Individual, institutional, and societal risk factors for the development of burnout can diff er for women and men physicians. While some studies on physician burnout report an increased prevalence among women, this fi nding may be due to actual diff erences in prevalence, the assessment tools used, or diff erences between/among the genders in how burnout manifests. In the following discussion paper, we review the prevalence of burnout in women physicians and contributing factors to burnout that are specifi c for women physicians. Understanding, preventing, and mitigating burnout among all physicians is critical, but such actions are particularly important for the retention of women physicians, given the increasing numbers of women in medicine and in light of the predicted exacerbation of physician shortages.

Women in medicine have made progress since Elizabeth Blackwell: the first women to receive her medical degree in the United States in 1849. Yet although women currently represent just over one-half of medical school applicants and matriculates, they continue to face many challenges that hinder them from entering residency, achieving leadership positions that exhibit final decision-making and budgetary power, and, in academic medicine, being promoted. Challenges include gender bias in promotion, salary inequity, professional isolation, bullying, sexual harassment, and lack of recognition, all of which lead to higher rates of attrition and burnout in women physicians. These challenges are even greater for women from groups that have historically been marginalized and excluded, in all aspects of their career and especially in achieving leadership positions. It is important to note that, in several studies, it was indicated that women physicians are more likely to adhere to clinical guidelines, provide preventive care and psychosocial counseling, and spend more time with their patients than their male peers. Additionally, some studies reveal improved clinical outcomes with women physicians. Therefore, it is critical for health care systems to promote workforce diversity in medicine and support women physicians in their career development and success and their wellness from early to late career.

There is considerable variability among individuals in musculoskeletal response to long-duration spaceflight. The specific origin of the individual variability is unknown but is almost certainly influenced by the details of other mission conditions such as individual differences in exercise countermeasures, particularly intensity of exercise, dietary intake, medication use, stress, sleep, psychological profiles, and actual mission task demands. In addition to variations in mission conditions, genetic differences may account for some aspect of individual variability. Generally, this individual variability exceeds the variability between sexes that adds to the complexity of understanding sex differences alone. Research specifically related to sex differences of the musculoskeletal system during unloading is presented and discussed. Musculoskeletal Health in Space It is well known that men and women differ in many aspects of the musculoskeletal system, with men generally having greater muscle and bone mass. Important questions for spaceflight application are whether the time course of loss with unloading is the same for men and women, whether the initial bone or muscle mass influences the rate of loss, whether that rate of loss is linear over an *3-year period (the most likely duration of initial exploration-class missions), and whether loss of bone and/or muscle over this period of time has secondary effects on other musculoskeletal tissues such as articular cartilage. If there are large sex differences in the time course of loss, this would be a compelling argument for sexspecific countermeasure development for exploration-class space missions. However, to the best of the authors' knowledge, there are no published human studies that have directly assessed sex differences in either the time course of disuseinduced bone or muscle loss or the impact of starting values.It is well established that the human musculoskeletal response to unloading is highly variable among individuals, with 10-fold differences in response among participants often observed. As an example, after 30 days of unilateral lower limb suspension, individual responses ranged from a 2.5% to a nearly 20% decline in plantarflexor cross-sectional area compared with before the suspension.1 Similarly, with actual spaceflight the loss of cancellous bone in the distal tibia after 6 months aboard Mir ranged from 2% to 24%; such changes range from a negligible loss to deficits equal to those observed after spinal cord injury.2 Understanding the factors that contribute to such large variability is an important step toward both selecting and protecting the first astronauts who undertake very long (2-3 year) exploration missions. The extent to which biological sex or sex-based hormones contribute to this variability is unknown.While this review is focused on sex differences in the response of the musculoskeletal system to the unloading of microgravity, it is important to remember that the overriding uncertainty about which factors contribute to individu...

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In the heart of New York City, adjacent to the Chrysler Building (left), the famed architect Philip Johnson designed the Trylons "as a monument for 42nd Street… to give you the top of the Chrysler building at street level" via visual analogy with the chevron-ornamented spire of its namesake. It's one of many visual reminders that the epicenter of the COVID-19 pandemic in the US is still a bejeweled city.