A Woman’s Touch to Improve Retina

Women bring a number of qualities to the table that can enhance patient experience and improve the bottom line.

By María H. Berrocal, MD

Vitreoretinal surgery has traditionally been a male-centered subspecialty, especially in the days when lengthy retinal detachment surgeries fit the field’s cowboyish vibe. Despite the scarcity of women in that era, there were still some great female role models, among them Alice McPherson, MD; Julia Haller, MD; and Cynthia Toth, MD. These women were (and still are) at the top of the field, a feat that required exceptional talent and effort.

Today, we rely on those women to guide us toward establishing workplaces that are friendly to both sexes. Gender equality in medical schools was not achieved until the late 1990s; thus, men still account for the majority of physicians. In 2014, 23% of US members of the American Academy of Ophthalmology (AAO) were female, but only 14% of US retina members in the AAO were female.1 Areas in which women are particularly underrepresented include large private retina practices, editorial boards (only 8% of editorial board members for the journal Retina, for example, are women), and department chairs. The gender wage disparity that exists in academic and private practice reflects US society in general: the United States ranks 28th in gender equality, and the total wage disparity hovers at an 82-to-100 ratio.2 More progressive countries have actively reduced gender disparity with significant societal benefits, an evolution we, not only as retina specialists but as a society, should undertake.3


Women account for more than half of the population, so not utilizing them is a gross misuse of intellectual resources. We should be training the best candidates, and full female participation would provide a larger talent pool. The unique perspective of women is beneficial at many levels. Avivah Wittenberg-Cox, in her 2014 book Seven Steps to Leading a Gender-Balanced Business, said that “companies with more gender-balanced leadership teams significantly outperform companies with only men at the helm.”4 Ms. Wittenberg-Cox pointed out that countries with more than 50% female participation in government outperform the United States (where Congress is made up of only 19% women) in education, preventing infant poverty and mortality, and providing family leave.4

The medical profession should be representative of the demographic it serves. Patients are 1.6 times more compliant with treatment when they can communicate effectively with their physician.5 Female physicians relate to patients differently than their male counterparts do, as female empathic styles are more in tune to the societal and environmental issues that patients and caregivers face.

A meta-analysis of the effect of gender on communication and consultation length shows greater patient engagement and longer consultation times by female doctors.6 The benefits of such interaction may not be immediately realized. The advent of monthly injectable therapies equates to increased patient burden, and retina practices in the injection era value speed and efficiency. Women’s increased engagement with patients comes at the cost of longer consultation times, which can be perceived as reduced efficiency.6

In an atmosphere that prizes doctor-to-doctor relationships, retina doctors who cultivate doctor-to-patient relationships produce satisfied patients. Mirroring the overall ratio of male to female retina doctors, referral networks are often male dominated. Male physicians who cement relationships with referring (mostly male) eye care professionals via traditionally male-centered activities (eg, golfing, sports bars) do so at the expense of cultivating doctor-to-patient relationships. A business structure that relies on referrals from a predominantly male physician pool undervalues female physicians’ interactions with patients, leaving female retina specialists as outsiders whose skills are excluded from the equation. Deepened relationships between physicians and patients, such as those forged during longer consultations, will likely lead to more patient satisfaction, the ultimate goal of any retina practice.

Furthermore, data from the Ophthalmic Mutual Insurance Company show that male ophthalmologists are sued 54% more often than their female counterparts.6 These differences may be due to the particular sets of interpersonal and social skills that women bring to the doctor/patient relationship, skills that likely derive from, according to one quantitative review of gender differences across 26 cultures, increased sensitivity and consideration.7


Female partners in retina practices enrich the practice environment. A setting in which men are bosses and women are technicians is inconsistent with today’s expectations of gender equality.

A female perspective is beneficial in human resources interactions and in determining how work-life balance can be improved to provide a better environment for all employees. Male employees benefit from experiencing the different work styles that female physicians provide. Male professional accomplishments have traditionally been defined by career success, whereas female professional accomplishment derives from a more diverse and encompassing formula of situations and scenarios. Further, female leaders tend to employ leadership styles that may be more effective that those chosen by men.8 Female partners provide a feminine perspective on mediation, children, aging parents, and many life challenges that we all face.


More egalitarian gender participation is important in all realms of medicine, particularly in research. Historically, male researchers performed most clinical research on male patients and animals. It was not until 1993 that federally funded trials mandated female and minority inclusion. Without such a mandate, women in both the patient and researcher populations were shortchanged because disease manifestations and drug responses differ in each sex. Recognizing that use of male cell lines and animals has been the norm in most research, the National Institutes of Health has tried to reduce the male bias in biomedical research since 2004.9


The reality is that a woman’s potential to lose time at work due to pregnancy works against women. When a practice envisions hiring a woman for a position in retina, often the dread of possible time off from work due to pregnancy, maternity leave, and child care trumps qualifications. People feel comfortable hiring and working with the familiar, and, often, men in hiring positions traditionally prefer hiring men married to housewives, as these doctors will not have to leave the practice for perceived parenting purposes. Such hiring practices perpetuate an environment characterized by the 1950s television show Father Knows Best.

Women have been guilted into thinking that children need a mother in the house to thrive. Recent data demonstrate that children of working mothers are more successful; in fact, sons of mothers with more successful careers are more involved with their children, and daughters pursue higher-achieving careers.10 A marriage of equal partners both actively involved with children has been shown to be psychologically beneficial to children.10 Sadly, gender inequality is often most prevalent in the home. Thus, our life partner choices are of utmost importance.

For children, particularly for girls, the example of an accomplished mother successful in her career pricelessly arms them with the self-confidence to excel. Humans learn by example, so role models are as vital in the home as they are in professional fields. I am very lucky that my father was an avid feminist who believed I could accomplish anything, and that all the women in my family had careers. As a Hispanic woman I also learned that women can be strong and nurturing at the same time. We do not need to look or act like men to show our resilience and talents. Our uniquenesses and differences are our true strengths.

A productive, progressive society is one in which the entire population contributes to the work force and where all sectors are represented. Women must be present in every field. We must be paid equally. Men must participate more actively in the family—it will be enriching not only to the children but also to themselves. Childbearing is a part of life and should be seen as affecting both men and women, not just women.


Yes, it is much harder for women: We are discriminated against—in hiring practices, in pay, in other aspects of personal and professional life—but we have talents that men do not, and these must be tapped and valued by society. We need to lead by example and encourage our daughters to aim for the stars and our sons to value and cherish accomplished women.

As more women enter ophthalmic fields and a gender-balanced distribution of physicians is achieved, the long-term health of practices that seek gender balance will be obvious. Our unique talents and perspectives can only enrich the workplace and improve patient experience. n

1. American Academy of Ophthalmology. Personal correspondence.

2. US Department of Labor, US Bureau of Labor Statistics. Women in the Labor Force: A Databook. Report 1052. December 2014. Accessed December 10, 2015. www.bls.gov/opub/reports/cps/women-in-the-labor-force-a-databook-2014.pdf.

3. World Economic Forum. Annual global gender gap report. http://reports.weforum.org/global-gender-gap-report-2015. Accessed December 10, 2015.

4. Wittenberg-Cox, A. Seven steps to leading a gender-balanced business. Boston; Harvard Business Review press; 2014.

5. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–834.

6. Fountain, TR. Ophthalmic malpractice and physician gender: a claims data analysis. Trans Am Ophthalmol Soc. 2014;112:38–49.

7. Schredl M, Vural S, Schäfer G. Gender differences in dreams: do they reflect gender differences in waking life? Pers Individ Diff. 1998;25(3):433-442.

8. Eagly AH, Jonannesen-Schmidt MC, van Engen ML. Transformational, transactional, and laissez-faire leadership styles: a meta-analysis comparing women and men. Psychol Bull. 2003;129(4):569-591.

9. Mazure CM, Jones DP. Twenty years and still counting: including women as participants and studying sex and gender in biomedical research. BMC Womens Health. 2015;15(1):94.

10. McGinn KL, Castro MR, Lingo EL; Worcester Polytechnic Institute. Mums the word! Cross-national effects of maternal employment on gender inequalities at work and at home. Harvard Business School working paper #15-094. July 31, 2015.

María H. Berrocal, MD
• director, Berrocal & Associates, San Juan, Puerto Rico; past president, Pan-American Vitreoretinal Society
• 787-725-9315;mariahberrocal@hotmail.com


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About New Retina MD

New Retina MD delivers cutting-edge content to retina specialists in their first 15 years of practice. Each issue provides fresh insight from younger physicians plus established mentors on clinical and nonclinical issues affecting ophthalmologists in the earlier stages of their careers. NRMD features surgical pearls, clinical research endeavors, practice management, medical reimbursement and policy, continuing educational requirements, financial planning, innovations, and more.