PLOS ONE

RESEARCH ARTICLE

Gender discrimination among women

healthcare workers during the COVID-19
pandemic: Findings from a mixed methods
study
Rachel Hennein ID1,2*, Hannah Gorman3, Victoria Chung4, Sarah R. Lowe ID3

1 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut,
United States of America, 2 Yale School of Medicine, New Haven, Connecticut, United States of America,
a1111111111 3 Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut,
a1111111111 United States of America, 4 Yale College, New Haven, Connecticut, United States of America
a1111111111
a1111111111 * Rachel.Hennein@Yale.edu
a1111111111

Abstract

OPEN ACCESS
Background
Citation: Hennein R, Gorman H, Chung V, Lowe SR
(2023) Gender discrimination among women Gender discrimination among women healthcare workers (HCWs) negatively impacts job
healthcare workers during the COVID-19 satisfaction, mental health, and career development; however, few studies have explored
pandemic: Findings from a mixed methods study. how experiences of gender discrimination change during times of health system strain.
PLoS ONE 18(2): e0281367. https://doi.org/
10.1371/journal.pone.0281367
Thus, we conducted a survey study to characterize gender discrimination during a time of
significant health system strain, i.e., the COVID-19 pandemic.
Editor: Syed Ghulam Sarwar Shah, Oxford
University Hospitals NHS Foundation Trust,
UNITED KINGDOM Methods
Received: November 4, 2021 We used a convenience sampling approach by inviting department chairs of academic med-
Accepted: January 22, 2023 ical centers in the United States to forward our online survey to their staff in January 2021.
The survey included one item assessing frequency of gender discrimination, and an open-
Published: February 6, 2023
ended question asking respondents to detail experiences of discrimination. The survey also
Copyright: © 2023 Hennein et al. This is an open
included questions about social and work stressors, such as needing additional childcare
access article distributed under the terms of the
Creative Commons Attribution License, which support. We used ordinal logistic regression models to identify predictors of gender discrimi-
permits unrestricted use, distribution, and nation, and grounded theory to characterize themes that emerged from open-ended
reproduction in any medium, provided the original responses.
author and source are credited.

Data Availability Statement: Data can be accessed Results

at the following link: https://doi.org/10.7910/DVN/
LPG7Y6. Among our sample of 716 women (mean age = 37.63 years, SD = 10.97), 521 (72.80%)
Funding: RH and SL received funding support
were White, 102 (14.20%) Asian, 69 (9.60%) Black, 53 (7.4%) Latina, and 11 (1.50%) identi-
from Yale University’s COVID-19 Response fied as another race. In an adjusted model that included demographic characteristics and
Coordination Team. SL received funding from an social and work stressors as covariates, significant predictors of higher gender discrimina-
Early- Career Research Fellowship from the Gulf
tion included younger age (OR = 0.98, 95%CI = 0.96, 0.99); greater support needs (OR =
Research Program of the National Academies of
Sciences, Engineering, and Medicine. The content 1.26, 95%CI = 1.09,1.47); lower team cohesion (OR = 0.94, 95%CI = 0.91, 0.97); greater
is solely the responsibility of the authors and does racial discrimination (OR = 1.07, 95%CI = 1.05,1.09); identifying as a physician (OR = 6.59,

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PLOS ONE Gender discrimination among women healthcare workers

not necessarily represent the official views of Yale 95%CI = 3.95, 11.01), physician-in-training (i.e., residents and fellows; OR = 3.85, 95%CI =
School of Medicine or the Gulf Research Program 2.27,6.52), or non-clinical worker (e.g., administrative assistants; OR = 3.08, 95%CI =
of the National Academies of Sciences,
Engineering, and Medicine. The funders had no
1.60,5.90), compared with nurses; and reporting the need for a lot more childcare support
role in the study design; data collection, analysis (OR = 1.84, 95%CI = 1.15, 2.97), compared with reporting no childcare support need. In
and interpretation of data; in the writing of the their open-ended responses, women HCWs described seven themes: 1) belittlement by col-
articles; and in the decision to submit it for
leagues, 2) gendered workload distributions, 3) unequal opportunities for professional
publication. There was no additional internal or
external funding received for this study. advancement, 4) expectations for communication, 5) objectification, 6) expectations of
motherhood, and 7) mistreatment by patients.
Competing interests: The authors have declared
that no competing interests exist.
Conclusions
Our study underscores the severity of gender discrimination among women HCWs. Hospital
systems should prioritize gender equity programs that improve workplace climate during
and outside of times of health system strain.

Introduction
Although women comprise the majority of the healthcare workforce, holding 76% of all
healthcare positions [1], gender discrimination against women healthcare workers (HCWs) is
widespread. Previous studies have estimated that 66–80% of women HCWs have experienced
gender discrimination in the workplace [2, 3]. Gender discrimination in the hospital can take
the form of sexual harassment [3], inequitable compensation [4–8], diminished career
advancement to leadership roles [9, 10], and the misidentification of women physicians’ roles
[3]. Gender discrimination can be perpetuated by individuals of all genders, and by the health
system itself (such as through gendered policies). Gender discrimination negatively impacts
women HCWs’ interactions with patients [11], job satisfaction [10], and mental health [12].
Women HCWs, compared with men HCWs, are at increased risk for psychological distress
during the COVID-19 pandemic [11–13], with one potential explanation being their height-
ened exposure to gender-based stressors. For example, a survey study including frontline
HCWs at an academic hospital in New York City during the COVID-19 pandemic found that
women HCWs were more likely than men HCWs to screen positive for depression, anxiety,
and PTSD [13]. This increased risk of adverse mental health outcomes was largely attributed
to background stressors for women that were exacerbated during the pandemic, including
burnout and family-related concerns [13]. Identifying other background stressors, such as gen-
der discrimination, is important to comprehensively understand why women HCWs have
been particularly impacted by the pandemic.
The COVID-19 pandemic has acted like a “stress test” for hospitals, exposing inequitable
and unsustainable structures and practices within the health system [14]. Studying experiences
of gender discrimination during the pandemic can assist in identifying important areas for
improvement during and outside of the current health crisis. For example, the pandemic has
highlighted how the dual responsibilities of being a HCW and mother are strained when hos-
pital surges are coupled with childcare shortages, providing an opportunity to advocate for
improved access to childcare even after the pandemic subsides [15].
Conceptualizing the pandemic as a “stress test,” we conducted a mixed methods survey
study of women HCWs to characterize gender discrimination during a time of significant
health system strain. In so doing, we aimed to identify the magnitude of and factors associated

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PLOS ONE Gender discrimination among women healthcare workers

with gender discrimination in the hospital, as well as narratives of these experiences to inform
opportunities for change.

Materials and methods

Setting and recruitment
This study is part of a larger project that assesses the psychological impact of the COVID-19
pandemic on HCWs. We purposively sampled from 25 academic hospitals located in 14 states
with the highest weekly incidence rates of COVID-19 based on real-time data [16]. By doing
so, we included hospitals that were particularly strained due to high burden of COVID-19 in
their catchment area. These hospitals are distributed across all regions of the US, including the
Northeast, South, Midwest, and West. We used a serial cross-sectional design, whereby we col-
lected data every six months beginning in June 2020 from different samples of HCWs in the
United States (US) [17]. The present study is a secondary analysis that focuses on the items
related to gender discrimination, and uses primary data that were collected from December 1,
2020 until January 14, 2021 when we met our recruitment target of 900 HCWs based on power
calculations. During this period, there were 139,152 to 314,093 new cases of COVID-19 per
day in the US [18].
We used a convenience sampling approach by emailing department chairs, such as the
Chair of Internal Medicine, to request that they forward our web-based survey to their staff.
We obtained contact details for these chairs using academic hospitals’ websites. Of the 298
department chairs we invited, 122 agreed to participate, four declined to participate, and 172
did not respond. The reason that department chairs declined to participate was survey fatigue,
as their staff were asked to complete numerous surveys on their wellbeing at the time. We
employed two inclusion criteria: 1) participants were at least 18 years of age; and 2) partici-
pants worked at a clinic/hospital, including physicians, physicians-in-training (i.e., residents
and fellows), nurses, health technicians, physician assistants, nursing/medical assistants, other
clinical workers, and non-clinical workers. Although the survey collected responses from men
(n = 261) and a small subsample of participants identifying as a gender minority (n = 9), the
present study only includes women HCWs.

Data collection
We used a convergent parallel mixed methods design by collecting and analyzing quantitative
and qualitative data simultaneously, then merging qualitative and quantitative results [19]. We
designed a web-based survey to include quantitative and qualitative questions on gender dis-
crimination and hypothesized risk and protective factors (S1 File). All data were collected
using the Qualtrics platform.
Gender discrimination. We assessed gender discrimination using a single item that
assessed how often respondents have been treated unfairly based on their gender in the previ-
ous year, since January 2020. Response options ranged from never (score = 1) to almost all the
time (score = 6). This item has been previously used to assess gender discrimination among
women, men, and gender minorities [20]. Respondents who reported any frequency of gender
discrimination (i.e., score>1) were presented with an additional open-ended question asking
them to describe an event in which they dealt with gender discrimination.
Covariates. We selected covariates based on previous studies that identified factors associ-
ated with gender discrimination among HCWs [21–24], as well as demographic characteristics
(i.e., age, race, ethnicity, marital status, and occupation). For example, previous studies have
found that gender discrimination is associated with childcare needs [23] and racial discrimina-
tion [21, 22]. We assessed childcare needs by asking respondents who had children if they

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PLOS ONE Gender discrimination among women healthcare workers

needed a lot (score = 3), a little (score = 2), or no more (score = 1) childcare support. The
childcare support variable was coded as two indicator variables, with no more additional child-
care support used as the reference category. We used the General Ethnic Discrimination Scale
to assess experienced racism in the past year [25]. This scale includes 18 items that assess vari-
ous experiences of racial discrimination. We included an additional item asking about racial
discrimination from patients. All items were scored on a 6-point Likert scale, from never to
almost all the time, and were summed to create a continuous racial discrimination score
(range: 19 to 114). This scale has been validated among Black, Latinx, Asian, and White
respondents [25]. We also assessed social factors to understand how gender discrimination
relates to perceived social support and team cohesion. Social support was measured using one
item from the Social Support Questionnaire from the National Health and Nutrition Examina-
tion Survey to assess if the participant needs a lot (score = 4), some (score = 3), a little
(score = 2), or no more social support (score = 1) [26]. The social support score was included
as a continuous variable. Team cohesion was measured using previously validated questions
from the Survey of Organizational Attributes for Primary Care to assess communication, deci-
sion making, and stress/chaos [27, 28]. This scale includes seven questions, each rated on a
five-point Likert scale from strongly disagree to strongly agree. The scale score is computed by
summing all items, and ranges from 7 to 35.

Data analysis
Quantitative analysis. We first conducted a missing data analysis to compare participants
included in the analytic sample with those who were dropped due to missing data using inde-
pendent-samples t-tests and chi-square analyses [29]. We assessed correlations between all
independent variables to assess for multi-collinearity and data suitability for analysis. After
ensuring the multi-collinearity assumption was not violated, we ran unadjusted ordinal logistic
regression models to test bivariate associations between gender discrimination and all factors
[29]. Lastly, we ran an adjusted ordinal logistic regression model to predict gender discrimina-
tion, which included age, race, ethnicity, marital status, occupation, social support needs, team
cohesion, childcare needs, and racial discrimination as covariates [29]. Analyses were con-
ducted in SPSS 27.0 (IBM Corp., 2020). We considered p < .05 to be statistically significant.
Qualitative analysis. We uploaded all responses to the open-ended question into Micro-
soft Excel. Our coding team included a woman doctoral student and a woman Master of Public
Health student (RH and HG, respectively). We coded all data using inductive approaches
based on grounded theory to develop codes and ultimately theory that describe how women
experience gender discrimination in healthcare professions [30]. First, we read all responses to
generate preliminary, inductive codes. We then met to develop the codebook by explicating
definitions, inclusion criteria, and exclusion criteria for each code. Using this codebook, we
independently coded the first 50 open-ended responses and met to discuss discrepancies and
make necessary modifications to the codebook. Once the codebook was finalized, we indepen-
dently coded the entire set of responses. We used Cohen’s Kappa to calculate intercoder reli-
ability [31]. We defined sufficient intercoder reliability as Cohen’s Kappa>0.80. Then, we
discussed any discrepancies in our coding to reach consensus and generate the final coded
datafile. Finally, we met to discuss relationships between codes to conceptualize broad themes
using thematic analysis [26]. We used reflexivity throughout the coding process by reflecting
on how our own experiences and identities could influence our interpretations of the data
[32].
Merging quantitative and qualitative findings. To merge our quantitative and qualita-
tive findings, we mapped themes that emerged from the qualitative analysis to significant

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PLOS ONE Gender discrimination among women healthcare workers

Fig 1. Mixed methods design.

https://doi.org/10.1371/journal.pone.0281367.g001

factors identified in the adjusted ordinal logistic regression model (Fig 1). We then made inter-
pretations by identifying how quantitative and qualitative findings converged, diverged, and/
or complemented each other [19]. We used the Good Reporting of A Mixed Methods Study
(GRAMMS) checklist to guide study reporting [33].
Ethics. The Yale Institutional Review Board approved our study and all participants pro-
vided written consent electronically before taking the survey. The first page of the online sur-
vey was a consent form, which the participant had to agree to before being directed to the
main survey.

Results
Study sample
Among the 752 women who took our survey, 36 (4.8%) had missing data for at least one of the
variables. We did not identify any significant differences between participants in the analytic
sample (n = 716) and those who were dropped. Among the 716 women who completed all
measures, 521 (72.80%) were White, 102 (14.20%) Asian, 69 (9.60%) Black, 53 (7.4%) Latina,
and 11 (1.50%) identified as another race, including American Indian/Alaska Native, Native
Hawaiian/Pacific Islander, and unspecified (Table 1). The average age of our sample was 37.63
years (Standard Deviation [SD]: 10.97). Most women (n = 515; 71.90%) did not have a child
who required childcare. Among those with a child who required childcare (n = 201), 45

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PLOS ONE Gender discrimination among women healthcare workers

Table 1. Participant characteristics.

Characteristic n (%) or Mean (SD)
Agea 37.63 (10.97)
Raceb
White 521 (72.8%)
Asian 102 (14.2%)
Black 69 (9.6%)
Otherc 11 (1.5%)
Ethnicityb
Latinx 53 (7.4%)
Non-Latinx 663 (92.6%)
Marital statusb
Married 383 (53.5%)
Single 287 (40.1%)
Divorced/widowed 46 (6.4%)
Occupationb
Physician 185 (25.8%)
Physician-in-training 182 (25.4%)
Nurse 113 (15.8%)
Health technician 66 (9.2%)
Physician, nursing, and medical assistant 42 (5.9%)
Other clinical worker 73 (10.2%)
Non-clinical worker 55 (7.7%)
Social support needsa 1.44 (1.05)
Has child that requires childcareb 201 (28.1%)
Childcare needs among those with a child (n = 201)b
No additional childcare support needed 45 (22.4%)
A little more childcare support needed 74 (36.8%)
A lot more childcare support needed 82 (40.8%)
a
Team cohesion 24.51 (4.71)
Gender discriminationa 1.85 (0.96)
Racial discriminationa 23.73 (8.44)

Abbreviations: SD, standard deviation.

a
The mean and standard deviation are reported for continuous variables.
b
The counts and percentages are reported for categorical variables.
c
Other race included: American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and unspecified

https://doi.org/10.1371/journal.pone.0281367.t001

(22.39%) did not need any additional childcare support, 74 (36.82%) needed a little more
childcare support, and 82 (40.80%) needed a lot more childcare support. More than half of
women (56.01%) reported experiencing gender discrimination in the past year.

Quantitative findings
In the unadjusted models, age, race, marital status, occupation, social support needs, team
cohesion, childcare needs, and racial discrimination were associated with reporting gender
discrimination (Table 2). After adjusting for all factors, younger age (Odds Ratio [OR] = 0.98,
95% Confidence Interval [CI] = 0.96, 0.99), greater social support needs (OR = 1.26, 95%
CI = 1.09,1.47), lower team cohesion (OR = 0.94, 95%CI = 0.91, 0.97), and greater racial dis-
crimination (OR = 1.07, 95%CI = 1.05,1.09) were associated with greater gender

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PLOS ONE Gender discrimination among women healthcare workers

Table 2. Unadjusted and adjusted models predicting gender discrimination.

Covariate Unadjusted OR (95%CI) Adjusted OR (95%CI)
Age 0.97 (0.96,0.98)��� 0.98 (0.96, 0.99)��
Race
White (reference) 1 1
��
Asian 1.85 (1.25,2.74) 0.78 (0.50,1.22)
Black 1.36 (0.86,2.17) 0.52 (0.30, 0.92)�
Othera 1.46 (0.49,4.36) 1.36 (0.41,4.55)
Ethnicity
Non-Latinx (reference) 1 1
Latinx 1.66 (0.99,2.78) 0.97 (0.56,1.71)
Marital status
Married (reference) 1 1
�
Single 1.37 (1.03,1.82) 1.31 (0.91,1.90)
Divorced/widowed 0.58 (0.32,1.07) 0.93 (0.48,1.80)
Occupation
Nurse (reference) 1 1
Physician 5.06 (3.15,8.14)��� 6.59 (3.95,11.01)���
Physician-in-training 4.79 (2.97,7.71)��� 3.85 (2.27,6.52)���
Health technician 1.20 (0.64,2.25) 1.09 (0.56,2.11)
Physician, nursing, and medical assistant 1.65 (0.81,3.33) 1.42 (0.68,2.98)
Other clinical worker 1.41 (0.77,2.56) 1.41 (0.75,2.64)
Non-clinical worker 3.02 (1.61,5.65)�� 3.08 (1.60,5.90)��
Support needs 1.45 (1.27,1.66)��� 1.26 (1.09,1.47)��
��
Team cohesion 0.95 (0.92,0.98) 0.94 (0.91, 0.97)���
Childcare needs
None (reference) 1 1
A little 0.97 (0.62,1.53) 0.98 (0.59,1.62)
A lot 2.01 (1.31,3.07)�� 1.84 (1.15,2.97)�
���
Racial discrimination 1.06 (1.05,1.08) 1.07 (1.05,1.09)���
�
p < .05 and > = .01;
��
p < .01 and > = .001;
���
p < .001
a
Other race includes: American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and unspecified
Abbreviations: OR, Odds Ratio; 95%CI, 95% Confidence Interval.

https://doi.org/10.1371/journal.pone.0281367.t002

discrimination. Additionally, Black women reported less gender discrimination than White
women after adjusting for all factors including racial discrimination (OR = 0.52, 95%CI = 0.30,
0.92). Compared with nurses, physicians had 6.59 odds (95%CI = 3.95, 11.01), physicians-in-
training 3.85 odds (95%CI = 2.27,6.52), and non-clinical workers 3.08 odds (95%
CI = 1.60,5.90) of reporting greater gender discrimination. Compared with not needing any
additional childcare support, needing a lot more was associated with greater gender discrimi-
nation (OR = 1.84, 95%CI = 1.15, 2.97).

Qualitative findings
Women HCWs described seven major themes related to experiencing discrimination based
on their gender in their workplace: 1) belittlement by colleagues, 2) gendered workload

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PLOS ONE Gender discrimination among women healthcare workers

distribution, 3) unequal opportunities for professional advancement, 4) expectations for com-

munication, 5) objectification, 6) expectations of motherhood, and 7) mistreatment by
patients. Cohen’s Kappa for each code ranged from 0.84 to 1.00, suggesting sufficient interco-
der reliability.
Belittlement by colleagues. First, many respondents reported feeling belittled when their
colleagues made gendered assumptions about their profession and used the incorrect profes-
sional title. For example, women physicians reported that they were often assumed to be
nurses by their colleagues. Even when colleagues knew of their profession, many would not
address women physicians as “doctor,” whereas men physicians were addressed by their
proper title. A Black/African American physician-in-training explained:

“Nurses, technicians, residents, other attending physicians always assume I am a nurse, based
primarily on gender, age, and race I would imagine- it happens countless times per day and if
I had the time to reflect on it while it happened, I wouldn’t have time to do anything else as it
happens so often.”

This respondent, in addition to others, suggested that being misidentified was due to a com-
bination of their gender, race, and age, suggesting that discrimination experiences among
HCWs are interpreted with respect to their intersecting identities.
Additionally, many women reported that their men colleagues used condescending lan-
guage and had a dismissive tone during conversations about work issues. A Black/African
American physician explained:

“As an attending hospitalist, I often have interactions with subspecialty attendings, particu-
larly when challenging patient care issues arise. Frequently, those attendings are older white
men. Many times, I’m spoken to in what I perceive as a condescending, belittling or dismissive
manner during these conversations, particularly when I’m advocating a position with which
that person disagrees. I’ve witnessed my male peers having similar conversations with those
same individuals that are far more productive and collegial. These interactions make me feel
unvalued and like a lesser member of the faculty than my equally-titled male peers.”

Despite her expertise, this physician described that when she advocates for her patients, her
ideas are dismissed. However, when “male peers” have similar conversations, they are treated
in a more collegial and professional way. This suggests that women HCWs are not given the
same credibility as men, which leads to feelings of being undervalued.
Workload distribution. Women reported that their workload distribution, both the con-
tent of their work tasks and hours, was gendered. Many respondents reported that they were
often given additional roles or responsibilities that they interpreted as gendered, including
organizing social events, secretarial work, and cleaning. For example, one physician wrote:

“I’ve been given more secretarial tasks rather than my male colleagues who were given leader-
ship tasks. My work was not visible or celebrated.”

Although this HCW is a physician and is thus qualified to take on hospital leadership tasks,
she is instead delegated secretarial tasks. This differential allocation of work tasks may impact
the ability of women HCWs to gain leadership experiences, and ultimately to be promoted to
leadership roles in their workplaces.
Women respondents also reported that they were asked to take on additional work com-
pared with men, which was oftentimes unpaid and unacknowledged. A nurse explained:

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PLOS ONE Gender discrimination among women healthcare workers

“Our APP [Advanced Practice Providers] team was all women. We were expected to work OT
[overtime] to continue to staff the COVID ICU [intensive care unit] even when much of the
hospital had returned to normal operations. There was no acknowledgement of the work we
had done throughout the pandemic despite other teams getting recognition. It felt very gen-
dered that there was the expectation that we’d keep doing unrecognized labor and OT
[overtime]”

This nurse described an implicit assumption that her majority-women team would work
overtime throughout the pandemic. Due to this assumption, her team failed to be recognized
for the sacrifices that they made throughout the pandemic. Thus, gender-based assumptions
about willingness and ability to take on additional work is an important form of gender
discrimination.
Unequal opportunities for professional advancement. Women reported that they faced
unequal opportunities for professional advancement such as salary, promotions, and job
opportunities. Many reported being grossly underpaid compared with men, which made them
feel undervalued. A Black/African American and American Indian/Alaska Native lab techni-
cian explained:

“I have been passed over for lead positions by those less qualified and with less seniority. I
believe this occurred because the other person is a young white male and I am a Female POC
[person of color]. I also make less money than my white male counterpart in the same lab
whom also has less experience and seniority than myself.”

This respondent again exemplifies the importance of considering both gender and race
when evaluating forms of discrimination in the workplace, as she perceives that unequitable
opportunities for promotion and pay on her team are due to her intersecting identities as a
woman and person of color.
Respondents also noted unfair hiring of new personnel based on gender. A health techni-
cian explained:

“Even when the female applicant had more experience and performed more work than the
male applicant, the male applicant was selected for job promotion. It felt unfair.”

This woman, in addition to others, reported blatant favoritism to advance the careers of
men, such as through hiring, promotions, and pay raises.
Expectations for communication. Respondents reported conflicting, gendered expecta-
tions for how women should behave and speak at work. For example, some women were told
to be less timid, while others were assumed to be aggressive:

“There seems to be a perception that women who speak normally are too timid—why is there
a need to be extra loud/abrasive to be heard? Confidence and competence come in many
forms.”
(physician-in-training)

“Called aggressive when expressed ideas that if one of my male colleagues would have
expressed would have been considered assertive.”
(physician)

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PLOS ONE Gender discrimination among women healthcare workers

The Asian physician-in-training was described as too timid, while the Black/African Ameri-
can physician was called aggressive. In this way, beliefs about how women HCWs should com-
municate are not only conflicting, but also function to prevent women from communicating
in their own style.
Many respondents also reported that they were critiqued for being too “emotional.” A phy-
sician shared:

“I was told that female faculty members of my division were ’emotional’ in their asks for addi-
tional staffing support during administrative meetings. This made me feel angry that all voices
were not being heard.”

This HCW described that being labeled as “emotional” functioned to silence women
HCWs from voicing their opinions on important staffing decisions.
Objectification. Women reported experiences of objectification in the workplace. For
example, they reported that colleagues made comments that communicate a fixation with their
appearance, rather than their performance. A physician shared:

“People are very fixated on my weight in a way that I think would not happen if I were a man.
I have lost weight but have a healthy BMI [body mass index] and everyone keeps bringing it
up with me. It makes me feel that my appearance counts more than my performance.”

This physician described that frequent comments fixating on her weight signal to her that
her appearance is more important than her performance in the hospital.
Many respondents also reported being explicitly sexually harassed in the workplace and not
receiving adequate support following these experiences. A lab technician explained:

“I was sexually harassed by a coworker who made frequent explicit sexual commentary along
with demeaning commentary about women (saying he hated women, using gendered slurs,
complaining about female doctors). When I reported this to my boss, I was placed alone with
the offending party on a COVID adjusted night shift schedule.”

This lab technician’s account of her experience and supervisor’s response underscores the
minimization of reports of sexual harassment in the workplace.
Expectations of motherhood. Respondents reported experiencing certain motherhood
expectations that colleagues who are men did not face. For example, respondents reported that
their colleagues assumed that their work would be negatively impacted by their role as a
mother. A psychologist explained:

“Some senior colleagues questioned whether I would return to work from a planned maternity
leave based on the suggestion that women often don’t. I felt underappreciated and
patronized.”

Questioning women HCWs’ decisions to come back to work after maternity leave inappro-
priately asserts gender-based expectations for childrearing. For this respondent, these com-
ments made her feel not only patronized, but also underappreciated.
Many respondents also noted how addressing childcare shortages they faced due to the pan-
demic and simultaneous added workload in the hospital, which disproportionately impacted
women, was not prioritized by hospital administration. A physician explained:

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PLOS ONE Gender discrimination among women healthcare workers

“Leadership did not understand the dire childcare situation. The COVID-19 pandemic will
set back accomplishments of women in the workplace for decades to come.”

Notably, respondents who were not presently mothers also reported certain expectations
related to their childbearing. A physician-in-training shared:

“It was assumed that I wanted to pursue anesthesiology because it ‘allows for more flexibility
to raise children.’ I currently have no desire to have children. . . though this could be consid-
ered an innocent assumption, it just happens to be a constant stigma women in medicine
must battle against and are hyper aware of.”

This account shows that HCWs’ experience in the gender discrimination related to mother-
hood could contribute to distress, including hypervigilance.
Mistreatment by patients. Lastly, respondents expressed that they faced mistreatment by
patients based on their gender. For example, they reported that their patients often assumed
they were a different profession based on their gender; namely, women physicians were
assumed to be nurses. A physician described:

“Often assumed to be a nurse, or not the doctor. Two times when patient assumed male med
[medical] student was the doctor and asked if he ‘approved’ of my recommendations. Both sit-
uations made me feel frustrated and disappointed.”

This physician’s recollection demonstrates how gender discrimination from patients can
influence women HCWs’ emotional wellbeing, perhaps undermining job satisfaction.
Women noted that even after they told patients that they were the physician, many would
still not address them as a doctor, and some would even refuse to be seen by a woman physi-
cian. A physician-in-training recalled:

“I had an instance where a patient requested their ‘real doctor’. They were not satisfied until a
male colleague intervened. As a woman in medicine this is not an unfamiliar encounter. It is
disheartening but even more so in this pandemic where I am working harder than ever for my
patients.”

This account demonstrates that gender discrimination, although present prior to the pan-
demic, was particularly hurtful given the profound sacrifices women HCWs were making for
their patients.
Notably, many women suggested that they were treated unfairly by patients based on a
combination of their gender and ethnicity. A Latina physician-in-training explained:

“Taking care of a patient at the VA [Veterans Affairs Hospital], he said that women should
not be doctors, and called me a foreigner. He then walked out of the room and refused being
seen by me. Like that, many other similar experiences.”

This HCW described how patients frequently refuse to be seen by her due to a combination
of her gender and ethnicity, underscoring the importance of considering intersecting identities
to interpret discrimination experiences. These common occurrences suggest that there is a
lack of mechanisms for reporting instances of patient-perpetuated discrimination.

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PLOS ONE Gender discrimination among women healthcare workers

Fig 2. Merging of quantitative and qualitative findings.

https://doi.org/10.1371/journal.pone.0281367.g002

Merged findings
We mapped themes that emerged from the qualitative analysis to significant factors identified
in the multivariable model (Fig 2). For example, in open-ended responses, many women
HCWs described being belittled by their colleagues and supervisors, which made them feel
unappreciated by their team. Accordingly, this theme mapped onto the finding from the multi-
variable model that lower team cohesion was associated with heightened gender discrimina-
tion. This mapping process enabled us to identify three ways that the quantitative and
qualitative findings merged to characterize gender discrimination among women HCWs.
First, through our qualitative analysis, we found that women HCWs experienced various
forms of gender discrimination from both patients and colleagues. These experiences included
belittlement, unequal opportunities for career advancement, gendered workload distributions,
expectations for communication, objectification, and expectations of motherhood. Some of
these experiences were occupation-specific; for example, many women physicians noted that
they were frequently misidentified as a nurse or custodial staff by colleagues and patients. Our
quantitative and qualitative findings converged regarding motherhood expectations; in open-
ended responses, women reported that having inadequate childcare support during the pan-
demic was a form of gender discrimination and needing a lot more childcare support was asso-
ciated with higher gender discrimination in the multivariable model. Our qualitative findings
further elaborated on the far-reaching implications of motherhood expectations, which
extended to women HCWs who were not currently mothers.
Second, we identified that gender discrimination may be most severe for younger physi-
cians of color. Our multivariable model suggested that younger HCWs, HCWs who experi-
enced greater racial discrimination, and HCWs in occupations that are men-dominant (i.e.,
physicians and physicians-in-training) reported more frequent gender discrimination.
Although race was not a significant predictor of gender discrimination in the unadjusted
model, Black women compared with White women, were less likely to report gender

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PLOS ONE Gender discrimination among women healthcare workers

discrimination after controlling for all factors including racial discrimination. This finding
could suggest that experiences of gender discrimination among Black women are also influ-
enced by experiences of racial discrimination. These quantitative findings converged with our
qualitative findings; in the open-ended responses, women HCWs reported that their experi-
ences of gender discrimination are likely due to a combination of their age, gender, race, eth-
nicity, and role as a physician.
Lastly, we identified that gender discrimination was associated with lower team cohesiveness
and inclusiveness, which could contribute to social and professional isolation and limitations to
professional growth. This interpretation was based on our quantitative findings that greater gen-
der discrimination was associated with decreased team cohesion and increased social support
needs. Our qualitative findings elaborated on these quantitative findings by describing how fre-
quent microaggressions, harassment, and inappropriate assumptions about motherhood
impacted their relationships with colleagues. Women HCWs also described that unequal career
opportunities and workload distributions negatively impacted their professional growth.

Discussion
This mixed methods study explored gender discrimination among women HCWs. In our
quantitative analysis, we identified factors associated with higher reports of gender discrimina-
tion, including younger age, certain occupations (i.e., physicians and physicians-in-training,
versus nurses), greater racial discrimination, lower team cohesion, greater social support
needs, and greater childcare needs. Our qualitative analysis bolstered these findings by describ-
ing how gender discrimination is experienced in the hospital and how it impacts women
HCWs. By merging our quantitative and qualitative data, we described how gender discrimi-
nation can present itself through various forms, may be most severe for younger physicians of
color, and how it can contribute to social and professional isolation and blunted professional
growth. Our findings expand upon previous studies of gender discrimination among HCWs
and can be used to change hospital systems to improve inclusivity of women in healthcare.
Women HCWs suggested that they experience various forms of gender discrimination per-
petuated by both patients and colleagues. Similar to previous studies, women HCWs reported
incidences of sexual harassment [3]; microaggressions [21, 34]; expectations of motherhood
[2, 34]; and unequal career advancement, compensation, and workload distributions [4–6, 9,
23, 34]. We found that certain forms of discrimination may only be applicable to certain pro-
fessions; for example, women physicians reported being frequently mistaken for nurses, which
is consistent with other studies [3, 10, 11].
Whether from patients or colleagues, gender discrimination takes a significant toll on the
wellbeing of women HCWs. Our findings suggested that some of these experiences of gender
discrimination may be more pronounced during the pandemic, such as shortages in childcare
and lack of support from the health system for HCWs who are mothers, similar to other stud-
ies [24, 35, 36]. Gender discrimination during the pandemic may be particularly damaging
given the profound sacrifices made by women HCWs. For example, in the present study,
women HCWs reported that these experiences of gender discrimination made them feel “dis-
heartened,” “unvalued,” “unrecognized,” “disappointed,” “angry,” and “hopeless.” Other stud-
ies have found that gender discrimination is associated with adverse mental health outcomes
[12, 21], and makes women feel less satisfied with their jobs, less respected by patients and col-
leagues, and that their gender impacts their opportunities for career advancement [10, 11].
Based on these findings, responses to health emergencies should include women’s perspectives
on support services that are needed, such as enhanced childcare services, which may offset
stressors disproportionately impacting women during health crises [24, 36, 37].

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PLOS ONE Gender discrimination among women healthcare workers

We identified that gender discrimination may be most severe for younger physicians of
color, as age, gender, occupation, and experiences of racism were associated with gender dis-
crimination. Women physicians of color suggested that they are commonly misidentified as
nurses or custodial staff by patients and colleagues, which they attribute to a combination of
their age, gender, ethnicity, and race. Furthermore, we found that non-clinical HCWs had
higher reports of gender discrimination compared with nurses. This trend reflects the impor-
tance of intersectionality in understanding women’s experiences of discrimination. The theory
of intersectionality describes how multiple social identities, such as gender, race, ethnicity,
occupation and age, interact to influence experiences of discrimination. This theory was first
proposed by Kimberlé Crenshaw to describe the unique experiences of discrimination that
Black women face in comparison to White women or Black men [38]. Other studies have also
described the importance of considering multiple social identities to understand experiences
of discrimination faced by women HCWs [39, 40]. For example, another study that utilized
quantitative and qualitative methods to explore racial discrimination among HCWs identified
that experiences of racial and ethnic discrimination were most common among HCWs of
color, and that these experiences were interpreted in light of intersecting identities, namely
gender, race, and ethnicity [41]. Another study including medical students found that micro-
aggressions were most frequent among Black women, compared with Black men and White
women [21]. These findings suggest that different power dynamics for subgroups of women
may be at play that influence women’s experiences of gender discrimination. Future studies
could explore varying power dynamics across different subgroups and settings, such as how
gender discrimination operates based on an individual’s occupation and racial identity, as well
as the gender and racial composition of others within that system. These findings also suggest
that hospital systems should prioritize gender equity programs that use an intersectionality
framework, through which all women HCWs—including those who occupy different occupa-
tions, come from backgrounds underrepresented in medicine, and are caregivers—can feel
supported and valued in their multiple and overlapping identities by their organization and
team [42].
Our findings also suggested that gender discrimination against women HCWs may contrib-
ute to social and professional isolation, blunted professional growth, and inequitable salaries.
Similarly, a study including data from the Association of American Medical Colleges on all
medical graduates from 1979 to 2013 found that women physicians were less likely to be pro-
moted to associate, full professor, or department chair, compared with men [9]. They also
found that gender differences in promotion to full professor increased over time. The lack of
women in leadership roles in the hospitals can have lasting impacts on the next generation of
women providers; for example, women physicians-in-training have reported that the lack of
women mentors in leadership roles is a significant barrier for them to advance their own
careers [23]. The inequitable advancement of women HCWs has been linked to gender-based
segregation of certain HCW professions and specialties in medicine [43]. Other studies have
also identified persistent gender wage gaps among HCWs serving the same role [4–8]. Taken
together, these findings suggest that hospital-based gender equity programs that validate and
respond to experiences of gender discrimination and prioritize the career development of
women HCWs, especially women HCWs of color, can address inequitable leadership opportu-
nities and provide more mentorship opportunities for the next generation of women HCWs
[42]. These programs should also implement or improve systematic approaches to identifying
and remedying pay and promotion discrepancies between women and men HCWs, such as
through auditing, salary transparency, and improving access to affordable childcare [44].
Our study was strengthened by its use of mixed methods to explore both the breadth and
depth of gender discrimination among women HCWs [19]. By merging our quantitative and

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PLOS ONE Gender discrimination among women healthcare workers

qualitative findings, we made novel interpretations for how gender discrimination impacts
women HCWs. Our study was also strengthened by its timing of data collection; asking
women HCWs to detail their experiences of gender discrimination during the COVID-19 pan-
demic highlighted the ways in which gender discrimination is particularly upsetting during a
time when women HCWs are making significant sacrifices for their patients and organiza-
tions. However, our study was limited by its use of a single item to assess gender discrimina-
tion frequency; additional studies may benefit from using a measure that also characterizes the
different experiences of gender discrimination based on our qualitative findings. Additionally,
our study used a convenience sampling approach, which prohibited us from assessing the
response rate of the survey, whether certain types of HCWs were more likely to respond than
others, and if selection bias was present. Thus, studies that use random sampling may be better
positioned to assess prevalence of gender discrimination among women HCWs. Furthermore,
the majority of our sample was White, and additional studies that have a more diverse sample
are needed to understand how gender discrimination is experienced differently for women
HCWs of color. We assessed gender by using sex-based indicators, i.e., female, male, trans-
female, trans-male, and non-binary, which could have introduced mismeasurement of gender
into our study. Future studies should use more appropriate categories for gender, i.e., woman,
man, trans-woman, trans-man, and non-binary. Lastly, this study only assessed gender dis-
crimination for women HCWs, and additional studies are warranted that characterize experi-
ences of gender discrimination for HCWs identifying as gender minorities and men.

Conclusion
Our study underscores the severity of gender discrimination against women HCWs. We
found that certain aspects of the pandemic exacerbated gender discrimination, such as child-
care shortages, while other factors were chronic stressors, such as inequitable career advance-
ment. Thus, our study has important implications for improving equity and inclusion during
and outside of health crises. Hospital systems should prioritize gender equity programs that
use an intersectionality framework [42], have measurable goals [45], facilitate the career devel-
opment of women HCWs, especially women HCWs of color [42], and implement systematic
approaches to identifying and remedying pay and promotion discrepancies between women
and men HCWs [44].

Supporting information
S1 File. Survey questions.
(DOCX)

Author Contributions
Conceptualization: Rachel Hennein, Sarah R. Lowe.
Data curation: Rachel Hennein, Sarah R. Lowe.
Formal analysis: Rachel Hennein, Hannah Gorman, Victoria Chung, Sarah R. Lowe.
Funding acquisition: Rachel Hennein, Sarah R. Lowe.
Investigation: Rachel Hennein, Sarah R. Lowe.
Methodology: Rachel Hennein, Hannah Gorman, Sarah R. Lowe.
Project administration: Rachel Hennein, Sarah R. Lowe.

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PLOS ONE Gender discrimination among women healthcare workers

Software: Rachel Hennein.

Supervision: Sarah R. Lowe.
Writing – original draft: Rachel Hennein.
Writing – review & editing: Rachel Hennein, Hannah Gorman, Victoria Chung, Sarah R.
Lowe.

References
1. U.S. Department of Health and Human Services. Health Resources and Services Administration.
National Center for Health Workforce Analysis. Sex, Race, and Ethnic Diversity of U.S. Health Occupa-
tions (2011–2015) 2017. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-
research/diversity-us-health-occupations.pdf.
2. Adesoye T, Mangurian C, Choo EK, Girgis C, Sabry-Elnaggar H, Linos E. Perceived Discrimination
Experienced by Physician Mothers and Desired Workplace Changes: A Cross-sectional Survey. JAMA
Intern Med. 2017; 177(7):1033–6. https://doi.org/10.1001/jamainternmed.2017.1394 PMID: 28492824
3. Schlick CJR, Ellis RJ, Etkin CD, Greenberg CC, Greenberg JA, Turner PL, et al. Experiences of Gender
Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US.
JAMA Surg. 2021. https://doi.org/10.1001/jamasurg.2021.3195 PMID: 34319377
4. Weaver AC, Wetterneck TB, Whelan CT, Hinami K. A matter of priorities? Exploring the persistent gen-
der pay gap in hospital medicine. Journal of hospital medicine. 2015; 10(8):486–90. PMID: 26122400
5. Muench U, Sindelar J, Busch SH, Buerhaus PI. Salary differences between male and female registered
nurses in the United States. JAMA. 2015; 313(12):1265–7. https://doi.org/10.1001/jama.2015.1487
PMID: 25803350
6. Lo Sasso AT, Richards MR, Chou C-F, Gerber SE. The $16,819 pay gap for newly trained physicians:
the unexplained trend of men earning more than women. Health Aff. 2011; 30(2):193–201. https://doi.
org/10.1377/hlthaff.2010.0597 PMID: 21289339
7. Whaley CM, Koo T, Arora VM, Ganguli I, Gross N, Jena AB. Female Physicians Earn An Estimated $2
Million Less Than Male Physicians Over A Simulated 40-Year Career: Study examines estimated
career gap in pay between female physicians and male physicians. Health Aff. 2021; 40(12):1856–64.
8. Ganguli I, Sheridan B, Gray J, Chernew M, Rosenthal MB, Neprash H. Physician work hours and the
gender pay gap—evidence from primary care. NEJM. 2020; 383(14):1349–57. https://doi.org/10.1056/
NEJMsa2013804 PMID: 32997909
9. Richter KP, Clark L, Wick JA, Cruvinel E, Durham D, Shaw P, et al. Women Physicians and Promotion
in Academic Medicine. NEJM. 2020; 383(22):2148–57. https://doi.org/10.1056/NEJMsa1916935
PMID: 33252871
10. Berwick S, Calev H, Matthews A, Mukhopadhyay A, Poole B, Talan J, et al. Mistaken Identity: Fre-
quency and Effects of Gender-Based Professional Misidentification of Resident Physicians. Acad Med.
2021; 96(6):869–75. https://doi.org/10.1097/ACM.0000000000004060 PMID: 33735130
11. Bhandari S, Jha P, Cooper C, Slawski B. Gender-Based Discrimination and Sexual Harassment
Among Academic Internal Medicine Hospitalists. J Hosp Med. 2021; 16(2):84–9. https://doi.org/10.
12788/jhm.3533 PMID: 33496657
12. Hennein R, Bonumwezi J, Nguemeni Tiako MJ, Tineo P, Lowe SR. Racial and Gender Discrimination
Predict Mental Health Outcomes among Healthcare Workers Beyond Pandemic-Related Stressors:
Findings from a Cross-Sectional Survey. IJERPH. 2021; 18(17). https://doi.org/10.3390/
ijerph18179235 PMID: 34501818
13. Lowe SR, Hennein R, Feingold JH, Peccoralo LA, Ripp JA, Mazure CM, et al. Are women less psycho-
logically resilient than men? Background stressors underlying gender differences in reports of stress-
related psychological sequelae. J Clin Psychiatry. 2021. https://doi.org/10.4088/JCP.21br14098 PMID:
34936244
14. Brubaker L. Women physicians and the COVID-19 pandemic. JAMA. 2020; 324(9):835–6. https://doi.
org/10.1001/jama.2020.14797 PMID: 32735329
15. Robinson LJ, Engelson BJ, Hayes SN. Who Is Caring for Health Care Workers’ Families Amid COVID-
19? Acad Med. 2021; 96(9):1254–8. https://doi.org/10.1097/ACM.0000000000004022 PMID:
33635839
16. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet
Infect Dis. 2020; 20(5):533–4. https://doi.org/10.1016/S1473-3099(20)30120-1 PMID: 32087114

PLOS ONE | https://doi.org/10.1371/journal.pone.0281367 February 6, 2023 16 / 18

PLOS ONE Gender discrimination among women healthcare workers

17. Hennein R, Mew EJ, Lowe SR. Socio-ecological predictors of mental health outcomes among health-
care workers during the COVID-19 pandemic in the United States. PLoS One. 2021; 16(2):e0246602.
https://doi.org/10.1371/journal.pone.0246602 PMID: 33544761
18. Centers for Diseases Control and Prevention. Trends in Number of COVID-19 Cases and Deaths in the
US Reported to CDC, by State/Territory 2021. https://covid.cdc.gov/covid-data-tracker/#trends_
dailytrendscases.
19. Creswell JW, Clark VLP. Designing and conducting mixed methods research. Thousand Oaks: Sage
Publications; 2017.
20. Vu M, Li J, Haardörfer R, Windle M, Berg CJ. Mental health and substance use among women and men
at the intersections of identities and experiences of discrimination: Insights from the intersectionality
framework. BMC public health. 2019; 19(1):1–13.
21. Anderson N, Lett E, Asabor EN, Hernandez AL, Nguemeni Tiako MJ, Johnson C, et al. The Association
of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort
of Medical Students. J Gen Intern Med. 2021. https://doi.org/10.1007/s11606-021-06786-6 PMID:
33939079
22. Hu YY, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT, et al. Discrimination, Abuse, Harass-
ment, and Burnout in Surgical Residency Training. NEJM. 2019; 381(18):1741–52. https://doi.org/10.
1056/NEJMsa1903759 PMID: 31657887
23. Dahlke AR, Johnson JK, Greenberg CC, Love R, Kreutzer L, Hewitt DB, et al. Gender Differences in Uti-
lization of Duty-hour Regulations, Aspects of Burnout, and Psychological Well-being Among General
Surgery Residents in the United States. Ann Surg. 2018; 268(2):204–11. https://doi.org/10.1097/SLA.
0000000000002700 PMID: 29462009
24. Frank E, Zhao Z, Fang Y, Rotenstein LS, Sen S, Guille C. Experiences of Work-Family Conflict and
Mental Health Symptoms by Gender Among Physician Parents During the COVID-19 Pandemic. JAMA
Netw Open. 2021; 4(11):e2134315. https://doi.org/10.1001/jamanetworkopen.2021.34315 PMID:
34767022
25. Landrine H, Klonoff EA, Corral I, Fernandez S, Roesch S. Conceptualizing and measuring ethnic dis-
crimination in health research. J Behav Med. 2006; 29(1):79–94. https://doi.org/10.1007/s10865-005-
9029-0 PMID: 16470345
26. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2):77–101.
27. Graetz I, Reed M, Shortell SM, Rundall TG, Bellows J, Hsu J. The association between EHRs and care
coordination varies by team cohesion. Health Serv Res. 2014; 49(1 Pt 2):438–52. https://doi.org/10.
1111/1475-6773.12136 PMID: 24359592
28. Ohman-Strickland PA, John Orzano A, Nutting PA, Perry-Dickinson W, Scott-Cawiezell J, Hahn K,
et al. Measuring organizational attributes of primary care practices: development of a new instrument.
Health Serv Res. 2007; 42(3 Pt 1):1257–73. https://doi.org/10.1111/j.1475-6773.2006.00644.x PMID:
17489913
29. Kleinbaum DG, Kupper LL, Nizam A, Rosenberg ES. Applied regression analysis and other multivari-
able methods. Boston: Cengage Learning; 2013.
30. Strauss A, Corbin J. Basics of qualitative research techniques: Citeseer; 1998.
31. Kurasaki KS. Intercoder reliability for validating conclusions drawn from open-ended interview data.
Field Methods. 2000; 12(3):179–94.
32. Hall WA, Callery P. Enhancing the rigor of grounded theory: Incorporating reflexivity and relationality.
Qual Health Res. 2001; 11(2):257–72. https://doi.org/10.1177/104973201129119082 PMID: 11221119
33. O’Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J
Health Serv Res Policy. 2008; 13(2):92–8. https://doi.org/10.1258/jhsrp.2007.007074 PMID: 18416914
34. Chow CJ, Millar MM, López AM. Gender Discrimination Among Academic Physicians. Womens Health
Rep (New Rochelle). 2020; 1(1):203–11. PMID: 32789303
35. Power K. The COVID-19 pandemic has increased the care burden of women and families. Sustain.:
Sci. Pract. Policy. 2020; 16(1):67–73.
36. Halley MC, Mathews KS, Diamond LC, Linos E, Sarkar U, Mangurian C, et al. The intersection of work
and home challenges faced by physician mothers during the Coronavirus Disease 2019 Pandemic: a
mixed-methods analysis. J Womens Health. 2021; 30(4):514–24. PMID: 33761277
37. Chesak SS, Yngve KC, Taylor JM, Voth ER, Bhagra A. Challenges and Solutions for Physician Moth-
ers: A Critical Review of the Literature. Mayo Clin Proc. 2021; 96(6):1578–91. https://doi.org/10.1016/j.
mayocp.2020.10.008 PMID: 33840524
38. Crenshaw KW. On intersectionality: Essential writings. New York, NY: The New Press; 2017.

PLOS ONE | https://doi.org/10.1371/journal.pone.0281367 February 6, 2023 17 / 18

PLOS ONE Gender discrimination among women healthcare workers

39. Balzora S. When the minority tax is doubled: Being Black and female in academic medicine. Nat Rev
Gastroenterol & Hepatol. 2021; 18(1):1-. https://doi.org/10.1038/s41575-020-00369-2 PMID: 32963339
40. Kaye EC. Misogyny in Medicine. NEJM. 2021; 384(24):2267–2269. https://doi.org/10.1056/
NEJMp2103616 PMID: 34133858
41. Hennein R, Tineo P, Bonumwezi J, Gorman H, Nguemeni Tiako MJ, Lowe SR. "They Wanted to Talk to
a ’Real Doctor000 : Predictors, Perpetrators, and Experiences of Racial and Ethnic Discrimination Among
Healthcare Workers. J Gen Intern Med. 2021:1–9. https://doi.org/10.1007/s11606-021-07143-3 PMID:
34561823
42. Haggins AN. To Be Seen, Heard, and Valued: Strategies to Promote a Sense of Belonging for Women
and Underrepresented in Medicine Physicians. Acad Med. 2020; 95(10):1507–10. https://doi.org/10.
1097/ACM.0000000000003553 PMID: 32590469
43. Pelley E, Carnes M. When a Specialty Becomes "Women’s Work": Trends in and Implications of Spe-
cialty Gender Segregation in Medicine. Acad Med. 2020; 95(10):1499–506. https://doi.org/10.1097/
ACM.0000000000003555 PMID: 32590470
44. Warner AS, Lehmann LS. Gender Wage Disparities in Medicine: Time to Close the Gap. J Gen Intern
Med. 2019; 34(7):1334–6. https://doi.org/10.1007/s11606-019-04940-9 PMID: 30963441
45. Boatright D, Berg D, Genao I. A Roadmap for Diversity in Medicine During the Age of COVID-19 and
George Floyd. J Gen Intern Med. 2021. https://doi.org/10.1007/s11606-020-06430-9 PMID: 33469768

PLOS ONE | https://doi.org/10.1371/journal.pone.0281367 February 6, 2023 18 / 18