Consented, p.22
Consented, page 22
This is just one snapshot of workplace misogyny. It easily goes beyond the casual “sweetheart” comments, reflecting the systemic devaluation of women’s labor. Workplace misogyny is a pillar of societal rape culture, upheld through gendered power imbalances, institutional tolerance of harassment, and routine financial disempowerment. These everyday expressions of hostility toward women in work environments, in turn, help trivialize the larger cultural erosion of their safety and worth.
Medicine was built on the same gendered hierarchy. In the framework of medical rape culture, workplace inequity—fueled by misogyny and racism—keeps women silenced, underpaid, and vulnerable. It punishes confidence, rewards submission, and protects the very systems that pay us in quarters but expect us to smile and say thank you. And while it hurts healthcare workers, it doesn’t stop there. By maintaining patriarchal status quos within the profession, workplace inequity seeps into the exam rooms, bleeding into patient care itself.
That day, we sent Nate home with a realigned finger. But the deeper dislocations remain, lodged in the bones of the medical profession.
The Untitling Truth
“You are awesome, Dr. Zha!” Nate shouted down the hall as he and his wife left the patient care area. “Can you be my primary care doctor?”
From sweetheart to awesome doctor to my doctor—what a proposal. I wasn’t the first woman to have to “earn” my title in medicine, and I won’t be the last. In an analysis of nearly thirty-five thousand patient messages at the Mayo Clinic between 2018 and 2021, women physicians were found to be half as likely to be addressed as “doctor,” regardless of their age, degree, specialty, or seniority.13 Similarly, a 2023 study revealed that while 67% of women orthopedic surgeons-in-training were called by their first names at work, only 4% of their male colleagues experienced the same.14 This doesn’t stop in clinical settings. Female speakers at professional medical conferences and presentations are more likely to be introduced and addressed without their titles, especially when the introducer is a man.15
This is untitling, the common practice of omitting titles for women while preserving them for men. The term was coined by gender equity researcher Dr. Amy Diehl and leadership professor Dr. Leanne Dzubinski in 2021, in response to The Wall Street Journal’s call for First Lady Dr. Jill Biden to drop the Dr. from her name.16
When I posted about untitling on social media, a man reposted, “[This] proves women care more about their titles than men do!” (I’ll explain what the “[This]” refers to in just a few paragraphs, so bear with me.) Indeed, women who insist on being addressed by their titles are often ridiculed as “uptight” or “insecure.”17 But here’s the truth: Untitling isn’t about our personal comfort with our credentials—it’s about the assumption that women are less deserving of authority, respect, or recognition. By subtracting our titles from their rightful place, untitling adds to workplace misogyny by keeping women “in their place.”
To be clear, untitling is the omission of a woman’s title when that title is known. This is different from simply being mistaken for a nurse, advanced practice clinician, or other healthcare professional. In fact, many of my best teachers were not doctors, and I’d have no problem being identified as one of these nonphysician roles. But even these misidentifications don’t occur at the same rate for men and women.
In a 2019 study, three-quarters of patients assumed the men directing their care in the ER were doctors, while only about half assumed the same for women.18 Another study conducted in 2017–2018 across several medical and surgical specialties found that patients and their families were more likely to mistake women physicians-in-training for nonphysicians: In fact, 100% of women reported being misidentified, compared to less than 50% of men. Even more troubling, staff members were also prone to make the same mistake, with 75% of women physicians-in-training reporting misidentification by staff, compared to 28% of men.19 And this statistic drives the point home: In 2019, when four thousand people were asked to imagine a doctor, only 5% pictured a woman.20 If these numbers don’t reveal the deeply ingrained gender bias that casts women as exceptions to positions of leadership and expertise, I don’t know what does.
Now, about the “[This]” from earlier: The full comment was, “His argument proves women care more about their titles than men do!” I can’t prove it, but is it possible the commenter assumed I was a man because of my handle—Dr. Zed Zha? Did his dismissal of gender-based untitling reflect the very gender bias it claimed didn’t exist? Hmm.
So, what’s the big deal? When women physicians are untitled, 61% report having their clinical decisions questioned by nursing staff. For men, this nearly never happens—only 2% report the same. The consequences of such misidentification extend to therapeutic relationships as well: 40% of women physicians say their rapport with patients suffers. That’s why 81% of women physicians prefer to introduce themselves by their titles—after repeatedly seeing their identities misrepresented and their authority undermined.21 So, excuse us for being “uptight” about not wanting to play along with this self-fulfilling cycle. The real problem is how relaxed society is about devaluing us.
Yes, to an extent, forms of address can vary with workplace culture. But untitling finds women everywhere. For instance, at one of my jobs, every physician was addressed by title. Even when I encouraged staff to call me Zed, they struggled to break the norm. But my boss had no such trouble during my orientation. Gesturing to the man beside me, he said, “Dr. Goodman, meet Zed. She’s a smart girl.” Only then did he list where I had trained and gone to medical school. To him, I was a girl first, and a qualified doctor second.
At another job, the culture was casual; everyone went by first names. But the patronization remained. When I moved into the workspace of a recently retired male physician, a physician assistant colleague came over and grinned: “Hi Zed! I see we replaced Dr. Scott with a young girl!” You can guess Dr. Goodman’s and Dr. Scott’s gender.
Personally, I don’t mind going by Zed. But I do mind being called a “smart girl” by my boss, a “young girl” by my coworker, and “sweetheart” by a patient. I am, simply put, no one’s sweetheart at work. Nor is anyone else. Yet women in medicine are far more likely than their male peers to be inappropriately addressed by patients using terms of endearment like dear or honey, to name just a few.22
On the surface, words like sweet, cute, adorable, bubbly, and young may sound flattering; they seem to describe a youthful, lovely woman. In reality, they infantilize. They reduce women to something less mature, less serious, less competent, undermining our expertise and achievements. What my boss really said was: Zed is smart, but don’t be threatened—she’s just a girl. And what my colleague really meant was: Doesn’t matter that you’re the new doctor—you’re still just a girl. They just threw in some nice words to soften the blow. How precious.
These toxic norms run deep in history. Women have always been healers and nurturers. Yet rarely have we been recognized as professionals.23 When Dr. Elizabeth Blackwell became the first woman to graduate from medical school in 1849, it was because the men at Geneva College had granted her admission as a practical joke.24 She starved herself so she wouldn’t blush during anatomy discussions, worried her “delicate sensibilities” would be exposed.25 Despite being forced to sit apart during lectures and often shunned from labs, Dr. Blackwell eventually graduated first in her class.26 Maybe the men had something to learn from her after all.
In 1983, Dr. Maureen Longworth of UCSF made a satirical film titled Turning Around: Sexism in Medicine, using gender-reversed skits.27 In one scene, a female attending greets the male students with a flirtatious “Oh, hello,” calls them “the boys,” then directs her attention only to the women. She picks up one male student’s hands and says, “My! You have lovely hands! Do you play the piano?”
“A little,” he answers.
“Well, perhaps you should consider that as a career. That’s a very good profession for a boy.”
The film was funny because it wasn’t real. And we don’t want it to be, because feminism isn’t about flipping the script so women can be aggressive toward men. It’s about dismantling the whole stage—ending workplace misogyny and ensuring gender equity. It’s about achieving equal respect.
Yet, forget equal respect, we don’t even get equal disrespect. Think about when men are regarded as boys in professional settings. For example, when Nate said, “Oh look, honey, this young lady is rubbing my middle finger up and down,” his wife rolled her eyes, implying: Ignore him. He’s not flirting. He gets like this when he’s scared.
In other words: Boys will be boys. Or rather, men will be boys—when they misbehave. We rationalize on their behalf, because supposedly boys struggle to express themselves, especially under stress, so they can’t be held responsible for misconduct or aggression. The burden falls on the rest of us to excuse and tolerate their inappropriateness. Unlike when women are called “girls,” men don’t get infantilized; they just get exonerated.
Unlike terms that infantilize and discredit women, referring to aggressive men as “boys” does something entirely different: It enforces an unequal, double standard and justifies toxic masculinity. Both attitudes, in turn, contribute to an environment where violence toward women is normalized and minimized, enabling rape culture.
Viewed through the lens of rape culture, Nate’s behavior becomes clear. Whether he was scared and unaware of his inappropriate conduct, or disempowered and threatened by my presence, he coped the only way patriarchy taught him: by sexualizing and belittling a woman to reassert dominance. Similarly, when my boss introduced me as a smart girl with an Ivy League education and a Mayo Clinic diploma, he was both managing his discomfort and reassuring himself—and his men—that they wouldn’t lose their dominance. And when my new colleague called me a young girl, he wasn’t complimenting my youthful appearance; he was marking his territory and asserting dominance.
“Not a young girl,” I said.
“Oh, sorry,” he replied quickly. “Young lady.”
Wrong again. “You can call me Zed. Or Dr. Zha,” I said, firmly. Had I ever sniffed a power play.
Whether we go by Doctor, Zed, or Ms. So-and-So, the point is respect. And here is the untitling truth: In medicine, respect is still conditional. And that condition is gendered.
During a Zoom interview, I asked Dr. Longworth what she’d say to those who believe medicine has already achieved gender equity.
“Bullshit,” she replied, not so sweetly.
The Trust Gap and Beyond
Despite our rocky start, Nate ended up leaving his previous doctor (a man) and became my patient. And honestly? That was an evidence-based decision. For decades, the assumption that women physicians were less knowledgeable or less capable was used to justify their exclusion from medical training. But the data tells a very different story. Study after study has shown what many of us already knew: Women make better doctors.
During training, women residents are more likely to work more than eighty hours a week, which is the upper limit of safe work hours mandated by the Accreditation Council for Graduate Medical Education.28 While I don’t endorse such overwork, these statistics highlight the gendered expectations that shape medical careers from the outset. Women primary care physicians are more likely to care for patients who are covered by Medicaid or belong to marginalized communities. We spend 15.7% more time with our patients, document more thoroughly, and order appropriate tests more frequently. Even though we work five fewer days a year, we somehow manage to spend 1,200 more minutes annually with patients.29 We also spend 20% more time reviewing charts and 22% more time documenting care. That extra attention shows up in our inboxes, too; we receive 24% more messages from staff and 26% more from patients. It all adds up to 62 more messages a month than our male colleagues.30 That’s 62 more problems to solve, to say the least. No surprise, then, that we’re also 62% more likely to work during vacation.31
What are we doing with all that time with patients? Oh, you know, the usual: listening, asking questions, discussing side effects and alternatives, engaging patients as partners, avoiding medication overprescribing, and providing more counseling, more encouragement, more humanity.32 As a result, women doctors are 24% more likely to screen for cancer. Our patients are 11% less likely to be hospitalized and 17% less likely to require ER visits, even if they require more complex care.33 A 2023 meta-analysis of thirteen million patients showed that those cared for by women physicians were 5% less likely to die and 3% less likely to end up back in the hospital.34 Even in surgery, a field that has resisted gender equity with particular vigor, patients are 7% less likely to die when operated on by women surgeons.35
More time, better communication, better outcomes. That should lead to greater trust and respect, right? Not exactly. Even though women are more patient-centered and produce better health outcomes in clinics, they don’t earn higher satisfaction scores.36 Instead, women physicians are consistently rated as less helpful, less knowledgeable, and overall lower than men by patients online.37 Where evaluations of women doctors mention kindness and compassion more often, those of men mention expertise more frequently.38 The only place women physicians are consistently rated better? Hospitals—where our patient-centeredness stands out more starkly. But even there, being patient-centered is more likely to lead to high patient satisfaction for men than for women. In other words, men are given more credit for caring for patients the way they should.39
Let me summarize: Women physicians see more underserved patients, spend more time face-to-face and behind the scenes (even on vacation), communicate better, listen more, are more patient-centered, investigate more thoroughly, prescribe more carefully, catch more cancers, reduce hospitalizations, prevent ER visits, perform surgeries with better outcomes, and prevent death. Still, our expertise is trusted less overall. Clearly—like respect, and deeply intertwined with it—trust is conditional. And that condition is also gendered.
At this point, you might be tempted to throw up your hands and say, “Forget it. I know I do a good job. That’s enough.” But here’s the real question: You do a good job, but do you have a good job? More pointedly: Does your job think you do a good job? To answer that, let’s compare what my boss sees from the C-suite with what’s actually happening in my day-to-day:
What my boss sees My reality
I see one to two fewer patients a day than Dr. Goodman = 330 fewer visits a year.1 I spend 2.4 more minutes per visit,1 which adds up to real care.
I generate $39,000 less revenue1 than Dr. Goodman. I provide more patient-centered care,2 which isn’t tied to pay.1
My patient satisfaction scores match Dr. Goodman’s, which is tied to pay.3 My patient outcomes are better,4 but currently, better outcomes don’t earn bonuses or better pay.
I’m less efficient, spending more time on unbillable tasks.5 That “unbillable” time is open communication with patients and staff, which gives me a much higher workload.5
I take more days off, though only five more a year1 than Dr. Goodman. On those days “off,” I still log in, answer messages, and work. Plus, I’m less likely to take long vacations,6 unless it’s for childbirth.7
When I have a baby, I’ll probably go part-time.8 31% of physician mothers work part-time. Only 5% of physician fathers do.8
1Data from I. Ganguli, B. Sheridan, J. Gray, M. Chernew, M. B. Rosenthal, and H. Neprash, “Physician Work Hours and the Gender Pay Gap—Evidence from Primary Care,” New England Journal of Medicine 383, no. 14 (2020): 1349–57, DOI: 10.1056/NEJMsa2013804.
2 Data from Klea D. Bertakis and Rahman Azari, “Patient-Centered Care: The Influence of Patient and Resident Physician Gender and Gender Concordance in Primary Care,” Journal of Women’s Health 21, no. 3 (2012): 326–33, DOI: 10.1089/jwh.2011.29.
3Data from Judith A. Hall, Pål Gulbrandsen, and Fredrik A. Dahl, “Physician Gender, Physician Patient-Centered Behavior, and Patient Satisfaction: A Study in Three Practice Settings Within a Hospital,” Patient Education and Counseling 95, no. 3 (2014): 313–18, DOI: 10.1016/j.pec.2014.03.015.
4Data from S. Dahrouge, E. Seale, W. Hogg, J. Younger, E. Muggah, D. Ponka, et al., “A Comprehensive Assessment of Family Physician Gender and Quality of Care: A Cross-Sectional Analysis in Ontario, Canada,” Medical Care 54, no. 3 (2016): 277–86, DOI: 10.1097/MLR.0000000000000480.
5Data from Eve Rittenberg, Jeffrey B. Liebman, and Kathryn M. Rexrode, “Primary Care Physician Gender and Electronic Health Record Workload,” Journal of General Internal Medicine 37, no. 13 (2022): 3295–301, DOI: 10.1007/s11606-021-07298-z.
6Data from C. A. Sinsky, M. T. Trockel, L. N. Dyrbye, H. Wang, L. E. Carlasare, C. P. West, et al., “Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians,” JAMA Network Open 7, no. 1 (2024): c23c51e065, DOI: 10.1001/jamanetworkopen.2023.51635.
7Data from Jane Herr, Radha Roy, and Jacob A. Klerman, Gender Differences in Needing and Taking Leave (Abt Associates, 2020).
8 Data from Elena Frank, Zhuo Zhao, Srijan Sen, and Constance Guille, “Gender Disparities in Work and Parental Status Among Early Career Physicians,” JAMA Network Open 2, no. 8 (2019): e198340, DOI: 10.1001/jamanetworkopen.2019.8340.
