Authors: Mallory Johnson, Rhea Manohar, MPH; Yun Weisholtz, MD, PhD on behalf of the Gender Equity Task Force
We live in an era where medical litigation is not the exception, it is expected. Each year, thousands of physicians face the threat of legal action, with nearly one in three reporting that they have been sued during their careers. These rates are even higher and especially prominent in some high-risk specialties, such as OBGYN and surgery (Guardado, 2023). While many factors contribute to this risk, one stands out across the data- gender. Across multiple specialties and studies, female physicians are consistently sued less often than their male colleagues. Understanding the reasons behind this gender gap and its implications for clinical practice, legal policy, and physician training is essential, not only to protect providers but also to advance equitable, patient-centered care.
A growing body of evidence indicates that male physicians face significantly higher rates of litigation compared to female physicians. A meta-analysis by Unwin et al. (2015) found that male physicians have 2.5 times the odds of facing medico-legal action. AMA data further reveal that career malpractice claim rates are 75 per 100 for men, compared to only 42 per 100 for women (Guardado, 2023). Specialty-specific research confirms this trend, with male OBGYNs, general surgeons, and orthopedic surgeons among the most frequently sued. Moreover, male physicians receive more patient complaints, which further increases their legal vulnerability (Hickson et al., 2022). These patterns suggest that the gender gap in malpractice cannot be attributed solely to specialty distribution, but may also reflect differences in behavior, communication, and patient relationships.
One potential explanation for this gap in patient complaints and medical malpractice claims is differences in physicians’ communication styles. Studies indicate that women physicians generally adopt a more patient-centered communication style, spending more time with patients, addressing psychosocial concerns, and expressing empathy (Howick et al., 2017). These behaviors strengthen the therapeutic relationship and foster trust, which in turn improves patient satisfaction and reduces the risk of legal action. Given that patient dissatisfaction is one of the strongest predictors of malpractice claims, the ability to foster trust through communication may be a key protective factor.
Differences in clinical practice patterns also contribute to the disparity. Female physicians tend to be more cautious and risk-averse in their medical decision-making, often adhering more closely to clinical guidelines and ordering preventive care at higher rates (Tsugawa et al., 2017; Greenwood et al., 2022). This approach not only enhances patient outcomes but may reduce the likelihood of error and litigation. Patient perceptions also play a role- female physicians are frequently viewed as more empathetic and collaborative, traits associated with greater satisfaction (Chen et al., 2020). However, these same traits may sometimes lead patients to perceive them as less authoritative, potentially altering decision-making dynamics (Schmid Mast et al., 2008). Together, these factors highlight how both physician behavior and patient perception influence the gendered experiences in clinical care and legal risk.
Another factor is specialty distribution. Women are underrepresented in high-risk surgical fields. Only 22.6% of active U.S. general surgeons are women, and just 6% of orthopedic surgeons are female (Anand, 2025). These specialties carry some of the highest malpractice risks, with 59% of general surgeons and 81% of orthopedic surgeons reporting lawsuits during their careers (AMA, 2023; Boyle et al., 2024; Condon, 2021). However, even within these high-risk specialties, women report lower litigation rates than men, suggesting that practice style and communication may have a greater influence than specialty alone.
Age discrepancies among physicians represent a significant factor in malpractice risk. Physicians aged 54 and older are substantially more likely to face legal action compared to their younger counterparts, with one study reporting lawsuit rates of approximately 46.8% for those 54 and older, versus just 9.5% among physicians aged 40 or younger (Payerchin, 2023). This disparity is not merely due to time in practice, but reflects a range of contributing factors including cumulative exposure, increased clinical responsibility, and higher-risk caseloads typically managed by senior physicians. Data from Studdert et al. (2016) reinforce this trend, showing that physicians under 35 years of age face only one-third the risk of recurrent malpractice claims compared to older colleagues. Moreover, recurrence risk appears to escalate with age, in part due to previous claim history- one of the strongest predictors of future litigation. Together, these findings suggest that while experience is invaluable, age may also correlate with greater medico-legal vulnerability, underscoring the importance of ongoing training, support, and monitoring throughout the physician career span.
The persistent gender gap in malpractice claims has important legal, financial, and cultural implications. Legally and economically, lower litigation rates among women may translate into reduced malpractice insurance premiums, lower institutional legal costs, and greater career stability- factors that affect recruitment, retention, and advancement. Culturally, these findings challenge outdated stereotypes that portray women as less capable or decisive in clinical roles. Instead, the data highlight how traits such as empathy, caution, and communication- more commonly associated with female physicians- can be protective in high-risk environments. Recognizing and valuing these strengths can inform leadership development, promotion criteria, and more equitable evaluations of clinical excellence, ultimately advancing both gender equity and patient safety.
To reduce overall malpractice risk and promote high-quality care, medical education should incorporate robust communication training that emphasizes empathy, shared decision-making, and active listening. These skills benefit all physicians, regardless of gender, by fostering trust and reducing conflict. Mentorship and training programs should also emphasize low-risk practice patterns often exemplified by female physicians, such as adherence to guidelines and patient-centered care. Risk assessment systems should evolve to account for individual behaviors and interaction styles rather than relying solely on specialty-based assumptions. Lastly, insurers and legal systems should adopt a more nuanced, gender-conscious lens when analyzing medico-legal risk, focusing on behavioral factors that more accurately predict outcomes.
In summary, women physicians consistently face lower malpractice claim rates, a pattern influenced by factors such as communication style, clinical decision-making, and systemic factors like specialty distribution and patient perception. Understanding these differences is not just a matter of gender equity, it is an opportunity to enhance patient safety, mitigate legal and financial strain, and promote physician well-being throughout the healthcare system.
References
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About the Authors
Mallory Johnson, MS4
Mallory Johnson is a fourth-year medical student from St. George’s University. She holds a Bachelor of Science in Forensic Science and a Bachelor of Science in Chemistry from Tiffin University. She worked as an Analytical Chemist at P&G and KAO before medical school. She is passionate about giving back to vulnerable communities and providing equal access and opportunity to medical care. She is a member of the Domestic Violence and Music in Medicine Committees within the American Medical Women’s Association. When she’s not doing schoolwork, you can find her playing her cello, reading cozy mysteries, and playing with her poodles, Gertie and Maple.
Rhea Manohar, MPH, MS3
Rhea Manohar is a third year medical student from St. George’s University. She has a Masters in Public Health with a concentration in Maternal and Child Health from George Washington University Milken Institute of Public Health and a Bachelors of Science in Microbiology, Immunology, and Public Health from the University of Miami. She served as Co-VP of OB/GYN Education for St. George’s University’s Women in Medicine chapter in St. George, Grenada where she developed and implemented hands-on workshops to further reproductive health issues and bolstered medical students abilities to navigate physician-patient communication. Prior to medical school, she was a Research Associate for Fors Marsh Group, where she led qualitative and quantitative public health research and campaign development for federal agencies (e.g., CDC, NIH, DHHS, CPSC). She is also a member of the Gender Equity Task Force and Reproductive Health Coalition within the American Medical Women’s Association. When she is not pursuing medicine, you can find her reading, exploring artistic passions, and spending time connecting with friends and family.
Dr. Yun Weisholtz
Dr. Yun Weisholtz is a physician-scientist and advisor with a deep commitment to mentorship and advancing equity in medicine. She completed her undergraduate studies at Stanford University, where she double-majored in Biological Sciences and Chemistry, and spent a year in Germany as a Fulbright Scholar. She went on to enter the MD-PhD program in Neuroscience at Harvard Medical School and MIT, where she developed her passion for research, teaching, and mentoring. Dr. Weisholtz is a Physician Advisor with MedSchoolCoach and the founder of MD-PhD Advising, a consulting practice dedicated to helping students navigate the medical school and residency application process. Outside of work, she enjoys collecting Delft pottery from the Netherlands and spending time with her family and pets.