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Men have been represented as physicians in movies four times more often than women, according to a cross-sectional analysis of three decades of films.

Among a total of 2,295 physician characters in 1,226 movies released from 1990 to 2020, 81.4% were men and 18.6% were women, reported Reshma Jagsi, MD, DPhil, of Emory University in Atlanta, and co-authors in a research letter.

Representation of female physician characters in movies did increase by about 2% per decade, from 16.6% to 18.6% to 20.8% (P=0.04), but most movies depicted physicians as men (71.5%). Movies portraying at least one female physician character ranged from 27.8% to 29.1% per decade.

Overall, 77.8% of the lead roles involving physicians were men and 90.9% were white. In the 22 instances in which a woman physician was a lead character in a movie, she was white in 20 and non-white in only two.

Movies rated G or PG were more likely to portray all doctors as men (78.8% vs 21.2% for women). In movies rated PG-13 or R, the percentage of women physicians was slightly higher (29.1%), though still much less than the percentage of movies with only male physician characters (70.9%).

"The woeful under-representation of women and people of color stands out most starkly in those movies rated G and PG, which is particularly disappointing since that's the depiction being presented to some of the youngest viewers and shaping their sense of who can and should be a doctor," Jagsi wrote in an email to 番茄社区.

More than half of movies had only one physician (61.3%) and that character was usually male (83.1%). Movies that portrayed multiple physicians had female physician characters more often than movies with just one physician character (46.8% and 16.9% respectively, P<0.001).

On multivariable analysis, factors associated with at least one female physician character included a higher total number of physicians in the film, movies with a physician as the lead, a greater proportion of women writers, and movies with an R versus G or PG rating.

For reference, half of medical students are now women, and according to data from the Association of American Medical Colleges' 2022 , 37.1% of active physicians in the U.S. in 2021 were women. Additionally, 63.9% identified as white, 20.6% were Asian, 6.9% were Hispanic, and 5.7% were Black.

"This study materialized because we believed it was important to capture some of the intangibles that could affect public perception and consciousness of what a physician was expected to look like," noted co-author Bismarck Odei, MD, of the Huntsman Cancer Institute at the University of Utah in Salt Lake City, in an email to 番茄社区, adding that seeing Ben Carson, a Black physician, portrayed in a movie affected his own decision to pursue a medical career.

"We certainly do hope for change in how the media narrowly portrays physicians along certain demographic lines," Odei added. "Some of that change will need to emerge from an increased resolve from current screenwriters and movie directors."

Jagsi pointed out that physician representation for all marginalized identities is important.

"If we want access to the full talent pool, we can't afford to keep major segments of the next generation of young people from even envisioning themselves as physicians. And we can't expect women and people of color to be optimally effective in their roles as physicians if they're constantly fighting to establish that they belong in the physician role," she said.

The authors concluded that "[a]ddressing the cinematic representation of women in the physician role may be instrumental in reversing entrenched stereotypes."

Vesta Silva, PhD, a professor of communication and global health studies at Allegheny College in Meadville, Pennsylvania, said that most of the research on physician representation in media has focused on television.

"Film is significantly behind television in terms of physician representation and diversity. So I think it's useful to think about film specifically since a lot more attention has been focused on television and we've seen a lot more gains both in television dramas, but also in reality television," Silva told 番茄社区 in a phone interview.

"What I think is really important about research like this, and this study in particular, is that we know after decades of research, that representation matters," she continued. "Seeing yourself embodied in characters on the screen, whether big or small, is an important piece in terms of cultural acceptance, understanding, and awareness of who can occupy which professional roles or which prestigious positions within the broader culture. So representation absolutely matters."

However, Silva also pointed out that the research didn't characterize whether the physician representation was positive or negative.

"While representation certainly matters, if your character is serving as the villain, it's a very different kind of representation," she said.

The fact that authors only used racial binary categorization -- white versus non-white -- limited how detailed the trends presented were. Silva said that nuance could be interesting data.

"One of the things that we've seen in some of the other research about representations of physicians is that Black physicians are significantly overrepresented compared to their actual presence in the medical field, while international physicians of all races, Asian, and Hispanic physicians tend to be actually underrepresented," she said.

The authors themselves noted that their research was limited by binary categorizations of both race and gender, subjectivity in assigning characteristics, as well as the possibility of missing some movies with physician characters. They added that future research should look into specific ethnic and racial backgrounds, as well as gender expression.

For this study, the researchers searched the Internet Movie Database (IMDb) for movies released from 1990 to 2020 for references to physicians in plot summaries, keywords, and casting credits. Using film clips and photos, the physician characters were coded in binary options of women or men and white or non-white, as were producers, directors, and writers. "Lead roles" were classified as main characters with significant contributions to the plot.

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