As Women’s History Month draws to a close, we wanted to put a spotlight on women in ophthalmology, the ongoing challenges they face, and the myriad ways they are overcoming obstacles and advancing the specialty.
A 2024 study titled “Sex Disparities in Ophthalmology From Training Through Practice: A Systematic Review,” revealed that female ophthalmologists:1,2
- Are still underrepresented in leadership roles
- Often faced sexual harassment and a questioning of their competency
- Earned less than their male counterparts
- Yearned for mentorship from women in the field
To glean this information, the researchers reviewed four cohort studies and 87 cross-sectional studies published between January 1990 and May 2022.1,2 These findings were mirrored in a survey sponsored by Johnson & Johnson Vision (JJV), which stated that 36% of women in ophthalmology felt bias barriers kept them from achieving their full potential and career success.2,3
According to Lori Tierney, former President of the Americas, in a 2023 press release, “Results from the Women in Ophthalmology Survey highlight the inequities disproportionately faced by women ophthalmologists today, which is unacceptable.”4
Using the major findings from this report, we formulated questions and garnered responses from five female ophthalmologists at the top of their field to discuss past experiences and gauge their optimism for the future.
The challenge of maintaining work-life balance for women ophthalmologists
“I think that a lot of women in ophthalmology feel pulled in multiple directions. We are committed to patient care and advancing our own careers, but also being present for our family. Internally, many of us are very high achieving perfectionists, and so we also might be struggling with self doubt, burnout, and the pressure to ‘Do it all.’” Shanika Esparaz, MD
The overwhelming consensus among our interviewees was that the most significant challenge facing women in ophthalmology today is neither new nor limited to physicians—it is maintaining career success while balancing home and family. Each expressed the frustration of meeting the demands of the day-to-day in both their work life and home life at a time when they are expected to fulfill the traditional role of wife and mother while simultaneously rising in the ranks of their field.
According to Dr. Alanna Nattis, “If you're going to have a family, usually, most of the responsibilities surrounding the home do fall on mom—although both partners may be very equal in it. Many times, you're being torn between your career and home.
I know for me, the most challenging thing is figuring out how I can balance the hustle at work and also come home with enough energy to run after my 3-year-old. Even when we're done seeing patients for the day, there's call backs, co-management, and serious conversations we have to have with patients. You take it home with you, whether or not you want to.”
Dr. Nicole Bajic echoed this sentiment, “The simple fact is that women [and people with a uterus], if they choose to carry a child, are the ones who grow the child in their body. This tends to cluster around either training in medical school, residency, or the period right after graduation. Those are critical periods in a surgeon's career—especially when they are straight out of training and trying to grow their practice.”
She added, “Ask any surgeon, male or female, 'What's the hardest time period in your career?' The vast majority will tell you it's those first 3 years outside of training. A lot of women are having children during that time. There's a lot of change, both at home and at work. So, it is definitely a challenging time, and navigating it all while also building your career can be exceptionally tough.”
When competency is questioned due to misogyny
“Once a patient implied that, being a woman, I would be ‘too emotional’ to make any decisions. After that, I said, ‘Well, that's fine. I can refer you to another physician.’ I never saw him again.” Alanna Nattis, DO, FAAO
The Women in Ophthalmology Survey reported that 32% of female ophthalmologists have had their competence questioned due to their gender.2,3 The majority of the physicians we spoke with have had their competency questioned, at some level, by either a patient or a fellow physician.
Having a husband who is also in medicine and went through medical training at a similar time gives Dr. Esparaz a unique perspective on this topic. “Unfortunately, this is a common experience for women in ophthalmology, women in surgical fields, and women in medicine as a whole.
I have been questioned about how many times I’ve done a procedure, how far I am out of training, and my age. In fact, I've been asked these questions right before wheeling a patient into the operating room. I compare my experience to my husband, who is the same age as me, same year out of training, also in medicine, and he has never had these experiences.”
Initially, as a new attending, Dr. Esparaz found herself internalizing these questions and comments, but with time, she has learned how to flip the script by understanding that these patients are coming from an area of fear and anxiety about their upcoming procedure.
“So, I've learned over the years to kind of brush it off with a joke and then tell them, ‘I can't even count the number of times I've done this procedure. I've done 20 of these alone today, so I'm nice and warmed up for you.’”
What is in a name…or rather title?
In regard to respect, Dr. Nattis has noticed a discernible difference in how she and her male counterparts are addressed. While the men in her practice are consistently referred to as “doctor,” she has found that both professionals and patients alike are much more likely to utilize her first name both in email correspondence and in-person encounters.
She explained, “I would say about 75% of the time, companies, research partners, and even representatives from pharmaceutical/device companies address me by my first name. I don't insist that people address me as Dr. Nattis, but I'm not your friend…yet.
Patients I’ve only seen a couple of times will also assume they are on a first-name basis. My male practice partners are exclusively called 'Dr.,' and while it may not be on purpose, it shows a lack of respect for the professional degree of a woman as opposed to that of a man.”
Sexual harassment in the ophthalmology clinic
One of the most alarming forms of workplace misconduct is sexual harassment. The aforementioned JJV study revealed that 11% of female ophthalmologists were disrespected/harassed by faculty, staff, or fellow students during medical school. An even larger number, 32%, have experienced harassment from a patient. Our interviewees reported instances of both.2,3
As for negative encounters during their training, both Drs. Bajic and Nattis fell victim. Dr. Bajic related, “When I was a medical student on my surgical rotation, there was a certain member of the team who was senior to me and quite crude.
I remember very vividly, in the middle of a busy clinic day, he expressed to me very explicit imagery of what he imagined I liked to do in my free time. It was very lewd and wildly inappropriate. And, he did this with patients milling about in the same hallway. It was shocking.” This same individual, after asking about Dr. Bajic’s ethnicity, furthered the harassment by showing her explicit photos of women of the same ethnic background during a busy clinic.
“Here I was, being confronted by someone responsible for evaluating me, who was making highly inappropriate comments of a sexual nature targeted at me. And I was expected to remain professional, cool, and calm. Fortunately, as you move on in your career and gain respect, those things happen much less often, but they can and still do happen,” Dr. Bajic stated.
Dr. Nattis recalled an incident that occurred when she was a medical student and a patient showed her a “very inappropriate” photograph. She recounted, “When I told the supervising attending, he brushed it off, which made me feel terrible.
It also made me second guess whether or not I wanted to be at that program because I felt, ‘Well, if this is how you're handling this personal situation, which [I considered to be] fairly serious, then I definitely don't want to be here to see what happens if there's a really serious issue.’
“Can’t you take a compliment?”
As with competency, Dr. Bal has noted a distinct difference between the way she and her physician husband are treated by patients. Dr. Bal stated, “Comments about attractiveness or appearance are very common for young, female physicians. I have at least one, and usually more, patients comment on my appearance every day.
This is in contrast to my husband, who is the same age as me and also a physician, but a tall, white, hetero, male who once told me he could count the number of times a patient has commented on his appearance on one hand.”
However, instead of downplaying her appearance, Dr. Bal leans into her femininity as a way to educate: “I really use the shock and awe of my age/appearance as an opportunity to win trust. You can often find me in the clinic wearing a pink blouse and pink heels.
I don't have an overly feminine style in my personal life, but in medicine, I make sure to bring the feminine flair because I want to set that example and help patients see that the face of medicine is changing.”
Narrowing the gender pay gap for women in ophthalmology
“There's absolutely an inequity, and we see that in the data. There seems to be this bizarre bias that, now, everything's equal, but that doesn't hold up. Look at the data; I think that's where we start. The power from updated knowledge is the best bargaining chip.” Nicole Bajic, MD
As an example of this data, a 2022 cross-sectional study analyzing the salaries of full-time academic physicians who practiced found that female ophthalmologists earned less compensation than their male colleagues across all ranks.5
Between male and female ophthalmologists, the median compensation difference was $50,000.5 Additionally, a separate 2021 study, taking into account the base starting salary with bonus (SWB), found that women earned significantly less in their first year of clinical position.6
Transparency can go a long way in mitigating this issue. Dr. Bal stated, “I am fortunate because I have a very open and honest circle of friends—and am also married to a physician. This transparency has empowered all of us to advocate for a fair salary and to negotiate the things that are important to us. I always tell my friends and mentees to make sure they know their worth and advocate for themselves, it will go a long way!”
The power of female mentorship
“I think female mentorship and sponsorship are so important. I stand on the shoulders of many wonderful female mentors who gave me sage advice and thought of me for many career-building opportunities. I always wish to do the same for my younger female mentees.” Nandini Venkateswaran, MD
A mentor is defined as a trusted guide or counselor.7 According to the JJV study, 66% of female ophthalmologists feel that a same-sex mentor would have led to an enhanced educational experience as well as a more positive professional experience.2,3
Dr. Esparaz felt firsthand the positive effect of female mentorship. She stated, “I give credit to my program director, who was a woman and a mom, as well as to the female attendings and females in leadership within my ophthalmology department. Their presence really paved for female trainees.”
As an Associate Professor in Ophthalmology and Surgery at NYITCOM, Dr. Nattis finds herself in the role of mentor for many upcoming female medical trainees: “I feel being a mentor is important, especially for the female students I have. It reinforces that they can go into a surgical field and still have a family and home life and hobbies.”
The social side of mentorship
Three of the doctors we interviewed are taking a modern approach to mentoring by sharing their experiences, both in and out of the clinic, on social media with the next generation of ophthalmologists. Each of this trio, which includes Dr. Esparaz, Dr. Bal, and Dr. Bajic, have amassed impressive followings. Their posts provide valuable insights into the day-to-day life of a practicing ophthalmologist.
Dr. Bajic said, “One of the best parts about social media is that you can have a broad reach. When you put yourself out there, you don't know if it has much of an impact. But I get a lot of positive feedback at conferences. Trainees come up to me and share how they find certain aspects inspiring or helpful as they go on their own journey. And that is extremely rewarding. It's the one way I can make a positive impact.”
Misconceptions about women in leadership positions
“We need more women in leadership roles across the board, in academics, in private practice, and in our communities. We need to see women in leadership positions who are supported and nominated for those positions. When we have women in those positions, it really paves the way for younger career physicians and physicians in training.” Shanika Esparaz, MD
After hearing two male colleagues with opposing views discussing the representation of women on panels, Dr. Bajic realized there was a disconnect. One saw the need for a greater female presence, while the other felt they were more than adequately reflected.
On this, she says, “If you look at the data, that's not the case. There seems to be this bias that there's already more than enough women, and that we make up the majority, and that's not even close; we're not even close to half. I think highlighting those things is important, especially with the data that backs it up.”
Out of the 100 honorees on The Ophthalmologist Power List 2024 posted each year by The Ophthalmologist, there was only one woman in the top 10, three in the top 20, and 29 overall.8 In addition, a cross-sectional analysis of 107 ophthalmology chairs of accredited US departments found that 89/107 (83%) are male.9
Addressing disparities for a more equitable future
“The best way is to meet them [i.e., inequities] head-on. Having these discussions, sharing our stories, and advocating for each other will empower women of future generations to have a strong voice and to hold more and more leadership roles.” Sila Bal, MD
There are several organizations that are working for more gender-equitable eyecare, including:
- Women in Ophthalmology
- Women in Eyecare
- Women Professors of Ophthalmology
- Women in Eye and Vision Research
- Women Leaders in Eye Health
- Ophthalmic World Leaders
As Dr. Bajic stated, “If you're not at the table, you're what's for dinner. You need to have representation.” Progress depends on greater visibility and increased influence amongst women in ophthalmology, whether that be through filling more leadership roles, actively advocating for more equitable policies, being open about the unique challenges of work-life balance for mothers, finding opportunities to mentor, or sharing pivotal experiences, as the women in this article have done.
Luckily, today’s female physicians are paving the way to ensure younger doctors will find their path a smoother one.
Final thoughts
In closing, Dr. Bal said, “The challenge of our predecessors was to simply get a seat at the table. To get a foot in the door. However, our biggest challenge now is to transform a previously nearly completely male-dominated field into the diverse and beautiful field of medicine today.”
