Imagine this: You're holding an offer letter for your dream job, floating on cloud nine. Then, two days later, you receive a call saying, "the position no longer exists." For Dr. Erin Nance, a board-certified orthopedic hand surgeon and founder of NanceMD, this nightmare became a reality, one she later shared through a storytelling reel. She was eight months pregnant when it happened.
Dr. Erin Nance was in her final year of orthopedic hand surgery fellowship at the Hospital for Special Surgery (HSS) in New York, the nation's top-ranked orthopedic hospital. After months of interviews with various hospitals and groups, one institution (which she refers to as "Hospital X") didn't just offer her a job; they created a brand-new position specifically for her.
The role was designed as a junior hand attending position, built around her exceptional skill set and training. She met with the chief of the hand department, the chairman of orthopedic surgery, and even the hospital's CEO. The feedback was overwhelmingly positive. Everyone seemed eager to onboard her.
When the contract arrived via email, something immediately felt off. The document was only two pages long and read more like a preliminary agreement than a comprehensive employment contract.
Critical details were conspicuously absent:
No call requirements specified
No vacation, sick leave, or maternity policy
No outlined duties or expectations
No surgery schedules or office day requirements
No mention of compensation structure beyond basic salary
Essentially, it stated: "Dr. Erin Nance will be a hand surgeon at X hospital starting in September." Nothing more.
Concerned, she asked her father, who is a healthcare attorney, to review the document. His advice was clear:
"There's really not much to this contract. If you sign it, you won't have a leg to stand on if you complain later about working every major holiday for the rest of your life."
Dr. Nance responded to HR with a professional request. She asked for one clarification to be added in writing: that she would take calls for an average of one week per month.
At HSS, where she was training, attending physicians were on call one week every two months. Her request was actually more generous to the employer than the industry standard at the nation's premier orthopedic hospital.
Two days later, her phone rang while she was in the middle of seeing patients in the clinic.
"Hi, I'm so glad you called," she answered. "Did you get my email about the contract?"
"Yes, we did get your email," came the reply from the HR of the hospital. "I'm just calling to let you know that the position no longer exists," she said.
Dr. Nance was stunned and asked ,"What do you mean the position no longer exists? You just hired me two days ago and sent me the contract."
"The position no longer exists," HR of the hospital said to Dr. Nance and hung up.
The phone slipped from Dr. Nance's hands and clattered to the floor. Standing there, eight months pregnant, she felt her world collapse. Here she was, about to graduate from the top fellowship program in the country, and she had no job.
A month later came her fellowship graduation ceremony, what should have been one of the proudest days of her career.
She thought, one by one, her colleagues' names were called:
"Congratulations to Dr. Jones, who is taking a position at Harvard University."
"Congratulations to Dr. Smith, who is starting with a large group in Dallas, Texas."
Then, on her turn, they would call: "Dr. Nance... who is still looking for a job."
"I was mortified, absolutely mortified," she recalled.
The next day, she gave birth to a beautiful, healthy baby girl. But instead of pure joy, the moment was clouded by uncertainty and shame.
Well-meaning friends and family told her, "Enjoy this time with your baby. You're so lucky to have all this time to spend with her."
But Dr. Nance's internal monologue was darker: "Enjoy this time with my baby? I'm unemployed. I'm the most overqualified unemployed person I've ever heard of. And I'm just so embarrassed and ashamed of the whole situation."
She had already missed the entire job recruitment cycle. The prospects of finding another position seemed bleak.
A month after giving birth, a former residency colleague came to visit. Over a conversation about the baby, he asked how things were going.
"It's awful," Dr. Nance admitted. "I don't have any prospects. I had the job taken away from me, and it's too late to apply anywhere else."
His response surprised her: "You're in a great position."
"What are you smoking?" she thought. "This is awful," she said.
Then he said something that changed everything:
"You could start your own practice."
Her first reaction was disbelief.
"No one starts their own practice now. Literally no one. I don't even know how that would be possible," she confronted.
But the seed was planted, and Dr. Erin Nance decided to run with it.
She threw herself into the work of building her own practice. There was paperwork to complete, insurance applications to submit, and hospital affiliations to secure. When you run your own practice, you need voluntary privileges at hospitals, meaning you can operate there without being employed by them.
Ironically, one of the hospitals where she needed these privileges was the very hospital that had fired her.
By this time, a new person had been appointed to chair the orthopedic department. As is standard with all hospital privilege applications, Dr. Nance had to undergo an in-person interview.
She went in and answered questions about her background, training, and surgical competence.
Then came an unexpected question: "Do you want to know why we took the position away from you in the spring?"
Dr. Nance's heart raced. "I would love to know why you took the position away from me in the spring."
The response was jaw-dropping: "We wanted you to know that you misrepresented yourself. You gave off the impression that you didn't want to work hard."
Dr. Nance was flabbergasted:
"Misrepresented myself? Did you think I was a foot and ankle surgeon and then found out I was a hand surgeon? I'm coming from the top program in the country. You don't think I'm someone who's a hard worker?"
She looked them straight in the eye and delivered her response:
"I'm sorry that you didn't think an eight-months pregnant person could do the same job as a man."
Dr. Nance's experience isn't an isolated incident. It represents deep-rooted gender bias in healthcare, particularly in surgical specialties.
Women in Orthopedic Surgery: A 2021 analysis from the National Provider Identifier Registry found approximately 6.5% of orthopedic surgeons to be female. At the current pace, it would take 217 years to reach gender parity in orthopedic surgery. (1)
The Pay Gap: Research shows that for every $1 in industry payment to men, women receive only $0.05 to $0.74. Female orthopedic surgeons earn less than men in both regular salaries and payments from companies, with this pay gap being large and consistent across different countries. (2)
Legal Protections Often Ignored: The Pregnancy Discrimination Act (PDA) of 1978 is a U.S. federal law that protects individuals from workplace discrimination based on pregnancy, childbirth, or related medical conditions. (3)
Yet, stories like Dr. Nance's reveal how easily these protections can be circumvented through vague justifications like "cultural fit" or "work ethic concerns."
Today, Dr. Nance runs her own successful practice, NanceMD, and has become an advocate for transparency in medicine through her #littlemissdiagnosed medical storytelling.
About Dr. Erin Nance: Dr. Erin Nance is a board-certified orthopedic hand surgeon and founder of NanceMD. She completed her fellowship at the Hospital for Special Surgery in New York and now practices independently while advocating for transparency and equity in medicine through her medical storytelling platform.
References:
1. Payares, Monica. “The Current State of Diversity in Orthopaedics.” Journal of the Pediatric Orthopaedic Society of North America 5, no. Supplement 1 (February 15, 2023): 561. https://doi.org/10.55275/JPOSNA-2023-561.
2. Gibbon, S. & Federico, A. & Kerslake, Sarah & Hiemstra, Laurie. (2025). THE GENDER PAY GAP IN ORTHOPAEDIC SURGERY IS STATISTICALLY SIGNIFICANT. Orthopaedic Proceedings. 107-B. 147-147. 10.1302/1358-992X.2025.10.147.
3. Chima, Sophia, Pregnancy Discrimination: A Silent Violation of Rights (February 25, 2025). Available at SSRN: https://ssrn.com/abstract=5193827 or http://dx.doi.org/10.2139/ssrn.5193827
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