Study: Systemic gender bias embedded in surgical practice

Editor's Note

Gender bias in surgery goes far beyond barriers for individuals, according to a study published April 8 in The American Journal of Surgery. Ethnographic data reveals women surgeons face entrenched structural inequities that influence their daily work lives, limit their professional standing, and shape perceptions of surgical competence, regardless of skill or experience.

The research is based on 67 hours of direct observation and six in-depth interviews at a Canadian academic hospital. Participants included women surgeons from general surgery, obstetrics and gynecology, and orthopedics. Findings indicate gender affected these women surgeons on three interconnected levels:

• Organizationally: Women’s surgical authority was routinely questioned, even in specialties where they were the majority. Fields like OB/GYN and breast surgery were not always recognized as "real" surgical disciplines, and procedures in these fields were often undervalued both in perception and pay. Women reported receiving fewer complex cases, lower consult volume, and diminished reputational capital compared to men.
• Individually: Women navigated a double bind, expected to embody both the technical attributes of a surgeon and the relational traits culturally associated with women. Assertiveness, often valued in male surgeons, was viewed as aggressiveness in women. Patients and colleagues sometimes evaluated their competence using gendered standards, such as complimenting a resident for having "good hands for a woman."
• Environmentally: Women’s physical presence in surgical spaces clashed with ingrained expectations of what a surgeon “looks like.” Patients were often surprised to encounter a woman as their surgeon, prompting women to feel they had to prove their qualifications more frequently. Instruments were frequently designed for larger hands, creating physical barriers to performance. Gendered signage and terminology—such as references to “men’s hats” on surgical attire checklists—reinforced implicit biases about who belongs in the operating room.

These findings add to a growing body of evidence suggesting that true equity in surgery requires institutional change—not just more women in the field, but systemic shifts in how the profession defines and supports surgical identity, researchers conclude.