In 1995, gender studies researcher Judy Chu found herself chauffeuring around her 13-year-old brother and his friend. The boys’ curiosity got the better of them, and they asked what she was learning: adolescent girls’ development, she told them. 

One of the boys looked at her and said, “‘You should study boys. You can start with me,’” Chu recalled. So she did. That fall, she spoke to 13-year-old boys from home for her clinical interviewing class.

In the years since, Chu has researched boys between the ages 12 and 18 — their wishes, their desires, what they wanted from their friendships and romantic relationships — and discovered some felt largely unknown. There was a gap between what the world expected of them — the stoic, strong, independent stereotypes that have persisted for centuries — and how they saw themselves, but had internalized so many messages for so long that they felt like they had no choice but to accept this version of masculinity. Chu theorized that these beliefs must have taken root during their childhood, and she later published a book on the subject.

When toddlers enter school, she discovered, they begin learning the rules of boyhood. “Regardless of what their parents had encouraged or enabled at home, they were learning that at school, if you wanted to be seen as and treated as one of the boys and you wanted to be with the boys, you wanted to play with the boys, be friends with the boys, there were rules you had to follow,” Chu said. “It was kind of like a microcosm of our society, which is if you want people to see you as and treat you as a quote unquote real boy or real man, you need to prove yourself.”

Since Chu’s work on the subject, American culture has changed to address gender inequities — the ones that negatively affect girls. As a part of this movement, girls were empowered to be more autonomous and pursue careers and financial independence to build a life beyond marriage and childrearing. (Though it should be said, women still trail men in earnings, outpace them in household responsibilities, and have higher rates of anxiety, depression, and PTSD.) 

But boys are still stuck in place. 

Across the country, lawmakers have promoted policies and legislation aimed at helping men reach their potential. In California, Gov. Gavin Newsom signed a 2025 executive order outlining education, career, and mental health initiatives targeting men. Maryland Gov. Wes Moore created the state’s Young Men and Boys Initiative, focusing on men’s health, employment, and community connections. But these programs are reactive, attempting to disrupt decades of socialization. At the same time, the rise of the manosphere and misogynist online spaces and increasingly right-leaning voting trends among men signal a cohort of young men at a turning point.

Recent studies have found that boys are less likely to graduate high school on time compared to girls — that gap is even bigger for Black and Hispanic boys — and fewer young men obtain bachelor’s degrees compared to their female peers. And as fewer men graduate from college, fewer participate in the labor force, too. The suicide rate among men is nearly four times higher than that of women. While men and women report similar rates of loneliness and number of friends, men are less likely to turn to their social networks for support. Out of the over 750,000 jobs created since Donald Trump took office in 2025, men have gained none of them. 

So what will it take to help men get unstuck? If we are truly committed to ending the male loneliness crisis, to tackling suicide and gun violence — society has the power to change things for the next generation, experts said. Rather than aiming to reach men after the constraining masculine worldviews have already taken root, we can prevent them from warping boys’ sense of self in the first place: To help men, we must change how boys are raised. 

Reject the myth of the “real boy” 

In 2023, psychologist Michael Reichert conducted a nationally representative survey of more than 2,000 American men, asking them questions about their lives, relationships, internet habits, and sources of social support. One finding was particularly staggering: two-thirds of young men between the ages of 18 and 23 felt like no one really knew them well. (In a follow-up report two years later, in which women were also surveyed, equal percentages of men and women — about 50 percent — said they were not truly known.)

The conclusion Reichert came to, he told Vox, was “boyhood is failing at the most important task.” American society is producing young adults who feel like they’re on their own, “a tragic outcome of a boyhood that’s not preparing our males for a resilient life in a world where things are harder, more complicated,” said Reichert, the executive director of the Center for the Study of Boys’ and Girls’ Lives at the University of Pennsylvania.

Because the idea of what a man looks like and how a man behaves is so ingrained, boys are taught to conform from an early age, experts said. From their earliest years, as evidenced in Chu’s work, boys are taught to adhere to stereotypical gender norms reinforced through comments like “boys don’t cry,” “toughen up,” and “don’t be a girl.” 

“It starts with mothers having a fear of turning their son into a mama’s boy, so they push them away at young ages — 3 and 4 years old. Go play with your dad, go play with your older male siblings,” Joseph Derrick Nelson, an associate professor in the department of educational studies at Swarthmore College, told Vox. Fathers, for their part, tend to emphasize self-defense, goal pursuit, and overcoming adversity with their sons, Reichert said. Black boys in particular are perceived as older and less innocent than their white counterparts, only pushing them further toward rigid gender roles, Nelson said. If they don’t conform, they may be teased by other boys.

A large part of proving yourself as a “real boy” means rejecting anything deemed feminine, including emotional vulnerability and relationships. As babies and young children, boys and girls are equally emotionally expressive, but by the time they start school, boys show fewer emotions and use less emotional language. When boys are taught that showing their feelings or forging deep friendships is girly, they stop prioritizing those relationships. That shift happens during the teen years, when boys go from reporting having best friends with whom they can share their deepest secrets, to feeling like they’ve drifted apart from these very connections by the end of high school. And it’s not for lack of desire, Chu said, or some inherent biological difference: Boys have simply learned not to show their need for affection, to hide their sadness, to not be tender. 

A new paradigm for raising boys, experts said, begins with how masculinity is first presented at home and in school. 

To encourage boys to be better in touch with their emotions means adults should not pit masculinity against femininity, Christopher Reigeluth, an associate professor at Oregon Health and Science University, told Vox. This goes beyond simply telling boys not to conceal their feelings, but making clear that confiding these feelings in a friend and fostering platonic connections isn’t girly: it’s a universal human need. 

In schools, specialized emotional education in curricula can help boys express their emotions and embrace vulnerability. 

Simply talk to them 

One of the easiest ways to do this is to allow and encourage boys to engage in an activity traditionally seen as more feminine: talking.

Reichert, the psychologist, has led an emotional literacy program in a boys’ school for over 30 years. In that time, he’s seen the sentiment among students shift from skepticism to genuine interest. “It has become, by 2026, the most popular program in the school,” Reichert said, due to an increased cultural awareness of emotional health. In the group, students discuss their daily stressors and hardships, and they learn that letting their peers see them for who they are — connecting with them — benefits their well-being. 

Before joining Reichert’s peer counseling group, high school senior Chris Burnetta expressed his emotions on the field. “You’re almost allowed to be emotional when you’re playing sports, and you’re not allowed to be emotional when you’re not,” Burnetta, 18, told Vox. In middle school, he attended a co-ed school and found himself performing aspects of masculinity to impress his female classmates. But once he met older classmates who he respected and wanted to emulate, he discovered many of them attended the counseling group and encouraged him to go, too. “I don’t want to speak for everyone, but I think for guys in general, looking up at people above you gives you a big impression and a big influence on how you want to live your life and what you want to be like,” he said. 

Seeing his peers so enthusiastically discuss their struggles and triumphs helps foster maturity and gives him permission to show his emotions, Burnetta said, an outlet he never had before.

Adolescence, a time when many behavioral health patterns are forged or discarded, is the time to engrain healthy social habits in boys — and for parents to be explicit, Matt Englar-Carlson, a professor of counseling and the director of the Center for Boys and Men at California State University Fullerton, told Vox. Now is the time to have dedicated phone-free time as a family, to give them opportunities to share how they’re feeling without fixing their problems, to listen to them even when they’re frustrating you. When his own son was younger, Englar-Carlson thought he knew all the tricks: showing empathy, trying to help. “Me doing that with him actually was making him feel worse, I think,” he said. Instead, Englar-Carlson took a lighter touch. He would acknowledge when his son was upset, but wouldn’t press a conversation. Whenever his son was ready to talk, he was available.

One easy way to do this? Talk to them when you’re driving. As my colleague Rachel Miller previously reported, not having to make direct eye contact can make it a little easier for kids to be vulnerable. 

And if you’re a man, make sure you’re leading by example: Be willing to share your own moments of embarrassment, disappointment, and sadness, so they know it’s okay for them to do the same.  

Help them foster non-romantic intimacy 

While in school, boys have ample avenues for connection through classes and sports, even if they aren’t interacting with others on a deeper level. It’s when they lose access to these organized outlets for socialization in adulthood that they slide into isolation or start looking to their romantic partners to fulfill all of their social needs. 

The idea that emotional intimacy is reserved for your significant other is how society gets to a point where 15 percent of men say they don’t have any close friends. Those without a partner are even more adrift: Men are less satisfied being single than their female counterparts. “We teach boys to not ask for help…figure it out on their own,” Nelson said. “I don’t know why we’re surprised when they become adult men and struggle with building relationships and close and connected communities, because all they’ve been taught, even since they were young children, was about figuring it out on their own and denying emotions, suppressing emotions, that then leaves you not in relationship and quite lonely.”

In the absence of in-person friendships, digital spaces provide an attractive alternative. While not altogether negative, some online forums — interactive video games, sports gambling, the manosphere — enable young men to further retreat from society. While pursuing community, boys may find their way to adult-centric spaces, which can be rife with misogynistic and patriarchal messages, feeding the belief that the only way to advance is through hyperconsumption, materialism, looksmaxxing, and dominating women, Nelson said. “They’re quarantining themselves to their rooms and their tech devices and these online communities where they play video games, they gamble on sports, and they have conversations with other boys and young men online about somehow feeling disadvantaged as men in our society,” he said.

Burnetta, the high school senior, said he and many of his classmates’ feeds are populated with “super masculine” content that sometimes pokes fun at men who open up about their feelings, which can further add to the stereotype that men should not be emotional. 

Even if boys don’t necessarily agree with these sentiments, they often don’t have other alternatives online. “I don’t think a lot of boys go on to YouTube…and say, ‘I really want to find the most misogynistic content I can find. That’s what I’m looking for,’” said Englar-Carlson, the director of the Center for Boys and Men. They may have simply wanted to watch a video about sports but were fed an ad for betting and then fell down the rabbit hole. Because traditional masculinity content is often fed to boys via their social media feeds, a brief introduction to these themes only leads to more. 

By young adulthood, they will have a fairly concrete idea of what’s expected of them as a man. In a 2017 study, young men largely agreed that the cornerstones of masculinity are self-sufficiency, toughness, physical attractiveness, being a financial provider, heterosexuality, hypersexuality, aggression, and control. Notably, they said they feel external pressure from family, friends, and society to meet these ideals.

If adults start with the understanding that boys are emotional and they have the same social needs as girls, they can encourage them to make friends before they learn otherwise. 

Teachers can recognize the signs of loneliness in young boys (resisting authority, talking back, and challenging boundaries) and use it as an opportunity to connect with their students instead of reprimanding them — because when they feel heard, their behavior softens. “What are these behaviors communicating to me from this boy about a met or unmet need, and how can I be responsive to it in my classroom? How can I help them facilitate close and connected friendships with not only their peers, but also with me as their teacher, like a primary adult in their lives?” Nelson said. When young boys simply get kicked out of class, they might fall behind and internalize a “bad boy” persona, he said, a cycle that enforces stereotypes and comes at the cost of their education. 

The story of masculinity online and from political leaders is that men must be protectors, high earners, and muscular and strong, and when boys fail to meet that standard (which they inevitably do because they are children), they are made to feel inadequate. “They’re struggling in school, they’re having a difficult time finding work, but everything about what they’re learning about to live in America is about the dream, the aspirations, acquiring, hitting these life milestones,” Nelson said.

Demonstrate an alternative masculinity

But for some young men, the most impactful interventions take place while they’re young. Growing up, Michael Dean looked to his father and his friends’ fathers for how to be a man. These men often spoke of the importance of providing for a family, being decisive, and being a stable force. Dean thought everyone was raised with these values and had similar upbringings until he reached high school and joined Reichert’s peer counseling program.

His junior year, one of Dean’s teammates on the football team suggested that some of the young men check out the group to discuss any problems at school, issues with parents, friends, or partners. Dean was frustrated with his performance on the field and decided to attend. Hearing from his classmates — their grief, their struggles — helped give him perspective. He also learned how to be an emotional outlet for the people he loves, including his younger brother. 

“I never felt that I had to be some kind of way or be some kind of man based on traditional values of being that strong, tough guy and to keep persevering through. I could definitely see that through my dad, and I did have that belief for a little while as I was in middle school and in the beginning of high school,” Dean, now 21, told Vox. “I learned that that’s not necessarily what it means to be a man, and I can make my own judgment through my own experiences and listening to other people to help me figure out what it means in my own belief to be a man.”

For Dean, learning how to be a man began when he was a child, but his path to adulthood was punctuated by formative adults — his mother, Reichert, and yes, even his dad — who fostered a safe environment to be vulnerable and emotional. Now, when he’s lonely, he knows he can call his family, friends, or his girlfriend for support. These are the outlets experts hope men feel empowered to call upon.

“If we’re really going to make a bigger difference with having healthier men who have connected friendships, who are emotionally expressive and connected in their friendships,” Reigeluth said, “it’s got to start with boys.”

In the moody alcoves of a lobby bar in Chicago in 2021 over French 75s, Dr. Louise King, a gynecologic surgeon, and Katie L. Watson, a bioethics professor, found themselves in conversation about a topic that had long frustrated them both: Female surgeons are consistently underpaid compared to male surgeons, even after accounting for specialty, rank, age, and other factors. 

What troubled them even more was how the pay gap compounded in King’s own field. Surgeons who perform procedures that are specifically for women, like gynecological surgeries, are paid less for their services than surgeons who perform comparable surgeries for the male anatomy. Gynecologic surgeons are also predominantly women. Over the course of the conversation, Watson termed this situation “double discrimination,” a phrase that captures the overlapping dilemma of lower pay for surgeries in a specialty that is overwhelmingly female and also serves a primarily female patient population.

That term, which has since entered the medical literature, stuck because the problem it describes has been well documented for decades. In 1997, a group of gynecologic surgeons published a paper in the journal Gynecologic Oncology with a title that gets straight to it — “Is Adam worth more than Eve?” Dr. Barbara A. Goff, now chair of Obstetrics and Gynecology at University of Washington Medicine, and colleagues found that doctors are paid around 44 percent more for performing male-specific procedures than analogous female-specific ones. 

In the three decades since, the problem hasn’t been fixed. To the contrary, it has been effectively institutionalized, built into the systems and codes that determine how surgeons bill for procedures of all kinds. Today, gynecologic or female-specific procedures are in large parts still reimbursed at lower rates than male-specific procedures even when they take similar time and skill.

Those disparities have consequences that extend beyond the compensation of individual doctors. When gynecological procedures don’t bring in as much money to hospitals, those same hospitals are disincentivised to offer women’s health services. That can lead to worse care for women and, crucially, fewer training opportunities for the surgeons who do that work. 

But this historically persistent inequality is not a foregone conclusion.

How healthcare services are billed changes all the time as procedures get reevaluated, new ones get added, and medical societies and experts push for revisions. In fact, one of the biggest changes in how maternity care is billed and reimbursed is set to take effect early next year, splitting up services for prenatal care, delivery, postpartum care, and more. While this is a long-overdue fix for obstetrics, gynecologic surgery — which covers most of a woman’s life outside of childbearing years — continues to be left out of the conversation. 

And although real change will require concerted efforts, King and Watson — and other advocates who have spent years documenting this disparity — have a fairly clear sense of how to start fixing it.  

How surgical procedures are valued

The work of deciding how much a medical procedure is worth starts well above the head of any given doctor, medical practice, or hospital. In the United States, the Centers for Medicare and Medicaid Services, a federal agency that administers healthcare and health insurance policies, sets rates for different procedures based on a metric called relative value units (RVUs). An RVU is supposed to take into account how long a procedure takes, the skill it requires, and the intensity of work it demands. Both Medicare and private insurers consider these figures when they’re settling on reimbursement levels. If a procedure has a higher RVU, it is valued more highly, and makes more money.

In a recent study, cheekily titled “Price and Prejudice,” researchers from the Mount Sinai Health System found that out of 55 pairs of sex-specific procedures that they evaluated in 2023, 75 percent had lower RVUs for procedures on female patients. On average, RVUs for male-specific procedures were 30 percent higher, and when those procedures were performed in a hospital or surgical center, surgeons were paid around 26 percent more.

For example, doctors will often perform biopsies — taking a small sample of tissues, cells, or fluids — on both male and female genitalia to diagnose problems. In 2023, researchers found that Medicare’s standard national rate for reimbursing surgeons was $121.32 for a penile biopsy but only $65.74 for a vaginal biopsy. 

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King, the director of reproductive bioethics at Harvard Medical School Center for Bioethics and a contributor on the study, believes that when the RVU system was created back in the 1990s, gynecological services were largely ignored, leaving the specialty undervalued from the start. While Medicare and Medicaid Services has undertaken some efforts to make RVUs more equitable across specialties over the years, that undervaluation has persisted. 

That problem may come down to how those values are determined in the first place — and who determines them. RVUs are set by a committee of doctors convened by the American Medical Association (AMA), with most of the seats allocated to members of major medical societies. The committee surveys different doctors on the time and skill required for procedures in their specialties. Based on these responses, the committee recommends values for each service to the federal government, which has historically accepted nearly 90 percent of them.

While the data quality of the underlying surveys has improved over the years, it is still not very high, said Dr. Miriam Laugesen, a tenured associate professor of health policy and management at Columbia University Mailman School of Public Health. Because the committee’s process isn’t transparent, it is often unclear what evidence its valuations rest on. This leads to distortions of all kinds, she said.

“It’s not a government process; It’s not a federal advisory committee,” Laugesen said. “It’s just a committee that was put together by the [AMA]. It’s pretty unusual in terms of how policy is made.”

In particular, King said that the surveys have a very low response rate from some specialties and are only sent to a small subset of doctors. She has never received a committee survey in the 17 years that she has practiced. 

The American College of Obstetricians and Gynecologists (ACOG) has a core seat on the committee that determines RVUs. But most ACOG members are general OB-GYNs, who split their time between obstetrics and gynecology and typically operate relatively rarely. The surgeons who perform the bulk of gynecologic operations are subspecialists – gynecologic oncologists, urogynecologists, and minimally invasive gynecologic surgeons — who complete an additional fellowship after residency. They mainly belong to their own societies and don’t have a seat at the table when RVUs are being determined. 

“From a purely cynical or economic standpoint, [ACOG] has no reason to advance billing for gynecology. It doesn’t represent a large portion of the practices of their members,” said King, adding that ACOG has been heroic in its efforts to obtain reimbursement equity for its own members. (One unintended possible result of that advocacy is that pushing for a smaller pay gap for services related to pregnancy, has in turn sent the message that women’s bodies are literally worth less, and are less deserving of care when they’re not engaged in the god-given duty of reproduction.)

The result is that doctors in specialties like OB-GYN who operate infrequently are answering the surveys about complicated surgical procedures that gynecologic surgeons perform more frequently. King said that her surgical schedule aligned more closely with those of general surgeons. For example, she operates two to three times a week whereas, according to her, an average OB-GYN will likely operate once a month. 

“So they’re not the right people to be answering these surveys. They [the survey committee and ACOG] don’t target the surveys to people who operate a lot,” she said. 

Part of the problem with using surveys to determine a key foundation of medical reimbursements is that the data is self-reported by doctors. This is especially relevant when more objective avenues may be available. One of those avenues is the American College of Surgeons’ National Surgical Quality Improvement Program, which is an initiative that collects and manages key surgical data to track quality and improvement in surgical fields, including the actual time spent performing surgical procedures, making it a more definitive measure than self-reported surveys.

Dr. Shitanshu Uppal, a gynecologic oncologist and division chief for gynecology oncology service at the University of Michigan, and his colleagues analyzed 901,917 surgeries using both the National Surgical Quality Improvement Program as well as the self-reported surveys used to determine RVUs. They found that median RVUs per hour vary widely between specialties. Gynecology had the third-lowest median RVUs per hour of all the specialties studied. In effect, that means that gynecological surgeons are paid less for every hour that they work. 

The researchers also found that compared to the operating times logged for real surgeries in the Surgical Quality Improvement Program, surgeons in certain specialties tended to report longer procedure times in the self-reported surveys sent out by the RVUs committee. Specialties that reported longer operating times were more likely to be awarded higher RVUs, leading to greater hourly rates of reimbursement.

According to Uppal’s analysis, urologists — a profession most often associated with procedures on men because their work routinely concerns the prostate and the testicles — reported times that exceeded the baseline data by a median of 20 minutes. By contrast, estimates from gynecologists only exceeded the actual time by a median of five minutes, meaning that urologists tended to overestimate their time spent in surgery by four times as many minutes. Generally, urologists earn much more than general OB-GYNs, who in turn earn more than other subspecialties like gynecologic surgery. Despite having access to reliable electronic records of operating time, Uppal and his colleagues note, the AMA committee still continues to use self-reported operating times, which influences their RVU recommendations, ultimately cementing disparities in female-specific procedures. 

“The system that they have now developed over time,” King said, “now creates discrimination because of its complexity.” She added that this is how systemic discrimination is perpetuated, even if systems or rules appear seemingly neutral.

How low reimbursement rates make women’s lives worse

The US healthcare system has never been especially good at putting its money where its mouth is when it comes to women’s health. Experts have been sounding the alarm on sex-based disparities in medical billing for a long time — long enough that governing authorities like the committee responsible for RVUs and ACOG have had time to respond to the concerns. 

Over the years, the gap between male-specific procedure reimbursements and female-specific reimbursements has decreased slightly. But researchers of the Price and Prejudice study showed that between 2003 and 2023, there were no statistically significant improvements to the pay disparities. Comparing a smaller set of procedures across 1997, 2015 and 2023, they found that the gap had narrowed only minimally.

One common justification that ACOG provides for the pay gap is that obstetrics and gynecologic services see a higher-than-average share of patients on Medicaid, which pays doctors less than other insurers. King agreed this is a real factor, but it doesn’t explain why Medicare itself values procedures on women lower in the first place. And as her account of double discrimination makes clear, undervaluing gynecology ultimately affects women everywhere for the worse.

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy.”

Dr. Louise King

Lower reimbursements in gynecologic surgery disproportionately affect female surgeons because they represent a majority of this specialty. It’s not just the surgeons’ salaries that are affected. Hospitals and facilities work on a revenue-based model — if gynecologic surgeries are not bringing in enough money, institutions tend to allocate fewer resources to those procedures. That, in turn, can limit access to operating rooms, surgical staff, and operating times. 

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy,” King said. As a minimally invasive gynecologic surgeon, she surgically treats women with endometriosis, fibroids, cysts or other such conditions.

It also affects the training that gynecologic surgeons receive. When there aren’t enough resources to operate regularly, opportunities to train residents are rarer than they should be. The result is that low reimbursement rates have contributed to a workforce of low-volume gynecologic surgeons who are sometimes not as well-trained as other surgeons who operate frequently.

The relationship between volume of surgeries performed and patient outcomes is well-documented in other fields. Research shows that surgeons who operate infrequently have worse outcomes, including more complications before, after, and during surgeries, compared to surgeons who operate regularly. 

Low volume gynecologic surgeons — who perform a particular procedure less than 12 times a year — have significantly higher rates of causing bowel and urinary tract injuries in their patients. Especially in benign gynecological surgery (procedures not related to cancer), having surgeons who operate frequently also increases the amount of minimally invasive procedures performed, which is related to better patient outcomes. 

Payment reform is an uphill battle, but not a lost cause

It takes multiple years and pressure from different entities to update or add new RVUs for procedures — but crucially, it is not impossible. The first few steps to creating a sustainable system might look like submitting gynecology-related procedure codes for reevaluation to the AMA committee or prompting a congressional report on the matter. 

For example, for years there has only been one billing code for endometriosis, regardless of the complexity of surgery or technique used. This disincentivizes surgeons from taking on complicated surgical cases of endometriosis because of the low reimbursement rate. Reevaluating that rate or diversifying the various surgical approaches that different cases require would help affected women get the care they deserve.

Medicare’s payment system also has what’s called a budget neutrality rule, which dictates that significantly increased payments for any given procedure must be offset by cuts elsewhere. The AMA itself believes that reforming this rule would make it easier to work toward reimbursement equity for female-specific procedures.  

Experts have suggested creating gynecology-specific conversion factors to bring parity to a system that naturally undervalues these procedures, while others think that eliminating sex-specific billing codes whenever possible is the right move. For example, the code for genitalia biopsies is different for men and women. This means that those procedures can be reimbursed differently even though they are essentially similar. Adopting one sex-neutral code for any genitalia biopsies would avoid this. While the reform required for this would be substantial, researchers believe that it would narrow the billing gap significantly.     

Authorities often justify lower RVUs for female-specific procedures by pointing to training: Gynecologists spend fewer years learning to operate than urologists and other higher-paid surgical specialists, according to King.

Historically, surgeons who operated on the female pelvis trained in ways that were more closely aligned with general surgeons than OB-GYNs. When obstetrics and gynecology merged into one specialty in the 1900s, the training for gynecologic surgery was truncated. 

“General OB-GYNs will train for four years and of that four years about 18 months is devoted to surgical training in gynecology,” said King, contrasting the new training period to those of general surgeons which is in years. 

She believes that training periods should be increased for gynecologic surgeons. That change would secure better reimbursement for the speciality, while also producing better trained surgeons who would be more attuned to advances in minimally invasive surgery that will ultimately improve the outcomes for their female patients. In some cases, the experience gained during a two-year fellowship in gynecologic surgery was equivalent to 19 years in practice.  

In their initial work on double discrimination, Watson and King argued that failing to implement solutions for parity is tantamount to saying that female patients deserve less well-trained surgeons than male patients.  

As with most women’s health issues, it is unclear if this systemic disparity in medical reimbursement is the result of conscious misogyny or a by-product of ignorance. But that question of origins matters little when its consequences have been enshrined in medical policy, with lasting consequences for the practice of medicine more generally. We have allowed this wage gap to persist, even as many have sounded the alarm for decades. It is long past time to heed their warnings.