It’s Monday morning. You walk into a well-lit room, taking in the familiar surroundings of several colleagues in easy conversation, laughing and joking. You can’t help but feel a change in the atmosphere when you are noticed. The conversation comes to a halt, and you hear someone mutter, “Now we’re in mixed company.”

This scene may bring to mind a woman accidentally walking into a men’s locker room. In reality, this is not uncommon for women physicians in emergency medicine.

As our news feeds fill with stories of women stepping forward to call out sexual harassment and discrimination, we watch with grim recognition. Gender bias in the workplace often occurs through exploitation of gendered power dynamics, causing women to be treated differently and subsequently fall behind in systems historically built around men. At this critical juncture, we have an obligation to look within our medical community to identify and remedy sexism, from frank harassment to subtle but equally damaging unconscious bias. Marginalization and discrimination do not need to be intentional to cause harm, and in many cases, men are not even aware of the harm they cause.¹

Emergency medicine is a male-dominated field. Although the medical field has shifted overall to near gender parity for enrolled medical students, only 27 percent of emergency physicians are women.^2,3 Evidence suggests women are also at a statistical disadvantage in emergency medicine training. A recent article found that women training in emergency medicine received inconsistent feedback on their work when compared to men. While men were consistently told how to improve clinical skills, women received conflicting advice, often centering on assertiveness and confidence.⁴

Another study found that while women and men entered emergency medicine training with similar skill sets, by the end of residency, men achieved training milestones at a higher rate than women. The achievement gap was measured as equivalent to a full three to four months of training.⁵

We must ask ourselves what sort of culture exists in our field that causes women to fall behind.

In discussions with female colleagues across several institutions, we discovered common themes. Many male doctors seem unconsciously uncomfortable working with female doctors, and the social environment of the emergency department often centers on gender norms. We hear remarks disparaging female physicians who make more money than their significant others, jokes about women’s clinical judgment being clouded by feelings, and questions about whether women may be inherently less suited for the job.