Why are California’s female physicians of color leaving medicine despite patient success?

Patient health outcomes improve as the diversity of the physician workforce grows, but a new report finds that women physicians of color are leaving the field because of the many barriers they face to career advancement.

While high entrance exam scores and research experience are often considered the hallmarks of superior physicians, those scores do not assess valuable attributes such as emotional intelligence or relatability, said Dr. Bianca Roberts, a family medicine physician who practices in Sacramento.

“We need people who can actually hear and listen to people, who understand people from different backgrounds, who come from different experiences and can actually try to figure out what’s going on with someone,” Roberts said.

Physicians for a Healthy California, the charitable arm of the California Medical Association, recommended ways that the state’s health care organizations can retain these doctors in a report released Monday titled “A Prescription for Change: Addressing Retention Among Women Physicians of Color in California.”

In addition to improving patient outcomes, female doctors often elect to practice in areas shunned by other physicians, the report’s authors noted. They pointed to a 2018 study showing that women physicians of Black, Hispanic and Native descent are more likely to work in heavily populated impoverished regions.

Effectiveness doesn’t translate to leadership positions

In one study after another, women physicians overall and women physicians of color rank highly in effectively caring for patients, but their numbers in leadership roles do not reflect their proportion of the workforce, said Dr. Deena Shin McRae, the associate vice president for Academic Health Sciences in the University of California Office of the President.

She and a team of researchers commissioned by Physicians for a Healthy California found that many women physicians of color are burning out and leaving the profession because they feel they aren’t valued at work and face workplace harassment.

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According to data from the American Association of Medical Colleges, McRae said, 57% of medical school applicants were women, but then by the time residency begins, they represent 47% of graduates in those training programs.

“And in California, only 38% of physicians with an active California medical license identify as female,” said McRae, one of the lead authors of the “Prescription for Change” report. “So our data was showing that the burnout rate for all women physicians had risen from 37.2% 2018 to 45.8% in 2022.”

These workforce losses come at a time when California already has a shortage of physicians in some regions and projections show the need for more doctors will grow.

Losing female doctors

When California loses women doctors, studies show that patients lose advocates focused on their overall well-being.

When it comes to screenings for cancers and chronic conditions, female physicians “are more likely to exercise diligence and compliance” than their male peers, studies have found.

Given these statistics on patient outcomes and careful oversight of screenings, it is perhaps no wonder that women doctors are less likely to have high-cost medical malpractice claims.

Despite these kinds of successes, McRae said, “our research showed that 24% of women physicians were considering a departure from medicine and entering an entirely different profession. The top reasons were burnout or exhaustion, frustration with the workplace politics and insufficient compensation.”

McRae and her co-author, Physicians for a Healthy California CEO Lupe Alonzo-Diaz, are calling upon health care organizations to ensure they have policies in place that will help to retain women physicians and demonstrate that their work is valued.

It starts, McRae and Alonzo-Diaz wrote, with recognizing that both structural racism and sexism throw up barriers for women physicians of color.

Roberts, who is African American, said she’s had patients tell her they didn’t want her as their doctor because of her race, and she’s had patients address the medical students she’s training as Dr. Roberts.

Roberts, who practices in the Sacramento region, said she also takes on the work of mentoring other physicians of color and ensuring they make the social connections they need to establish firm roots in the region. This work is often referred to as diversity, equity and inclusion.

“There is an opportunity cost for these DEI leaders who spend their time on DEI initiatives rather than on more clinical work to generate revenue or scholarly work to support their own individual advancement,” McRae and Alonzo-Diaz wrote. ”To combat this diversity tax, such DEI service opportunities must be compensated and resourced appropriately and be weighted in promotion and compensation decisions.”

Studies have shown that both employers and patients benefit from having a diverse workforce that can easily surmount language and cultural barriers, Roberts and the researchers said.

Facing stereotypes

Women physicians also face outdated societal expectations of their role at home and at work, according to the Prescription for Change report. If two spouses are doctors, for instance, the woman often is expected to take care of cooking and child-rearing duties while her husband puts in extra hours at work to advance his career.

At work, patients expect women to have a more nurturing approach than male doctors, so female doctors spend more time answering patient questions in the exam room or going over electronic charts. Women doctors also often are assigned to roles, committees or groups focused on improving the well-being of their colleagues rather than positions that improve pay.

Paid roles come with titles such as “chief medical” or “medical director,” Roberts said, but women often are given the role of “physician champion” or other titles that do not improve compensation.

The report makes clear that many women physicians would rather leave the profession than endure this sort of sexism or racism. It’s imperative that health care organizations identify high-yield, meaningful patient outcome measures and ensure they have diverse enough physician workforce to meet those goals, researchers said.

Health care leaders should approach matters of diversity, equity and inclusion with humility and curiosity, McRae and Alonzo-Diaz wrote, and they have to make disrupting systemic racism and sexism a priority.

Much of this will happen if leaders reward a quality of care model rather than a quantity of care model, the researchers said, and this means ensuring that physicians don’t have to spend a lot of time managing electronic health records.

How can organizations know where they stand with women doctors? The report from Physicians for a Healthy California recommends “regularly scheduled anonymous surveys administered to both current and past employees, using large cohorts and aggregating responses to minimize fear of retaliation and to optimize honest feedback.”

Interview departing employees to get their suggestions on how to improve the workplace environment, the researchers said. Also, provide feedback on survey results and collaborate with a diverse group of stakeholders to implement suggested improvements.

Be transparent with the public and with employees about efforts to diversify an organization’s workforce and what studies have shown patients and companies gain when such measures are taken.

Do company leaders know what the gap in wages and benefits are by race and gender? If not, McRae and Alonzo-Diaz recommend in their report that they make themselves aware and then work to reduce those disparities. Also, they urged employers to address the impact of outdated expectations for women.

When the “Prescription for Change” researchers surveyed women doctors around California, the physicians said that some key resources and benefits can have on career satisfaction. Those include flexible schedules, child care, paid parental leave, protected time for lactation and easy access to lactation rooms, plus strong career support such as path development for advancement, guidance for successful promotions, exposure to leadership opportunities and adequate staff support.

“These resources remove some barriers that disproportionately affect women physicians and women physicians of color,” the authors said.