For the first time, women now make up the majority of physicians in U.S. training programs, according to the Association of American Medical Colleges’ annual report on residency trends.
In the 2024-25 academic year, women accounted for 50.2% of residents and fellows across all specialties and subspecialties, per the report. The figure marks a stark contrast from the 1970s, when women comprised less than 10% of physicians, and reflects decades of steady growth in female representation in medical schools and training programs.
But the milestone lands in an industry that remains far from gender parity. Women represent 38% of the active physician workforce as of 2022, up from 26% in 2004, AAMC data shows. They remain underrepresented in higher-paying specialties and senior leadership roles, with persistent pay gaps and high rates of harassment continuing to shape many physicians’ career trajectories.
The question for hospitals, health systems and academic medical centers is no longer how to get more women into the profession. It is whether the profession’s structures are prepared for a future in which women comprise a growing share of its workforce, and whether institutions are ready to confront long-standing gaps in compensation and career advancement, as well as cultural barriers that representation alone has not resolved.
“Now we’re at this point where the profession as a whole really needs to address systemic climate and environmental issues that have prevented everyone from equally rising in their career ranks, and also from being able to practice medicine in the best way that they possibly can,” said Diana Lautenberger, senior national adviser and program leader of gender equity initiatives at the AAMC.
Becker’s spoke with medical school leaders and industry experts about what this demographic shift means for healthcare organizations and what steps institutions should take to support and retain a workforce that is increasingly female.
Growth without diversification
Even as women make up a majority of residents overall, their distribution across specialties has shifted far less dramatically. AAMC data shows that the specialties with the highest and lowest representation of women a decade ago largely remain the same today.
Women continue to concentrate in specialties focused on family and women’s health, including pediatrics, obstetrics and gynecology, dermatology and family medicine. Meanwhile, they remain significantly underrepresented in surgical and procedure-driven specialties. In orthopedic surgery, for example, women accounted for just 6% of active physicians in 2022, up from 3% in 2004.
“We’re not really diversifying overall across specialties,” Ms. Lautenberger said. “We’re kind of just seeing even more women go into OB-GYN, pediatrics, family medicine” and other family care-centered specialties.
Experts say long-standing cultural and environmental barriers within certain specialties may contribute to those patterns. Research has documented high rates of harassment and gender bias across medicine, and some specialties historically have been characterized by rigid hierarchies and demanding schedules.
Those cultural norms can influence specialty choice, particularly when trainees weigh lifestyle considerations, Ms. Lautenberger said.
Mentorship is also a key factor in specialty choice. Medical students often gravitate toward fields in which they see mentors and leaders who reflect their own identities and career aspirations. Elevating women as visible mentors in specialties in which they remain underrepresented could help broaden those pathways. Without greater representation and mentorship in those fields, she said, the profession is likely to see the same specialty gaps persist even as more women enter medicine overall.
Pay and career advancement gaps persist
Medicine’s gender pay gap has widened in recent years, with the average gap between men and women across all physician types growing to $96,000 in 2024, according to a Medscape report published in 2025. Among specialists, men reported earning an average of $447,000 compared to $339,000 for women.
Some research has also shown that when more women enter a field, average compensation and perceived prestige can decline — a dynamic also seen in industries outside of healthcare, leaders said.
“In other fields, literature highlights that the more women that enter a field, the more likely the salary is to drop, the more likely the prestige is to drop,” said Vineet Arora, MD, dean for medical education at UChicago Medicine. “There’s still a cultural phenomenon here that even though it’s exciting to see more women enter fields, it’s still important to make sure that we’re aware of that.”
As such, salary equity has long been a central concern for physicians, leaders said. Internal AAMC analyses have found that inequitable pay contributes to faculty turnover, Ms. Lautenberger said, underscoring the workforce implications for health systems and medical schools.
Even in specialties in which women make up a significant share of the workforce, material gaps persist. In primary care, for example, men earn an average of $307,000 compared to $268,000 for women, according to Medscape’s survey data.
Alongside pay imbalances, gaps in advancement and leadership continue to shape career trajectories.
Academic medicine has made notable progress in expanding women’s representation in midlevel leadership roles over the past decades, Ms. Lautenberger said. But advancement has been far slower in positions with the greatest authority and budgetary oversight.
Department chair roles — which oversee clinical specialty areas — are one of the starkest examples of uneven progress. Women account for 15% of department chairs in 2013. By 2023, that figure had risen to 25%, according to AAMC data.
“Department chairs have not cracked 25%, which is really, really low when you think about just how long women have been a good majority of the representation coming into medical school,” Ms. Lautenberger said. “We have really seen the most progress being made in leadership positions that quite frankly have very little budget, very little cachet, very little institutional responsibility and influence, but there is a lot of work that goes into those positions.”
Tracey Conti, MD, vice president of academic practice at St. Louis-based SSM Health and vice dean of clinical affairs at SLUCare, pointed to mentorship and sponsorship as critical drivers of advancement. Women need access not only to advisers who understand career pathways, she said, but to sponsors who can advocate for them and open doors to leadership roles.
She urged organizations to look beyond residency representation and examine executive pathways and C-suite leadership, where structural disparities often persist. Leaders in those roles shape policies and priorities that affect front-line physicians, she said.
As more women move through the training pipeline, leaders say both compensation models and institutional policies must evolve alongside workforce demographics.
“My ultimate goal is — it doesn’t matter if you’re a man or woman — we should have policies that are for all genders to be able to manage the things we do outside the hospital and the things we do inside the hospital,” said Julie Oyler, MD, associate director of the internal medicine residency program at UChicago Medicine.
Compensation systems that reward increased clinical productivity, such as additional hours or higher visit volumes, can disadvantage physicians with caregiving responsibilities, she said. Parental leave and flexible scheduling policies should be structured to support all parents, not solely women.
Dr. Arora highlighted an example from UChicago Medicine during the COVID-19 pandemic, when the institution secured grant funding to support physician scientists whose careers were disrupted by caregiving responsibilities — including child care and elder care — regardless of gender.
Alexa Kimball, MD, CEO and president of Harvard Medical Faculty Physicians at Boston-based Beth Israel Deaconess Medical Center, said leaders at the organization have sought to embed flexibility and support into organizational culture rather than treat it as a one-off benefit.
The organization has introduced programs designed to give physicians a range of options to ease family and caregiving pressures, from meal and grocery delivery to in-home tax preparation and other household support services, allowing individuals to choose what is most useful to them.
Both men and women have reported feeling more valued by the initiative, Dr. Kimball said. But women were more likely to say the services meaningfully reduced stress, reflecting the disproportionate share of caregiving and household responsibilities many continue to shoulder.
She also pointed to structural adjustments — such as avoiding early morning meetings that can conflict with school drop-off or child care — as practical steps that can broaden participation in leadership and committee work.
“That’s one example of a tactic, but it has to be a philosophy,” she said.
Rooting out bias and harassment
In 2022, the AAMC published its first report on the prevalence of sexual harassment in academic medicine, finding more than one-third of all women faculty have experienced harassment. Taking a broader view, about the same portion of female physicians report experiencing sexual harassment in the workplace, according to a 2019 study from researchers at Ann Arbor-based University of Michigan. The same study also found 66% of women experience gender bias.
The statistics underscore the need for all areas of medicine to take targeted actions to root out long-standing bias and cultural issues that can hinder women’s career advancement, or prevent them from going into a certain field altogether, leaders said.
For hospitals and health systems, this starts with having zero tolerance policies that are visible to both patients and staff, and having anonymous reporting systems in place that are elevated in meetings, Ms. Lautenberger said.
“Medicine is second only to the military in terms of the rates of harassment and sexual-based violence that occur in the profession,” she said. “The rampant bias, discrimination and harassment that is pervasive in medicine I believe is one of the leading contributors to burnout. Having more solid policies and practices in place that are zero tolerance for harassment and discrimination will really help.”
The AAMC’s 2022 report found that anesthesiology and emergency medicine were specialties with the highest rates of harassment, each at 52.6%. Since then, Ms. Lautenberger said both specialties have undertaken efforts to address this issue, including convening task forces, conducting surveys and hosting educational sessions.
In 2025, the AAMC revisited harassment data and found rates in anesthesiology and emergency medicine went down.
“We should be looking at those specialties that have historically higher rates but have done the work to bring those numbers down,” Ms. Lautenberger said. “Those are bright spots we can look to.”
Flexibility and the structural roots of burnout
As more women enter medicine, leaders say addressing physician burnout requires reexamining long-standing expectations around availability, caregiving and workload that shape how physicians practice.
“Everyone has a life outside of their profession, and we just haven’t really made space for that in terms of what the culture of medicine looks like,” Ms. Lautenberger said. “We have to address long-held notions and norms around what an ‘ideal’ physician looks like as someone who we do not acknowledge their outside life, their personal life or their family life and they should just tolerate abuse and harassment. These are issues we have not fully dealt with yet.”
The consequences of failing to address those structural challenges are already visible in the workforce. Nearly 23% of women physicians are not working full time within six years of completing residency, compared to 3.6% of men, according to a study published in JAMA. The gap underscores the retention risk for health systems that fail to address structural barriers related to flexibility, compensation gaps and cultural issues.
Healthcare is beginning to see meaningful progress in women’s representation across specialities, driven by a growing pipeline of women entering college, STEM majors and medical school — as well as evolving practice models that better support work-life balance, according to Neda Etezadi-Amoli, MD, vice chair of education for the OB-GYN department at Reno, Nev.-based Renown Health and senior associate dean for undergraduate academic affairs at UNR Med.
“The surgical specialties, historically, have been behind in terms of recruiting women,” Dr. Etezadi-Amoli told Becker’s. “That’s because the traditional models didn’t allow for the balance of the many hats that women tend to wear in terms of balancing personal and professional life, but we’ve seen a shift in that.”
An increase in fellowship programs and further subspecialization in procedural-based specialties such as OB-GYN — including roles in maternal-fetal medicine specialists and gynecologic oncologists — has created more flexibility in practice structure and call models, allowing physicians to better tailor their careers to work-life preferences, she said.
“I credit [increasing representation] to a lot of national reforms as well as a focus on work hours, well-being and making sure that the culture is hospitable to all — not just women, but everybody,” Dr. Arora said.
The structural challenges women in medicine face — from harassment and pay inequities to limited flexibility — are closely tied to burnout risk. When health systems excel in those areas, reduced burnout should follow, Ms. Lautenberger said.
Still, flexibility alone does not resolve deeper workload imbalances. Women physicians may carry a higher burden of nonclinical responsibilities and often take on more complex patient panels, which can contribute to burnout, Dr. Conti said.
“I’ve often found that women sometimes carry what people consider complicated patients, because we have the ability to manage them. … But those patients sometimes take longer to care for,” she said. “How do we make sure that we are aware of that, that we’re utilizing data, not just patient visit times, but also looking at the complexity to ensure we’re not adding more on to our women’s position?”
Although organizations increasingly measure burnout, Dr. Conti said the next step is ensuring resources are in place to address it — from behavioral health support to flexible scheduling.
“From a retention standpoint, if we consider the cost of losing a provider from our system because they’re burnt out, versus implementing robust wellness initiatives, your systems can save money from a loss of employees by instituting these things,” she said. “Do you have to be more creative and make sure that all the jigsaw puzzle pieces fit? Absolutely, but it can be done.”
Where health systems can start
Taking steps to better support and retain a workforce that is increasingly female starts with taking a rigorous look inward at compensation structures, promotion patterns and institutional policies, leaders said.
“You’re not going to know how to take action unless you look at your own data and take an audit of your policies,” Ms. Lautenberger said.
That means closely examining pay equity, advancement rates by gender and specialty, and representation at different career stages. Satisfaction and engagement surveys can also help pinpoint where physicians report barriers related to flexibility, bias or culture.
Many organizations are now conducting pay equity studies as a risk mitigation strategy, Ms. Lautenberger said. Trends can vary widely from one institution to another, making it essential to analyze local data and understand what policies and equity efforts are — or are not — already in place.
“It always surprises me that sometimes it’s news to even hospital leadership whether or not they have a caregiving policy or if they’ve never done a pay equity study,” she said.
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