Why are female physicians more prone to burnout than their male counterparts?

I’ve had several conversations lately at the ACOG national meeting and with other individuals interested in physician burnout about why female physicians are more prone to burnout than even our male colleagues.

The key takeaway from everything below is this:  There is nothing wrong with you!  It’s not us.  It’s the system.  It’s the social expectations that surround medicine and how women in general are “supposed” to act / be / interact with the world that increase our propensity for burnout. 

And many of these things have names.  We can find articles about them.  There are data!  Which feeds my data driven brain – and I’d imagine yours too, so here are some descriptions of the issues and links to the data.

Status leveling burden - the pressure put on women in male-dominated occupations from women in occupations lower in the institutional hierarchy to be their equal.

For example, how many times have you said to yourself,  “Nurses would never treat a male physician this way?”   The authors of the study linked below did structured interviews with 45 surgeons – 29 women and 16 men – and collected data on “whether the woman nurse–woman surgeon dynamic was different than the woman nurse– man surgeon dynamic”.  They found that there are several “nonsymmetric gendered expectations” placed on women physicians as it relates to their interactions with female nursing staff.  We engage in certain behaviors because of these expectations that impact our quality of work, our work efficiency, and our risk of attrition.

Cardador, M. T., Hill, P. L., & Salles, A. (2021). Unpacking the Status-Leveling Burden for Women in Male-Dominated Occupations. Administrative Science Quarterly, 67(1), 237-284. https://doi.org/10.1177/00018392211038505 (Original work published 2022)

Leadership double bind – The pressure to “be warm and nice (what society traditionally expects from women), as well as competent or tough (what society traditionally expects from men and leaders). The problem is that these qualities are often seen as opposites. This creates a “catch-22” … for women leaders”.  The HBR article linked below give advice as to how to navigate this double bind.  But I think that just knowing it exists is helpful – it makes it easier for me to think that the issue is not about me – again, it’s the system.

https://hbr.org/2018/11/how-women-manage-the-gendered-norms-of-leadership

Unpaid labor at home –  Women are generally responsible for more of the physical and mental work of running a household and parenting. As the article linked below states, “Globally, women spend a greater number of hours on unpaid labour; this review suggests that inequities in the division of unpaid labour expose women to greater risk of poorer mental health than men.”

Gender differences in the association between unpaid labour and mental health in employed adults: a systematic review.  Ervin, Jennifer et al.  The Lancet Public Health, Volume 7, Issue 9, e775 - e786

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00160-8/fulltext

Higher number of and longer inbox messages – We know intuitively as women physicians that there is a disparity in the expectations patients have of us.  Again, there are data here.  A study of EHR message usage by primary care physicians in the Brigham and Women’s hospital system found that “female physicians spend more time working in their EHR in-baskets because both staff and patients make more requests of female PCPs”.  Specifically, female PCPs received 24% more staff messages, and 26% more patient messages than their male counterparts.  And all those messages take time to figure out, respond to, enter orders, etc.  So, we spend more time in the EHR than our male counterparts.

Primary Care Physician Gender and Electronic Health Record Workload.  Rittenberg, Eve, et al.   J Gen Intern Med. 2022 Jan 6;37(13):3295–3301

https://pmc.ncbi.nlm.nih.gov/articles/PMC9550938/

Lower patient satisfaction scores – I don’t recommend any physician read their online reviews, because in general the only people who take the time to submit them are unhappy.  And pay / bonuses certainly shouldn’t be tied to online reviews.  This is because there are data that female physicians are reviewed more harshly than their male counterparts, in spite of data that show patients of female physicians have better outcomes.

In the study cited below that encompassed 345,000 online reviews, “the findings suggest that patients harbored negative gender biases about the interpersonal manner of female physicians, especially female PCPs, and also assessed disproportionate penalties related to technical competence for both female PCPs and female surgeons.”

Madanay F, Bundorf MK, Ubel PA. Physician Gender and Patient Perceptions of Interpersonal and Technical Skills in Online Reviews. JAMA Netw Open. 2025;8(2):e2460018. doi:10.1001/jamanetworkopen.2024.60018

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2830232?resultClick=1

Gender pay gap – Most studies on this issue show that female physicians – who make up almost 50% of the physician population – make on average about 75 cents on the dollar compared to their male counterparts, even when adjusted for hours worked, number of patients seen, etc.  This has been demonstrated across multiple studies – I’ve linked one below.   Over a 30 year career, this disparity results in about 2 million fewer dollars of earnings. 

Hoff, Timothy; Lee, Do Rim. The gender pay gap in medicine: A systematic review. Health Care Management Review 46(3):p E37-E49, 7/9 2021. | DOI: 10.1097/HMR.0000000000000290

https://journals.lww.com/hcmrjournal/abstract/2021/07000/the_gender_pay_gap_in_medicine__a_systematic.11.aspx

So we get that there are multiple issues that predispose female physicians to burnout, right?  What can we do about it?

1. Realize it’s not our fault individually. Seeing the data on these things enables us to make a powerful mindset shift.  It’s not us.  It’s the system.
2. Advocate for changes to our organizations. We can advocate to stop tying pay to satisfaction scores.  To have administrative help for inbox management if we don’t already.  We can advocate for transparency in pay scales, and equal pay for experience level and workload. 
3. We can advocate for flexible work schedules to allow us to manage the unpaid labor at home without feeling like we have to burn the candle at both ends. I don’t know about you, but feeling like I was “half-assing’ everything in my life was a huge burnout contributor for me early in my career. Women physicians are expected to work as if they don’t have kids, and parent as if they don’t have jobs.  It’s an impossible standard.  We have to give ourselves grace and realize we’re all doing the best we can.
4. Learn to set boundaries to protect your time. Don’t take on “housekeeping” tasks at work that aren’t tied to pay increase or promotion. Don’t join committees you don’t want to join.  Speak up when required meetings happen during prime parenting hours about how this differentially affects men and women, and disincentivizes women to take on leadership roles so that they have a seat at the table to address other issues that need all perspectives.
5. Recruit male colleagues to speak up for us when they see their female colleagues being treated differently than they are treated by nurses and staff. The study above on status leveling showed that our male colleagues notice the difference.  We need to encourage them to speak up on our behalf when they see it.
6. Call out gender biased interactions. One of my coaches, Dr. Sasha Shillcutt, has a perfect way to handle this.  When someone says something that is biased, say “excuse me, could you repeat that?”  This gives people pause and gets them to reconsider what they said, and often is all you need to do to shine a light on the issue.
7. Outsource help with home tasks, and discuss equitable distribution of the mental and physical workload of parenting with partners. If a to-do list needs to be made, you both make it together and divide it up.  You making a list for a partner just keeps that mental burden on you. 

Yes - it’s all work.  

And yes, I share the thought that it shouldn’t be this hard.

But that’s arguing with reality. And as Cy Wakeman says, when you argue with reality, you’ll lose, but only 100% of the time. 

What’s the alternative?  Walking away / doing something else?  That’s ok too if that’s what you choose. We get to choose how we spend our time and what career path we follow. 

If the tasks above seem overwhelming, realize you aren’t required to do them all at once – or ever.  Even if the system never changes, you can choose to be happy with the circumstances where you are.

My point in this summary is to empower you to realize that it’s not just you, and it’s not your fault.

If you want to work through any of this with coaching sessions specific to your individual situation, I’m here for you and would be happy to help. Just reach out.