In the late 1990s, Jennifer Grandis, today a physician scientist at the University of California, San Francisco, began to train incoming female scientists as more women began to enter medical specialties. To better understand how these incoming physicians felt about coming into a male-dominated space, Grandis sent surveys to all of the 502 women otolaryngologists in the US, as well as two men of the same specialty from a similar region and with similar years of training for every woman.
Grandis said that, at the time, she felt comparable to her male colleagues in terms of her productivity and overall acceptance by others in her field. When she analyzed her data, though, she said, “The results really shocked me.”
Women ear, nose, and throat specialists were more likely to not have children, be divorced, recount discrimination and harassment, and regret their career choice than the men in her survey.1 Women also earned 20 percent less than the men.
Recently, though, Grandis was alarmed to realize that little had changed in these trends. After studying the experiences of men and women in academia and how these impacted the scientists' careers, Grandis collected the stories into a book, Harsh Medicine, that published earlier this month. Through these personal accounts, Grandis hopes to provide a resource for people experiencing discrimination to feel less alone and to bring issues of equity to light.
Gender Discrimination in Academia Takes a Toll on Women Scientists
Physician scientist Jennifer Grandis interviewed women and men scientists to untangle the factors leading to gender inequality in academic medicine.
Marco Sanchez, UCSF
After publishing her findings in 2004, Grandis returned to her work as a surgeon and scientist. Almost 20 years later, though, she was stunned to read an article that showed that almost none of the trends she reported on had changed. “I was really baffled by why progress was so incremental, if not impossible,” she said.
Grandis reached out to sociologist Arlie Hochschild at the University of California, Berkeley about what may be slowing the career success and negatively impacting the experiences of women in medicine, but Hochschild said that researchers had not studied the reasons. So, Hochschild helped Grandis design a study to investigate these trends, leading to the latter interviewing 52 men and 52 women across 16 US institutions.
In her interviews, Grandis said that a common theme she encountered among women scientists was that they felt like they had to put in more work to be recognized, such as for promotion and tenure, than the men they worked with. “They felt unappreciated and unseen,” Grandis said.
As a result, Grandis said that many of the women she spoke to felt exhausted. Although she did not speak to scientists who left academia, plenty of women physicians and researchers leave academia because of this stress.5 Early in their careers, Grandis said that men and women are equally successful. “But something happens, and the women leak out of the pipeline. Or—one of my new phrases is—they're actively flushed out of the pipeline,” she said.
This leads to fewer women in senior positions. Those that do remain, she said, appear to struggle to receive grants and publish in high-impact journals. Grandis said that, ultimately, the loss of this talent and skill hurts all people because there will be fewer doctors and researchers to provide care and develop new cures.
Meanwhile, Grandis said that the men that she spoke to agreed that gender discrimination was a problem and should not be tolerated. But she said that most spoke as if it was an issue at other institutions and had not realized that the problem was also present in their own workplace. Grandis added that, during the interviews, many men came to the realization that, in fact, gender discrimination was happening everywhere.
“It was a scary idea that they might be wrong. The idea that it was happening made them feel guilty, and that made them react a little bit defensively,” she said, adding that many men also asked what they could do to address the problem. Grandis said that a great first step is to reach out to the women in one’s workplace about their experiences. “If you ask it respectfully, and the space you create is a really safe one, it's really remarkable what we can hear from each other,” she said.
Stories of Inequity in Science Can Reveal Solutions to Improve Medicine
From these interviews, Grandis and her colleagues published several of their findings highlighting men and women’s experiences of several different academic factors. For example, they found that women faced more challenges achieving promotion and tenure, and they struggled to network successfully in male-dominated activities.2,3 Additionally, while mentorship provided an important opportunity to learn about the inequities that women faced, Grandis and her team heard this was often a time when women they spoke to experienced harassment from a male mentor.4
The stories from these interviews stayed with Grandis after she and her team published the results, though. “I thought it would be a great opportunity if I could write a book and share these stories and hopefully change hearts and minds,” she said. She did just that, publishing Harsh Medicine on July 7, 2026.
“I hope it helps open our eyes to what's really happening all around us,” Grandis said. “Once you become aware of something, it remains front and center, and then you can do something about it.”
Reflecting on her own takeaway from this project, Grandis said, “I finally have accepted that being a role model, hopefully a good role model, is important, but it's not enough. If the systems don't change, even the best role models can't help everybody who follows.”
Grandis’s biggest hope for her book is that people realize that they need to talk about these uncomfortable issues, including confronting examples of discrimination and addressing them. She added that, although complex issues like the gender pay gap will take time to address, using microaggressions, like referring to men by their title and women by their first name, is something people can stop doing immediately.
But the work cannot just fall on individuals. She said that institutions need to make an effort to improve systems of addressing discrimination, which currently put the burden on the people being harmed. They also must collect data on the success of their women scientists and identify obstacles they may be facing.
- Grandis JR, et al. The gender gap in a surgical subspecialty: Analysis of career and lifestyle factors. Arch Otolaryngol Head Neck Surg. 2004;130(6):695-702.
- Murphy M, et al. Women’s experiences of promotion and tenure in academic medicine and potential implications for gender disparities in career advancement: A qualitative analysis. JAMA Netw Open. 2021;14(9):e2125843.
- Murphy M, et al. Networking practices and gender inequities in academic medicine: Women's and men's perspectives. eClinicalMedicine. 2022;45:101338.
- Murphy M, et al. Mentoring relationships and gender inequities in academic medicine: Findings from a multi-institutional qualitative study. Acad Med. 2022;97(1):136-142.
- Steinman RA, et al. Career trajectories of MD-PhD physician scientists: The loss of women investigators. Cancer Cell. 2024;42(5):723-726.
