2025 Theses Doctoral

White Coats, Hidden Costs: Masculinity Contest Culture in Medicine and Its Impact on Physician Outcomes

Monton, Katrina

Physician attrition has risen in recent years, drawing attention to the broader culture of medicine and its potential contribution to adverse outcomes such as poor mental health and wellbeing, and increased burnout, mistreatment, and dissatisfaction. Evidence suggests these challenges are particularly salient for women, who face significantly higher attrition rates than men.

This study applied the masculinity contest culture (MCC) framework to medicine for the first time to examine how organizational norms may impact physician experiences and outcomes. MCC is defined by four norms, show no weakness, strength and stamina, put work first, and dog-eat-dog (Berdahl et al., 2018). Using a cross-sectional survey of US-based physicians (n=215), we assessed the impact of MCC on outcomes, including mental health, well-being, burnout, workplace incivility, turnover intentions, career satisfaction, and job performance.

The findings revealed that higher levels of MCC were associated with adverse outcomes among physicians, including lower well-being, greater mental health symptoms, workplace incivility, burnout, and turnover intentions. Gender moderated some relationships, such that MCC showed a stronger negative association with well-being for women physicians than men, and MCC was negatively associated with career satisfaction and self-rated job performance for women but not men. Exploratory analyses indicated that MCC was positively associated with turnover intentions among physicians with caregiving responsibilities, but not among non-caregivers. MCC was also linked to greater behavioral disengagement and self-blame among women, but not men.

By extending the MCC framework to the medical profession, this study offers novel insight into how entrenched cultural norms contribute to physician attrition and undermine well-being, with particularly harmful consequences for women. Recognizing the impact of MCC highlights the importance of cultural reform in medicine. Targeted interventions that challenge harmful norms and promote healthier organizational values could help reduce attrition, support physician well-being, and foster more sustainable medical workplaces.