This is without a doubt an exciting time for women in medicine. There have never been more women applying and being accepted to med school, and pursuing residency. A mere fifty-some years ago, women made up only 9% of medical school applicants and only 6.7% went on to graduate. In today’s world, women represent nearly half of all med school hopefuls, at 43.6%, and have a higher chance of graduating than their male counterparts. We should be celebrating, right?

Don’t get me wrong, I’m all for whacking a piñata, but medical school admissions, attendance and graduation are only one piece of a larger puzzle. Of the most respected and highest-paying specialties — orthopaedic surgery, neurosurgery, cardiac surgery, plastic surgery, gastroenterology, dermatology and urology — women only make up a majority in dermatology with 62.4%. While that may seem like a wide margin, men represent 86.2% of orthopedic surgeons, 84.2% of neurosurgeons, 64% of all surgery subspecialists, 67.9% of plastic surgeons, 62.6% of all IM subspecialists and 75.6% of urologists.

Even beyond hospital hallways, in 2000 a landmark national survey highlighted the widespread gender bias in academic medicine. More than half of women interviewed in medical academic institutions reported feeling discriminated against or even sexually harassed — by both patients and fellow doctors. Additional studies over the past 15 years have found that women in faculty roles are paid less than men for the same work. Even more shockingly, women are promoted more slowly throughout their academic careers than male counterparts and are therefore less likely to reach high-level positions at medical schools.

Though many people have speculated on why fewer women flourish in the profession and I’m certainly no expert, I don’t think it’s because of outright discrimination. I don’t even believe it’s a pipeline problem (i.e. there are fewer females in power, therefore looking to promote fewer women). I think it comes down to something far more complicated and messy — that one word we so often hear institutions throw around: “fit.”

Residency programs look at multiple key factors when considering prospective residents, including Step 1 and 2 CK scores, CV, recommendations, audition rotations, etc. More subtly, residencies also look for applicants who will be a good “fit” for their program and specialty. This isn’t a bad thing. “Fit” or “culture” is what allows students with less-than-stellar USMLE scores to end up at the best program for their needs. “Fit” is what allows someone to surmount the name of their medical institution and excel in a residency ideal for their skillset. But I think it’s also what often limits women from breaking into different medical fields at quicker rates. If orthopedic surgery has been without women since its inception, a female candidate may not seem like the obvious choice come Match Day.

To borrow the words of Dr. Linda H. Pololi, a senior scientist at Brandeis University: “It is shocking that the situation for women in academic medicine hasn’t changed that much in the last 10 years… But it’s not always easy to notice the quality of an organization’s culture. That culture is like the air we breathe or the water that fish swim in. It has the potential, for better or worse, to affect everybody in the same way.“

So, where does that leave us? I’m not totally sure. Again, my goal is not to take away from everything women in medicine have achieved in the last fifty years, because it’s truly been a lot, but we have to keep pushing. What does it say about our society when a woman can become president, but even at the top of her class, can’t match into neurosurgery?

This conversation continues in Med School Tutors’ sponsored podcast, My First Cadaver. Listen to: 

Disclaimer: This post is just one staff writer’s opinion. The views here may or may not be shared with other members of the MST staff.