Montgomery County Commissioner Val Arkoosh, a physician and the lone woman in the top tier of Democratic Senate primary candidates, is dropping out of the race.

“It’s become increasingly clear over the last month or two that I’m unlikely to be the Democratic nominee,” Arkoosh said in an interview Friday ahead of an announcement. “And in my book there’s just nothing more important than flipping this seat, and I think the thing I can do to best ensure that is to suspend my campaign.”

She said she doesn’t plan to endorse in the primary but will campaign for the Democratic nominee in the general election.

“Every Republican in this race is deeply concerning,” she said. “They are all willing to continue to divide this country to score cheap political points.”

Arkoosh struggled to gain traction despite leading the state’s third largest county and one of its most Democratic, and running as a physician with local government experience during a pandemic.

She entered the race last April, a few months behind Lt. Gov. John Fetterman and State Rep. Malcolm Kenyatta. She was soon endorsed by EMILY’s List, an influential women’s group that plays a major role in Democratic politics.

But Arkoosh never found a political opening. In limited polling of the primary, she was often in last place among established candidates in the race. She got just 17 votes last month out of about 300 Democratic Party activists who gathered to consider a formal endorsement, which eliminated her from consideration in the first round of balloting.

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She raised more money than Kenyatta but still trailed far behind Fetterman and U.S. Rep. Conor Lamb. The Democratic field now effectively shrinks to three top-tier candidates, all men: Fetterman, Lamb, and Kenyatta, who would be Pennsylvania’s first Black and first openly gay senator if elected.

It also leaves Kenyatta as the only candidate who’s gained traction from the populous Philadelphia region. Philadelphia emergency room physician Kevin Baumlin is also running. Fetterman and Lamb are from Western Pennsylvania.

The race to replace retiring Republican Sen. Pat Toomey is being closely watched nationally. It’s seen as one of the most competitive in the country and could help determine control of the chamber and the fate of President Joe Biden’s agenda after this year. Several candidates are running in a competitive GOP primary.

Fetterman is widely seen as the early Democratic front-runner, with Lamb his closest competitor. It remains to be seen how Arkoosh ending her campaign will change the dynamics of the race.

Arkoosh got a master’s degree in public health from John’s Hopkins Bloomberg School of Public Health, which she completed while practicing medicine part time and caring for three young children. That led to a job with the National Physicians Alliance, where she advocated for passage of the Affordable Care Act during the Obama administration.

She lost her first congressional campaign in 2014 before being appointed to the Montgomery County Commissioners that year. She later won reelection to a full term, and has chaired the governing board since 2016.

» READ MORE: From last summer: Val Arkoosh would be the first Pa. woman elected to the Senate. But she’s running as Dr. Arkoosh

Montgomery is the third most populous and second wealthiest county in Pennsylvania. It’s also increasingly emerged as a Democratic stronghold in recent years — but her local government experience didn’t resonate the way she’d hoped.

Arkoosh said last summer that she shifted from a career in medicine to politics because her patients needed more help than she could provide in an exam room. On the campaign trail, she made abortion rights, health care, and climate key issues.

Pennsylvania ranks in the bottom half of states for gender representation in politics. The state has never elected a female U.S. senator or governor. There are four women, all Democrats, in a congressional delegation of 18 — up from zero women before the 2018 elections. The state legislature is about 26% female.

A few Republican women are running for statewide office. Carla Sands, a former ambassador to Denmark in the Trump administration, and Kathy Barnette, a Montgomery County conservative commentator, are running for Senate. Melissa Hart, a former congresswoman, is running for governor.

Arkoosh said Friday that it’s hard to say if gender played a role in her campaign struggles.

“It’s impossible for me to know the answer to that,” she said. “I’ve gotten a lot of support from across the commonwealth from people of all different backgrounds. ... That’s all I had under my control.

“I’ve worked in male-dominated professions my whole career, medicine and politics,” she added. “And I do believe that women have to work harder ... but I’ve never let any of those things stop me.”