Discrimination Within Ophthalmology: Implications for Practice

Significant disparities persist for women and physicians who are underrepresented in medicine (URiM) within the ophthalmology workforce, highlighting ongoing inequities in our field.^1-3 Such disparities are likely compounded by the discrimination faced by these groups, which not only undermines the diversity of our workforce, but also threatens the career achievement and well-being of our colleagues and trainees within the field. Here, we explore new research that uncovers the prevalence of discrimination in the US ophthalmology workforce and ways to combat it.

DISCRIMINATION BY THE NUMBERS

Our team recently surveyed 463 clinicians from 10 US-based ophthalmology organizations to evaluate discrimination within the US ophthalmology workforce. We found that 41.9% of ophthalmologists and ophthalmologists-in-training reported experiencing discrimination on the basis of gender; race or ethnicity; or lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus (LGBTQIA+) status.⁴ Discrimination was more often experienced by respondents identifying as female, from non-White racial and ethnic backgrounds, and who identified as LGBTQIA+. For example, 67.7% of female respondents, 92.9% of Black respondents, 50% of Asian respondents, and 50% of LGBTQIA+ respondents reported some form of discrimination. Commonly cited consequences of discrimination included disrespect or passive aggression (34.1%) and loss of income (23.1%). The most common sources of discrimination were senior faculty (48%) and hospital administration (29.5%). Those who reported at least one encounter of discrimination experienced significantly lower job satisfaction and lower achievement of career goals.

IMPROVING PRACTICE

Tackling the issue of discrimination in ophthalmology begins with understanding the extent of the issue, and this study serves as a starting point for characterizing the discrimination faced by members of our field. Measuring progress and the success of future interventions will require continued study over time. While tools for measuring discrimination have not yet been validated for the ophthalmology workforce in particular, scales already validated to measure discrimination in the health care setting should be employed in future efforts to measure discrimination within our workforce.

To measure outcomes on diversity, it is important that organizations also collect and analyze demographic data to track progress. Gender and ethnicity data as well as information on sexual orientation and gender identity are now collected through the San Francisco Match, and continued efforts to collect such data at organizations at different levels will be crucial to monitor trends in diversity over time.

Combatting workplace discrimination in ophthalmology requires intentional efforts and collective action at the individual and institutional level. On the individual level, studies of bystander intervention programs in medical training have found that such interventions strengthen individuals’ abilities to intervene and advocate for others.⁵ Further study is needed to demonstrate whether such empowerment ultimately improves workplace culture, with individuals feeling more supported and respected. Colleagues and faculty can stand in solidarity by listening and validating the experiences of URiM individuals, affirming belonging, advocating for change, and speaking out against discrimination. Individuals in leadership positions can model allyship and incorporate values of diversity, equity, and inclusion into the organization's core values. They can also advocate and offer resources for ally development, through programs such as the free online Accreditation Council for Graduate Medical Education Equity Matters program.⁶

At the institutional level, efforts that increase diversity through recruitment and ongoing mentorship should be promoted, as the presence of diversity itself can reduce discrimination by improving cultural competency and challenging biases and stereotypes. Many mentoring programs provide women and URiM students and residents opportunities for research and professional development (For more, see the featured article You Belong: The Value of Mentorship in Retina in this issue). By improving exposure and mentorship, these programs play a key role in improving the workforce “pipeline” starting with first-year medical students.

EXAMPLE: PARENTAL LEAVE

A common experience among women is the inconsistent or restrictive parental leave policies that disproportionately affect female physicians. Pregnancy, maternity leave, and breastfeeding have been linked to gender discrimination against women, often manifesting as disrespectful treatment from colleagues and disparities in pay and benefits.⁴ A 2023 study of female ophthalmologists found that nearly half of women received inadequate information about family leave and felt the length of leave was inadequate, with many feeling pressured to return to work early.⁷ A solution to maternal bias is the establishment of clearly communicated family leave policies that do not disadvantage female physicians for taking the necessary time off for pregnancy complications, childbirth, adoption, or postnatal leave.⁸ Organizations may additionally choose to implement a gender-neutral parental leave policy to all caregivers within the first year of a child’s birth or adoption, which can be offered in addition to medical leave related to pregnancy and childbirth. Having a parental leave that is equal for male and female employees can reduce the stigma associated with taking family leave as well as ensure inclusivity for all parents, regardless of gender.

The Accreditation Council for Graduate Medical Education has set minimum requirements for parental leave in residency programs, but minimum requirements are not standardized across practices or institutions. By providing paid parental leave that aligns with guidelines from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, organizations can address the systemic discrimination that disenfranchises mothers, restricts their career progression, and creates a work culture that penalizes pregnancy.^9,10 Women who choose to breastfeed should also be provided accommodations in time and space for lactation and milk storage upon their return. Such accommodations not only promote both maternal and infant health, but also are a legal requirement.¹¹ To this end, adequate facilities and equipment should be made available, and physicians should be given protected time away from patient care and other responsibilities for lactation, without fear of repercussions.⁸

PUT IT IN WRITING

Finally, a critical step to reducing workplace discrimination may be the development and enforcement of clear antidiscrimination policies along with a transparent, anonymous reporting system. In 2020, the AAO published rule 18 of its Code of Ethics, condemning harassment and discrimination in ophthalmology.¹² Institutions should also seek to create their own policies that allow reporting and oversight of discriminatory behaviors. The effectiveness of such reporting and review mechanisms will be contingent on factors such as trust in the system, follow-through on inquiries, and clear accountability structures.

WE ALL BENEFIT

As we work toward creating a more diverse, equitable, and inclusive environment within ophthalmology, we should be cognizant of the discrimination faced by many groups within ophthalmology and in medicine at large. Addressing these challenges requires a multifaceted approach, including allyship, institutional commitment, and policy reforms. Additionally, while much of the focus has been on race, gender, and sexual orientation, other forms of discrimination—such as those based on disability and socioeconomic status—also affect inclusion and career advancement in ophthalmology. 

By fostering an inclusive and equitable environment, ophthalmology can attract and retain a talented and diverse workforce, ultimately improving patient care and strengthening the field as a whole. Continued efforts in research, advocacy, and systemic change are necessary to ensure lasting progress.

1. Woreta FA, Gordon LK, Knight OJ, Randolph JD, Zebardast N, Pérez-González CE. Enhancing diversity in the ophthalmology workforce. Ophthalmology. 2022;129(10):e127-e136.

2. Aguwa U, Williams B, Woreta F. Diversity, equity and inclusion in ophthalmology. Curr Opin Ophthalmol. 2023;34(5):378-381.

3. Rousta N, Hussein IM, Kohly RP. Sex disparities in ophthalmology from training through practice: a systematic review. JAMA Ophthalmol. 2024;142(2):146-154.

4. Sirivolu S, Pike S, Reid MW, Berry JL, Chang MY, Nguyen AM. Discrimination within the US ophthalmology workforce. JAMA Ophthalmol. 2025;143(1):73-77.

5. McMahon S, Connor RA, Frye V, Cusano J, Johnson L. The presence, action, and influence of bystanders who witness sexual harassment against medical students. Med Teach. 2023;45(10):1134-1139.

6. ACGME Equity Matters. Accreditation Council for Graduate Medical Education. Accessed February 18, 2025. dl.acgme.org/pages/equity-matters-catalog

7. Zimmermann CM, Kraus CL, Campbell AA, Kaleem MA, Shukla AG, McGlumphy EJ. Maternity and family leave experiences among female ophthalmologists in the United States. PLoS One. 2023;18(4):e0277376.

8. Heshmati A, Honkaniemi H, Juárez SP. The effect of parental leave on parents’ mental health: a systematic review. Lancet Pub Health. 2023;8(1):e57-e75.

9. Dammann CEL, Montez K, Mathur M, Alderman SL, Bunik M; Council on Community Pediatrics, Council on Early Childhood, Section on Breastfeeding, Section on Neonatal Perinatal Medicine; Paid family and medical leave: policy statement. Pediatrics. 2024;154(5):e2024068958.

10. ACOG Statement of Policy: Paid Parental Leave. ACOG. www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2020/paid-parental-leave

11. Frequently Asked Questions–Pumping Breast Milk at Work. Department of Labor. Accessed February 18, 2025. www.dol.gov/agencies/whd/nursing-mothers 

12. Code of Ethics. American Academy of Ophthalmology. Accessed February 18, 2025. www.aao.org/education/ethics-detail/code-of-ethics