doctors devote to their patients if they didn’t have to expend so much brain space defending their expertise, pushing down misogyny, and fighting against the patriarchal U.S. medical system?
Photograph by Catherine Viox
Enter the pregnancy problem. And by “problem,” I mean that American medicine as a business model is practically designed for mothers to fail or at least lag behind their male counterparts. It feels wrong to consider health care a business, but it is. In some ways, it has to be.
Each of these four physicians has given birth. Half of them came back to work between two and four weeks postpartum, when they likely were still bleeding, leaking, and deeply sleep-deprived. Even when colleagues encouraged them to take more time off, they felt they couldn’t because it would cost them too much.
Many hospitals and medical practices don’t have maternity policies for doctors, especially those with few female partners. When Owen was one of few females in her M.D./Ph.D. program, the university administration decided to drop all maternity benefits. “Had I wanted to get pregnant, there was definitely not support from anyone,” she recalls.
In the absence of a practice-wide maternity policy, women physicians typically take unpaid time off through the federal Family and Medical Leave Act. Depending on the practice, postpartum physicians may still have to contribute to their practice’s benefits and overhead charges during their leave—while not getting paid. They can also miss out on valuable weeks of productivity, which will continue to affect their earnings long after returning to work. For any physician on leave, it can take upwards of a year to recover financially from the hit of taking just six weeks off.
This reality isn’t a reflection of individual practices or hospital systems so much as it is about poor maternal health care in the U.S. as a whole. “Change has to come from a legislative area, and I don’t think we value women in our country enough to fix that,” says Wiggins.
It isn’t news that the U.S. has one of the worst federal maternity leave policies in the world, a truth that’s especially evident in medicine. It’s ironic, of course, given that physicians are trained to care for the human body—the exact vessel that needs adequate time to recover after the trauma of giving birth.
In some ways, the stories of these female physicians are similar to any other office situation across the U.S., where breastfeeding mothers pump in dusty storage closets and Millennial moms get eye-rolls from bosses for leaving to pick up sick kids from school. Gender-based workplace discrimination is a not a new conversation, but the implications for female physicians are particularly dire for the state of public health.
When women are discouraged from entering medicine and then face gender-based adversity once they’re practicing, health care quality diminishes. When women are not empowered to perform at their fullest potential in medicine, the data proves that patients aren’t getting the best possible treatment—especially female patients.
In an Annals of Internal Medicine study that assessed Medicare claims of nearly 800,000 patients between 2016 and 2019, researchers found that mortality rates among both male and female patients were lower when treated by a female surgeon. “Female physicians spend more time with patients and spend more time engaging in shared medical decision-making and partnership discussions than male counterparts,” study co-author Lisa Rotenstein, M.D., told Medical News Today. “In the surgical realm, female physicians spend longer on a surgical procedure and have lower rates of postoperative readmissions.”
A February 2022 study in JAMA Surgery concluded that patients treated by a female surgeon were less likely to experience death, hospital readmission, or a major medical complication. The study drew from more than 1.3 million patients and nearly 3,000 surgeons. Surgeries ranged from knee replacements and spinal surgeries to appendectomies and aortic aneurysm repairs.
For female patients who had a female surgeon, only 7 percent experienced an unfavorable post-operative outcome. For female patients treated by a male surgeon, that rate jumped to 50 percent. The data doesn’t hold true in the inverse: 39 percent of male patients operated on by a male surgeon experienced unfavorable outcomes, while only 4 percent of male patients with a female surgeon had complications.
If we can agree that female physicians are fundamental to an optimal health care ecosystem and having more of them will statistically improve patient outcomes, how can we ensure that women are “allowed” to enter operating rooms and hospital board rooms alongside their male peers? It starts early, with our children—especially making female physicians visible to little girls. “If you see it, you can be it,” Owen says.
Is it possible to raise a new generation of boys who view female physicians with the same authority as male physicians and who aren’t threatened by women health care leaders? Wiggins takes her young sons to female physicians; the normalization of women in health care has been so ingrained into her family that a son once asked, “Can boys be doctors, too?”
Professional mentorship can also be important for women in medicine, particularly in their formative residency years. It’s why Patel hosts regular roundtables with residents and faculty to discuss gender parity in neurosurgery. She coaches students and newly coated doctors to recognize the signs of gender discrimination, such as being taxed with busywork that isn’t assigned to male counterparts or witnessing disparaging jokes about “hormones” when female physicians express emotion. “I think the first thing is just really awareness that it’s happening to you or that it can happen to you,” says Patel.
There is also power in numbers, particularly around leadership tables where it’s crucial for women’s lived experiences to be represented, heard, and honored. It’s one of the reasons Owen uprooted her family from Utah to take her current role at Children’s and be another female voice at the decision-making table, paving a smoother and more inclusive road for female ophthalmologists who are coming along behind her. “We can partner with our wonderful male colleagues, who are great advocates, but they can’t replace us just being there and raising our voices when decisions are being made,” she says.
Progress is happening, in fact, and the gender climate is trending upward, especially in Cincinnati. The University of Cincinnati College of Medicine was recently ranked a Tier 1 medical school, on par with the likes of Harvard Medical School, which is partly thanks to its growing dedication to faculty diversity.
Nationally, in the 2023–2024 academic year, women made up nearly 55 percent of the total medical student population. UC’s orthopaedics residency program is currently home to the first and only all-female resident class in the U.S. In 2020, 16 percent of U.S. orthopaedic surgery residents were women, a 10 percent improvement from current practicing parity.
Women represented just 8 percent of U.S. practicing neurosurgeons in 2018, but there have been steady increases in parity there as well. There currently are five female residents in the pipeline in UC’s neurosurgery residency program, where a total of eight females have graduated in its 79-year history. “I’m really excited about the future of neurosurgery,” says Patel. “As one of the five surgical subspecialties with a truly male-dominated vibe to it, we’ve done an incredible job of working toward encouraging women.”
For lasting change to take root, the burden lies on all of us: patients, providers, professors, parents. “It’s just a matter of respect,” says Wiggins. “When you don’t even realize you have a bias, how can you fix it?”
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