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Gender-based disparities in medicine: a theoretical framework for understanding opposition to equity and equality
  1. Shannon M Ruzycki1,2,
  2. Allison Brown1,
  3. Aleem Bharwani1,
  4. Georgina Freeman3
  1. 1 Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  2. 2 Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  3. 3 Cumming School of Medicine, W21C, Calgary, Alberta, Canada
  1. Correspondence to Dr Shannon M Ruzycki, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary T2N 2T9, Canada; shannon.ruzycki{at}

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In 2018, our study team was commissioned to investigate gender inequity and inequality in the Department of Medicine at our institution. During this work, consisting of surveys, one-on-one interviews, and an extensive literature review,1 we noted that, even when presented with peer-reviewed evidence or personal experiences, individuals would resist the idea that women physicians have different experiences than men. This observation is supported by experimental evidence; Handley et al demonstrated that men academics evaluated a peer-reviewed article reporting evidence of gender inequities more negatively than an altered version of the same article reporting no evidence of inequity.2

In seeking to understand this resistance, our team realised that the fields of behavioural science and public health had developed theoretical frameworks to understand how beliefs impact behaviour. Based on our research, we believe that understanding barriers to gender equity and equality in medicine using evidence-informed theoretical frameworks is the next critical step in reducing disparities faced by underrepresented groups in medicine.

Inequity and inequality in medicine have been consistent and persistent over decades

Gender-based disparities in medicine have been extensively documented in peer-reviewed literature including inequalities and inequities in compensation,3–8 academic opportunities,9–12 parenthood,13–16 leadership17–19 and harassment.20–25 These disparities consistently disadvantage women physicians across decades,26 27 countries,20 28–31 specialties,32–34 and throughout medical training and physicians’ careers35–38 (Box 1).

Box 1

Gender-based disparities will impact any person from any marginalised gender identity, including transgender, non-binary and gender non-conforming individuals, in addition to cisgender women. While men physicians may experience discrimination based on characteristics such as race, disability, nationality, language, gender identity, religion, Indigeneity, and sexual orientation, men physicians do not experience discrimination based on their gender. In this article, we have focused on gender-based disparities that impact cisgender women physicians because the majority of the evidence available describes this group rather than other individuals. The frameworks …

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  • Contributors SMR conceived and designed the idea for this manuscript, wrote and revised drafts of the manuscript, and is accountable for all aspects of the accuracy and integrity of this work. A Brown contributed to the design of this manuscript and revised drafts of the manuscript. A Bharwani revised drafts of the manuscript. GF contributed to the conception, design, writing, and editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.