Authors: Mallory Johnson, Bethany Fenton, Meghan Etsey, Vaishnavi Patel, DO on behalf of AMWA’s Gender Equity Task Force
Since Dr. Elizabeth Blackwell became the first woman in the U.S. to earn a medical degree in 1847 (Michals, 2015), women in medicine—particularly in surgical fields—have continued to navigate longstanding barriers that challenge inclusion and advancement (Lim et al., 2021). Despite progress in medicine, women remain significantly underrepresented in surgical specialties, comprising less than 20% of permanent faculty and only 7.7% of surgical chairs (Mehta, 2023). This male-dominated landscape limits the diverse perspectives crucial for inclusive problem-solving and decision-making. Studies have shown that women patients often feel more comfortable with women providers, and outcomes data suggests that patients treated by women surgeons experience a modest but significant reduction in 30-day mortality, though complication and readmission rates remain similar between sexes (Fink et al., 2020; Wallis et al., 2017). However, systemic gender bias, cultural norms, and institutional barriers continue to hinder women’s entry and advancement in surgery. Addressing these persistent biases is essential to fostering a more inclusive surgical workforce and improving patient care.
Systemic gender bias in surgery begins early, shaping the experiences of women medical students and residents. Research shows that women often receive gendered feedback and evaluations, which can subtly undermine confidence and limit opportunities for advancement, while simultaneously facing unequal access to operative procedures (Gerull et al., 2018). The scarcity of women mentors and role models further discourages women from pursuing surgical specialties, perpetuating the cycle of underrepresentation (Lim et al., 2021). Contributing factors include time constraints, lack of formal mentoring programs, and persistent stereotypes about women’s emotional sensitivity or physical capability (Entezami et al., 2012; Lim et al., 2021). These challenges are compounded by disparities in access to leadership roles and opportunities to participate in complex surgical cases, experiences critical for career growth (Lim et al., 2021). Addressing these systemic barriers requires intentional efforts: building inclusive mentorship networks, implementing equitable evaluation practices, and fostering a departmental culture that actively supports gender equity in surgical training and leadership.
In the operating room, skill and precision should matter most, but for women surgical trainees, bias often shapes their journey from the very start. Female residents receive more critical evaluations and are perceived as less competent than their male peers, even when technical skills are equal (Gerull et al., 2018; Kerluku et al., 2023). Feedback is often vague or unhelpful, while harassment and gendered expectations create an isolating, unwelcoming environment. Critical learning opportunities—complex procedures and emergency surgeries—are frequently less accessible to women, limiting skill development and confidence. These challenges are compounded by a pervasive culture of harassment: in one comprehensive survey of U.S. general surgery residents, nearly 43% of women reported experiencing sexual harassment- often in the form of crude or demeaning comments- compared with just over 21% of men (Schlick et al., 2021).
Even before residency begins, disparities emerge in the surgical pipeline. Pre-med and medical school experiences- such as exposure to surgical clerkships, access to mentors and perceptions of specialty culture- can discourage women from pursuing surgery. This early attrition narrows the field of female surgical residents before training even starts. In one study of over 700 medical students, women were significantly more likely than men to perceive verbal discouragement as being rooted in gender, age, or future family plans, contributing to their early disinterest in surgical careers (Larsen et al., 2021).
Beyond the OR, professional growth often happens informally. The “boys’ club” culture in surgery fosters exclusive social networks, golf outings, dinners, or after-hours gatherings, where career advice, fellowship recommendations, and job opportunities are shared. Women are rarely included, missing out on connections that accelerate advancement (Anderson et al., 2018). Grueling schedules exceeding 80 hours per week, high-stress expectations, and a competitive environment that values stoicism and endurance signal that the field can feel unwelcoming. This impact disproportionately falls on women—whose unequal caregiving responsibilities, combined with minimal institutional support like parental leave or lactation facilities, make persistence even harder. As a result, these systemic pressures tend to drive many women away from surgical training. This point also extends beyond training—women surgeons routinely earn significantly less than their male counterparts even after accounting for specialty, experience, and productivity (for example, women earn around 82–90 % of men’s salaries) (Association of Women Surgeons, n.d., retrieved September 9, 2025).
The consequences ripple beyond individual careers. Underrepresentation of women limits diversity of thought, leadership, and innovation in surgical fields. Patients may also be affected, particularly in specialties where gender concordance matters, such as obstetrics or breast surgery. Meanwhile, these barriers discourage future generations of women from entering the field, perpetuating the cycle. Addressing these challenges requires both structural and cultural reforms, including:
- Equitable evaluation practices – Ensure feedback is fair, actionable, and free of gender bias.
- Mentorship and sponsorship – Connect women trainees with experienced surgeons to guide career advancement and provide access to complex procedures.
- Inclusive networking – Expand access to informal professional networks and social events that foster career opportunities.
- Supportive work-life policies – Provide paid parental leave, flexible scheduling, and adequate lactation facilities.
- Cultural transformation – Promote collaboration, inclusivity, and diverse leadership styles over traditional masculine-coded norms like stoicism and competitiveness.
To build a truly inclusive and effective surgical workforce, systemic barriers that limit women’s access, advancement, and leadership must be dismantled. Equitable evaluations, mentorship, inclusive networking, supportive work-life policies, and a culture that values collaboration over outdated masculine norms are essential. Institutional change alone is not enough. Small, everyday choices such as giving equitable credit in group settings, calling out biased feedback and dismissive or exclusionary comments, or avoiding gendered assumptions- can collectively shift the culture of surgery toward inclusion. By implementing these changes, the field can retain talented women, enhance diversity of thought, improve patient care, and ensure that surgical skill and potential, rather than gender, determine success. It is incumbent on institutions, leaders, and colleagues to act now to create a surgical environment where everyone can thrive.
References
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About the Authors
Mallory Johnson, MS4
Mallory Johnson is a fourth-year medical student from St. George’s University. She holds a Bachelor of Science in Forensic Science and a Bachelor of Science in Chemistry from Tiffin University. She worked as an Analytical Chemist at P&G and KAO before medical school. She is passionate about giving back to vulnerable communities and providing equal access and opportunity to medical care. She is a member of the Domestic Violence and Music in Medicine Committees within the American Medical Women’s Association. When she’s not doing schoolwork, you can find her playing her cello, reading cozy mysteries, and playing with her poodles, Gertie and Maple.
Bethany Fenton, MS4
Bethany Fenton is a fourth year medical student from St. George’s University. She holds a Master of Science in Nutritional Sciences from the University of Kentucky and received a Bachelor of Science in Dietetics from Eastern Kentucky University. She worked as a critical care dietitian for ten years prior to pursuing medical school. She is also a member of the Gender Equity Task Force and Sex and Nutrition and Medicine Working Group Committees within the American Medical Women’s Association. When she’s not studying, you can find her spending time with her husband and cats, using her Holga camera for experimental photography, lifting weights at the gym, playing board games, and reading science fiction novels.
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Vaishnavi J. Patel, DO is an early career family medicine physician. She is passionate about Women’s Health and advocacy, serving on the Executive Board of the American Medical Women’s Association GETF and playing a crucial role in their initiatives to support women in medicine. Her research expertise includes scientific computation, data sciences, and analyzing methods to improve patient outcomes and women’s health. She is a dedicated volunteer for local free clinics and a speaker at various programs focused on patient education and advocacy. She serves as an ambassador of the Gold Humanism Honor Society and is a recipient of the Lifetime Presidential Volunteer Service Award and the Eliza Lo Chin Unsung Hero Award. In her spare time, she enjoys archery, reading, spending time with her family, and spoiling her pets. Her patients describe her as compassionate, thorough, and knowledgeable. Her classmates, coworkers, and mentors describe her as a genuine leader, hard-worker, and a valuable asset to the future of medicine.