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Let’s Talk About Sex Inequality

“When a woman speaks in a professional setting, she walks a tightrope. Either she’s barely heard or she’s judged as too aggressive. When a man says virtually the same thing, heads nod in appreciation for his fine idea. As a result, women often decide that saying less is more.”

This quote comes from “Speaking While Female” – a 2015 opinion piece by Sheryl Sandberg, Facebook’s Chief Operating Officer at the time, and Adam Grant, organizational psychologist and professor at Wharton, Adam Grant (1). The article took an analytical look at the experience of women in professional settings, as well as the barriers to and drawbacks of making their voices heard. Notably, it was referenced this year – in both name and content – by Julia A. Haller in an editorial she titled, “Apparently It’s Still Thought Risky to Speak While Female” (2). Haller’s piece, an invited commentary, accompanies recent research demonstrating that, nearly a decade after Sandberg and Grant penned their series, women attending ophthalmology grand rounds still participate less than their male colleagues – even in a virtual setting (3). These findings are consistent with others showing that this isn’t a problem limited only to ophthalmology (4).

It would be bad enough if this was the only issue facing women in the field, however, as Haller noted in her editorial, the findings shine a light on “another part of our academic life that deserves intentional discussion and remediation.” There is a well-documented gender-pay gap, with female ophthalmologists earning significantly less than male ophthalmologists in the first year of clinical practice – a difference which over the course of an individual’s career can lead to substantial losses of accumulated earnings (5). Another paper, published in the American Journal of Ophthalmology, reports, “Women ophthalmologists and trainees report sharply differing training experiences from male peers, including fewer opportunities to operate, more bullying and harassment, less access to mentorship, and contrasting expectations around contributions to family life” (6).

So what can be done to tackle the systemic issues of gender inequity within ophthalmology? As Sandberg and Grant put it, “The long term solution to the double bind of speaking while female is increasing the number of women in leadership roles.” This solution is echoed by both Haller and Dagny Zhu, co-host of the “Mend the Gap” podcast, which highlights and dissects the issues facing women in ophthalmology and medicine at large (7). Speaking to The Ophthalmologist on how ophthalmology can facilitate an environment in which women can thrive, Zhu says, “Seeing more women in leadership roles and having mentors in place is the number one thing that we can do to help the next generation. Seeing someone who looks like you and has the same struggles as you in a leadership role gives you something to aspire to and is encouragement that, yes, it is achievable.”

Although positive change needs to be embraced by the field as a whole, as Zhu explains, there are also things women can do to advocate for themselves and others in the field. “One of the recent topics that we discussed was how women can better navigate job contract negotiations, and part of that is finding the confidence within ourselves to ask for what we deserve – and doing so in a way that shows that we are on the same team as our employer and colleagues. Another topic that we recently covered was sexual harassment discrimination, which is unfortunately underreported but very prevalent among women in medicine. We discussed strategies to recognize when a colleague is being harassed or bullied and how to stand up for those colleagues and for yourself as well. Hopefully, as we continue to advocate for ourselves, we will be able to achieve that point of equity.”

Zhu acknowledges that the field of ophthalmology is working to make it easier for women to become ophthalmic surgeons, but it is clear that the issues facing women in ophthalmology are systemic and need effective solutions that tackle deep-rooted problems. Let’s hope that, another decade from now, we do not hear – yet again – about women who continue to face barriers to both speaking and practicing as ophthalmologists. Rather, let’s all work toward the point where we only hear and recognize the valued contributions made by everyone within the field.

What do you think can be done to reach gender equity in ophthalmology? What’s your experience of being a woman in ophthalmology? How about your female colleagues? Are there any other comments or perspectives that you would like to share? Please let us know below or at[email protected].

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  1. The New York Times, “Speaking While Female” (2015). Available at:
  2. JA Haller, JAMA Ophthalmol, 141, 903 (2023). PMID: 37471102.
  3. L Hennein et al., JAMA Ophthalmol, 141, 900 (2023). PMID: 37471083.
  4. N Telis et al., Am J Hum Genet, 105, 189 (2019). PMID: 31256875.
  5. JS Jia et al., Ophthalmology, 128, 971 (2021). PMID: 33248156.
  6. HK Gill et al., Am J Ophthalmol, 236, 232 (2022). PMID: 34283980.
  7. Healio, “Mend the Gap – Equity in Medicine” (2023). Available at:
About the Author
Oscelle Boye

Associate Editor, The Ophthalmologist

I have always been fascinated by stories. During my biomedical sciences degree, though I enjoyed wet lab sessions, I was truly in my element when sitting down to write up my results and find the stories within the data. Working at Texere gives me the opportunity to delve into a plethora of interesting stories, sharing them with a wide audience as I go.

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