When an attending physician recently pulled me aside after a particularly challenging clinical case involving a first-year resident, she was keen to emphasize to me that the resident felt she was being treated unfairly by nurses due to her gender. The physician continued to explain the challenges faced by women in a professional environment where male peers are often accorded more seriousness and respect, irrespective of their knowledge. My immediate reaction was one of compassion because I completely understood the feeling of being overlooked, spoken over, and minimized in a clinical context. However, I was soon struck by a profound and unsettling contradiction.
Nursing stands as one of the most female-dominated professions in healthcare, especially in the obstetrics field where I am employed. For generations, nurses have managed the emotional and physical burdens of medicine, yet they remain at the lowest level of its hierarchy, consistently undervalued, independent of their education, experience, or even basic competence. In a workforce predominantly led by women who have been historically devalued, the entry of female physicians—who persist in their fight for recognition in a male-dominated profession—can result in a silent but painful clash.
**The irony of gendered hierarchies**
Medicine and nursing were never established as equals. The early 20th-century hospital institutionalized a gendered labor division: the male physician as the authority figure and the female nurse as the aide. Even as both professions expanded, the framework of power endured.
Currently, women account for roughly 40 percent of physicians in the U.S. workforce and over 85 percent of registered nurses, but gender parity hasn’t obliterated the hierarchy; it has merely added complexity. In obstetrics, the disparity is even more pronounced; women constitute the majority in the field, with 62 percent of specialists being female and more than 95 percent of the nursing workforce. This gender dominance is unprecedented among labor forces worldwide. Nonetheless, female residents report being interrupted, doubted, or undermined by attendings and patients alike. Nurses, conversely, are frequently expected to defer to those same residents, even when their clinical expertise and experience far surpass that of the trainee doctors. This is likely due to the shared struggle both groups face in proving their worth continuously.
In the clinical setting, when frustration lacks a safe immediate outlet, it often manifests outwardly. In nursing, this well-documented occurrence is referred to as horizontal violence: the aggression or blame that circulates among colleagues rather than targeting the systems perpetuating the inequality. In the hospital environment, this can appear as curt interactions, exclusion from decision-making, or subtle subversion disguised as guidance or instruction. Residents often internalize the same hierarchies that marginalize them. In their quest for authority in a field that favors masculine traits of confidence and control, they may inadvertently project their insecurities onto nurses. The nurse, seen as both subordinate and female colleague, becomes an all-too-easy target.
This pattern often emerges during periods of high stress or clinical ambiguity. When outcomes are scrutinized, blame is more likely to be directed at the nurse who possesses less institutional authority, not less expertise. I have witnessed nurses with two decades of obstetric experience, advanced qualifications, or exceptional clinical abilities being corrected by residents who have yet to manage their first uncomplicated delivery or postpartum hemorrhage. The tension isn’t about ego; it’s about recognition. Expertise lacking authority is, or at least feels, invisible.
**Internalized oppression & the cost of habitus**
Years ago, feminist and race theorist Audre Lorde cautioned against the replication of patriarchal power structures, noting that internalized oppression leads the marginalized to repeat oppressive systems among themselves. The prevailing medical model reflects a miniature version of a society that demonstrates authority over specific individuals.
French sociologist Pierre Bourdieu extensively analyzed how structured social spaces (fields) establish their own norms and forms of capital. In hospitals, doctors possess capital in the form of prestige, authority, and legitimacy, while nurses hold practical, embodied knowledge and emotional labor. The hierarchy endures because our field validates specific types of knowledge: medical “objective” over embodied “subjective.” Female residents absorb this hierarchy as they acquire knowledge within the established framework and, perhaps unknowingly, reinforce the dominant structures that came before them. This replicated habitus creates a feedback loop, inducing stress and anxiety, which is displaced laterally (from resident to nurse, and vice versa) until everyone feels diminished.
**Towards gender parity: a model for medical collectivism**
When respect diminishes, so does communication. In medicine, communication is vital for ensuring patient safety. I am one of many seasoned nurses increasingly reluctant to voice opinions due to the expectation of being dismissed, as residents often resist feedback that challenges their perceived authority. The consequence of a silenced nurse with valuable experiential knowledge (which is undeniably crucial for effective medicine) is not merely emotional exhaustion; it poses a risk to patients. Numerous studies have demonstrated