Major themes identified from thematic analysis of 56 eligible SRs, definitions, review content and key findings
| Theme | Definition | Content and key findings |
| 1. Career lifecycle | This theme includes issues of recruitment, progression, promotion, retention and attrition at all stages of physicians’ medical careers. | SRs consistently reveal obstacles to female and minority ethnic doctors advancing in medicine. These are mostly a culture of gendered norms and ingrained implicit bias,36–40 as well as under-representation in leadership roles and progression pathways.41–46 Two reviews identified a gap in evidence on how to address these inequalities47 48; one highlighted a worrying difference in doctors’ intentions to leave the profession.49 One review reported similar issues across the world.50 |
| 2. Burnout | This theme includes issues of emotional and physical exhaustion, depersonalisation and low personal accomplishment caused by the chronic stress of medical practice. | The current evidence base in this area is less consistent. Four reviews indicate higher burnout levels among women,51–54 while one review concludes male residents suffer more burnout.55 The remaining five reviews conclude that any differences cannot be reliably determined, largely due to fundamental differences in how burnout is conceptualised, measured and by whom it is experienced.56–60 |
| 3. Discrimination | This theme includes the unfair or prejudicial treatment of physicians in the workplace based on gender, race and/or ethnicity, including issues of sexual harassment, sexism, racism and microaggressions. | SRs analyse both explicit and more subtle forms of discrimination. There is evidence that the focus has shifted from the former to the latter over time.61 Reviews of overt sexual harassment show female physicians are exclusively targeted.62 63 For more subtle discrimination, SRs provide evidence that women experience lower levels of respect64–66 and are asked illegal questions by senior colleagues.67 68 Only two SRs consider explicit racism.67 69 Both report a high prevalence of workplace discrimination, particularly among women physicians of colour. |
| 4. Academic roles | This theme includes issues of academic publishing, citation-related publication productivity and faculty ranks. | SRs identify that even after adjusting for academic rank and specialty, female faculty have lower citation-related publications,12 70 are less likely than male faculty to be full professors,11 and fare worse than men in all aspects of academic activity.71 The one review that investigated intersectional bias concluded that very few primary studies apply an intersectional lens.72 |
| 5. Motherhood | This theme includes issues of pregnancy, maternity leave and returning to work after giving birth. | SRs reveal experiences of discrimination and stigma related to pregnancy,73 negative work-based attitudes before, during and after birth74 and that this theme has persisted in the literature at least over the past 50 years.75 Two reviews call for organisational policies to better support mothers and mothers-to-be and help address the challenges evidenced in reviews.76 77 |
| 6. Competencies | This theme includes issues of skills, abilities and confidence, both observed and subjectively assessed. | One SR found no evidence that women and men differ in their strengths or clinical performance,78 while two concluded that women tend to perceive deficiencies in their abilities more often than their male counterparts.79 80 |
| 7. Mental health | This theme includes the unique pressures among physicians of depression and anxiety and the possible outcome of suicide. | One SR found gender to be one of the risk factors associated with higher levels of anxiety and depression,81 while another found that women are at higher risk of suicide compared with men.82 |
| 8. Organisational factors | This theme includes issues of workforce planning, policy and management. | One SR found significant research gaps in studies of gender equity in HR planning, systems-level developments, change management, mentorship and professional development.83 Another found that organisations need to introduce more flexible career pathways and work patterns to provide more family-friendly working conditions and provide female mentors.84 |
| 9. Violence | This theme includes acts or behaviours in which a person is abused, threatened or humiliated in the workplace. These acts and behaviours can be verbal or physical and can be overt or subtle. | One review reports the evidence is inconclusive due to issues of methodological quality.85 Another identifies verbal abuse as the most common type of violence regardless of gender, with over three-quarters of physicians also experiencing physical violence.86 |
| 10. Earnings | This theme relates to direct financial remuneration. | One SR identifies that female doctors earn less than men despite having similar profiles, and that this earnings gap persists across time, medical specialty and country of practice.2 |
| 11. Mentorship | This theme includes professional relationships where peers or more senior colleagues act as advocates, advisors, coaches or counsellors. | One SR focused on the evidence of mentorship programmes for under-represented groups, reporting a positive impact and recommending training of more mentors from both dominant and under-represented groups.87 |
| 12. Patient outcomes | This theme relates to a physician’s gender, race or ethnicity as a factor in the delivery of medicine. | A scoping review found evidence gaps regarding the relationship between patient outcomes and the gender, race or ethnicity of the physician.88 We were unable to identify a SR on this topic. |
SRs, systematic reviews.