This article first appeared on STAT News.

It isn’t easy being a female physician these days. Although new data may suggest progress in several gender equity areas, deep-seated inequality still exists.

The pay gap between male and female doctors decreased for the first time in three years, yet women physicians still earned an average of $90,490 less than their male counterparts (down from a difference of $105,000 a year ago). Advancement for female physicians continues to lag in academic medicine, as well as in NIH grants, clinical trial roles, and publications. And in a recent study sponsored by the American Medical Association, female physicians reported routinely being perceived as a nurse or other type of non-physician during day-to-day work.

When the Me Too movement was in full swing in March 2018, my company, InCrowd, used its technology platform to survey how female physicians — half of them primary care physicians and half of them specialists — felt about their profession. Instead of conducting a deep exploration of the topic, we asked one simple question to gain a broad context: What is it like to be a woman in medicine? We sought open-ended remarks so we could listen deeply, and later coded and categorized the remarks into 10 sentiments.

We asked the same question a year later in March 2019, adding a second question specifically about the impact of Me Too.

Despite heightened societal focus on gender equity in the past year, the 2019 responses showed that negative experiences in three key dimensions of respondents’ work life had tripled or even quadrupled over the course of a year: perceptions that women were treated less professionally than their male counterparts, were discriminated against, and were working in a male-dominated field.

Verbatim remarks were particularly strident. Reading them, it’s as if in 2019 the group stood up and shouted, “We’re professionals, damn it. We’re sick of this and here’s why.”

“It’s hard,” was the predominant sentiment respondents shared about being a woman in medicine. As an emergency medicine physician from Maryland said, “Lots has changed in recent years but there’s definitely still a patriarchy within health care, and women are seen as supporting cast members rather than big time decision-makers and physicians.”

Statements about being treated with less professional respect jumped from 10% of respondents in 2018 to 36% in 2019, with numerous cringe-worthy anecdotes. “Patients and colleagues constantly comment on my appearance. Despite gender equality strides in general, the OR environment lags behind,” said an anesthesiologist from Utah. And this from an Illinois primary care physician: “Especially in training, we deal with the looks, comments, and stereotyping by older male physicians.”

“I often have patients call me by my first name even though I never introduce myself that way. My male partners rarely have that happen,” said an OB-GYN from Wisconsin.

In 2019, 34% of respondents remarked that they felt a greater sense of inequality compared to 8% in 2018. Feelings that medicine was a male-dominated profession also rose dramatically, from 4% of respondents in 2018 to 15% in 2019. Respondents commented on both subtle and overt disparities. “I am one of only two female surgeons in my hospital, and I’m the only full-time female surgeon. The surgeon’s lounge is attached to the male locker room without a door between the two, so there really isn’t a comfortable place for me to wait or chart between cases,” said the Wisconsin OB-GYN.

Me Too appeared to have had little impact on this community. In the 2019 survey, 66% of respondents said the movement had not changed their own behavior at work, although 10% of those made remarks qualifying their answers. Nearly 20% said MeToo gave them the strength to “out” harassment and not put up with sexism, while 8% shared the sentiment of this Ohio primary care physician: “It has made me more aware of how much women physicians had to work at in the past and fight for women like myself to be taken seriously in medicine.”

Only about one-fifth of respondents in each year’s survey shared solely positive remarks about being a woman in medicine, characterizing their work as “a great experience.” A minority professed loving their jobs, even despite the kinds of struggles shared by this veteran internal medicine physician in Pennsylvania: “It can be demanding as well as rewarding. Knowing who you are and your limitations can help you go a long way. Always fighting for the best pay and maintaining competitiveness. Just leading the way for others to follow.”

In both years, fewer than 1 in 10 of those responding to the survey said gender played no role in their experience, stating flat out that their experience was no different than a man’s. “I actually feel lucky to be in health care as opposed to other fields like law or business that seem to have more gender discrimination,” said one primary care physician from Georgia.

As a female CEO and company co-founder, the most hopeful part of the results for me were comments from those who had put words and feelings into action. Many weren’t just enduring perceived slights and passing them off with an “oh well,” but had begun initiatives to spark the change they seek in three areas that will improve the experiences of the next generation of women in medicine.

Entrepreneurship. Several respondents told us they have founded nonprofits and side businesses to help women physicians achieve breakthroughs that will also directly affect patient care. For Dr. Sasha Shillcutt, a cardiac anesthesiologist from Nebraska, it was starting Brave Enough, which empowers and encourages women in leadership, particularly physicians. For Dr. Stephanie Wellington, a pediatrician and neonatologist in New York, it’s a side practice coaching physicians on how to better shape their jobs. For Dr. Jessica Gold, a psychiatrist at Washington University in St. Louis, it was becoming one of the founding members of Time’s Up Healthcare, a nonprofit that insists on fair, safe, and dignified work for women in health care.

Mentoring. Other female physicians told us about mentoring programs they started. One was Dr. Narjust Duma, a hematologist at the Mayo Clinic who founded a Latinx mentoring group to encourage others who look and sound different than their peers to not be afraid to sign up for medicine’s rigorous career path and maybe even become first in their medical school class — like her.

Resetting expectations. Male physicians rarely need to remind patients or staff members that they are “the doctor.” Female physicians often have to do this, and also must often address inappropriate comments on appearance and attractiveness. Dr. Suzy Feigofsky, a cardiologist from Iowa, started speaking and writing on the topic after becoming particularly aggravated by remarks from a senior cardiothoracic surgeon on her lipstick color.

The American Medical Association is rightly shining a spotlight on the experience of women physicians as part of its “AMA Members Move Medicine” initiative. At a time of unprecedented change in health care, when women comprise 75% of health care staff (but 36% of physicians), and rising physician burnout levels threaten to make talented staff depart, the industry has zero time to get tripped up in anything but delivering the finest care by cultivating the finest care providers.

Leaders of health care systems need to pay extra attention to the work experiences of their entire teams, including women, and, where needed, fix issues before they sap their already challenged resources. We will all be the better for it.