The Second Surgeon
In 1946, when the French philosopher Simone de Beauvoir set to writing the sweeping treatise which would become her most influential work and a foundation for second-wave feminism’s criticism of patriarchal sociocultural structures, she wondered if the discussion was already tired. “For a long time I have hesitated to write a book on woman,” she begins, “the subject is irritating, especially to women; and it is not new.”1 Eighty years on, the intersectionality and strategies with which we approach gender disparities have evolved, but our frustration with having to do so certainly has not. (1)
Few fields have been as central to both the disempowerment and empowerment of women as medicine. As women occupy more positions as practitioners and surgeons, we continue to confront the discordance of “abstract rights and concrete possibilities” that de Beauvoir and her compatriots sought, however imperfectly, to reconcile for the working women of her time. The character of this discordance for today’s women in surgery is explored here.
Medical school classes in the western world achieved gender parity in the early 2000s, and the resident and attending physician workforce have followed at variable paces based on specialty, with surgical programs generally trailing furthest behind. (2,3) A 2024 retrospective study comparing Canadian surgical match rates between 2003-2007 versus 2018-2022 found that the proportion of women matriculating from surgical residencies, obstetrics & gynecology not included, increased from 30% to 43%. (4) This does mark a changing landscape, with recent reviews reporting that only around 20% of Canadian non-obs/gyne surgical division faculty members are women, and that women are significantly less likely to hold advanced academic and leadership positions such as full professor, residency program director, or division head. (2,5)
While the trend toward parity at the entry level is promising, this classic pyramidal gender distribution, embedded in which is the so-called ‘glass ceiling,’ is a well-documented detriment to the job satisfaction and mental health of women across career stages in multiple industries 6-9 – and in medicine, we know that these factors impact patient outcomes. (10,11) As relatively small communities with rapidly changing demographics, surgical programs are positioned to make impactful policy and culture changes to ensure the well-being of both physicians and patients.
To better understand the experiences of some of the women within this expanding workforce, I anonymously surveyed four Canadian surgical residents who identify as women on their experiences as trainees.
Like many surgeons, respondents listed using their hands, real-time problem-solving, and working on a team as motivations for pursuing surgery. They also shared similar experiences around gender-based assumptions. For instance, when asked about their experiences in the workplace, three of the four volunteered that they are often misidentified as nurses. They also discussed a sense that they are expected to deliver instructions to junior learners and allied health colleagues more cordially than are their male coresidents. One resident reported “having to be extra nice before being assertive,” and another described the need to “psychologically be like friends, but also find a way to integrate what you want.”
As much as they are responses to expectations, these behaviours can represent defenses against a disproportionate risk of harassment. Another 2024 retrospective study of Canadian residents and staff in three surgical programs found that 59% of female surgeons reported experiencing verbal, sexual, or physical harassment, compared to 26% of men. (12) Unsurprisingly, residents were about twice as likely as staff to experience harassment. A 2019 national survey of over 7000 American surgical residents published in the New England Journal of Medicine also reported that 65% of female respondents had experienced harassment of some kind. (13) While medicine will never be a conflict-free profession, these figures clearly demonstrate room for improvement.
Another area of deficiency is pregnancy and parenting supports, which was raised in the present survey as a major persistent systemic barrier for female trainees, and is a well-known source of stigma and career planning anxiety for female surgeons. A 2024 scoping review of 42 studies on American surgeons’ experiences with parenthood found that most female-identifying trainees surveyed had heard negative remarks about having children during residency. (14) Furthermore, most of those that did so themselves worked unmodified hours throughout pregnancy, had limited postpartum support for childcare and lactation, and felt that nonetheless their career advancement was ultimately impeded. Surgeons were also found to have increased rates of infertility and pregnancy complications relative to national averages.
Although this data comes from the US, it was generally corroborated by the few trainees I surveyed. When asked about family planning, one respondent noted that “even though as a resident you are protected by the union, there are likely still whispers among colleagues when/if you go on leave (i.e. who will cover you), and similar conversations exist at a staff surgeon level which I have personally witnessed.”
Staffing certainly becomes a challenge when illnesses, family emergencies, or pregnancies inevitably arise, especially in the context of larger funding and hiring decisions, and the best teams support each other through these events. If nothing else, we can control how well we adapt and advocate for each other, being mindful of what we would want for ourselves and our families.
Many of the experiences described here arise from unconscious biases that are as old as time, but as we know from the practice of medicine, individual pioneers and systems change can reciprocally drive progress. One resident stated that it “takes a lot of strong women to be able to make an impact on the future generations,” while another pointed out that “any policy change needs to be made at an institutional level or even organizational level (requirements from accrediting bodies) in order to trickle down and see any progress downstream for learners.” In short, we all – learners, mentors, and leaders – have a role to play.
Since Mlle de Beauvoir’s time, we have invented chemotherapy and laparoscopy, made a range of operations fathomable and then common with mass-produced antibiotics, and taken organ transplantation from experimentation to standard practice. It is possible and necessary that we devote some part of that intellectual persistence, and that curiosity about what could be, to the flourishing of a full half of our colleague and patient population.
Please note that while experiences of gender disparity in medicine are not limited to cisgender women, the existing literature and the perspectives gathered from this survey are. Therefore ‘women’ is used in this article to refer to anyone who identifies as such, although the unique experiences of gender-diverse surgical trainees could not adequately be explored.
References
De Beauvoir S. The Second Sex. Parshley HM, trans. London: Vintage Books; 2015.
Pickel L, Sivachandran N. Gender trends in Canadian medicine and surgery: the past 30 years. BMC Med Educ. 2024;24(1):100. doi:10.1186/s12909-024-05071-4.
Kiran T, Schultz SE, Moineddin R, et al. Proportion of Female Physicians in a Specialty and Median Annual Payments in Ontario, Canada. JAMA Netw Open. 2025;8(12):e2549815. doi:10.1001/jamanetworkopen.2025.49815.
Bondok M, Bondok MS, Nguyen AX, et al. Gender trends in match rate to surgical specialties in Canada: A retrospective study from 2003-2022. PLoS One. 2024;19(4):e0300207. doi:10.1371/journal.pone.0300207.
Hunter J, Crofts H, Keehn A, Schlagintweit S, Luc JGY, Lefaivre KA. Gender imbalance amongst promotion and leadership in academic surgical programs in Canada: A cross-sectional Investigation. PLoS One. 2021;16(8):e0256742. doi:10.1371/journal.pone.0256742.
Rim H, Kim J. The influence of perceptions of gender discrimination in the workplace on depressive symptoms among Korean working women: The moderating role of job satisfaction. Soc Sci Med. 2024;341:116527. doi:10.1016/j.socscimed.2023.116527.
Feenstra S, Begeny CT, Jordan J, Ryan MK, Stoker JI, Rink FA. Reaching the top but not feeling on top of the world: Examining women's internalized power threats. Front Psychol. 2022;13:931314. doi:10.3389/fpsyg.2022.931314.
Wei Y, Subramaniam G, Wang X. The glass ceiling perception and female teacher burnout: the mediating role of work-family conflict. Front Psychol. 2025;16:1551903. doi:10.3389/fpsyg.2025.1551903.
Anker J, Krill PR. Stress, drink, leave: An examination of gender-specific risk factors for mental health problems and attrition among licensed attorneys. PLoS One. 2021;16(5):e0250563. doi:10.1371/journal.pone.0250563.
Hodkinson A, Zhou A, Johnson J, et al. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ. 2022;378:e070442. doi:10.1136/bmj-2022-070442.
Pereira-Lima K, Mata DA, Loureiro SR, Crippa JA, Bolsoni LM, Sen S. Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(11):e1916097. doi:10.1001/jamanetworkopen.2019.16097.
Jariwala K, Wilson CA, Davidson J, et al. A Canadian National Survey Study of Harassment in Surgery-Still a Long Way to Go. J Surg Educ. 2024;81(8):1075-1082. doi:10.1016/j.jsurg.2024.05.010.
Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 2019;381(18):1741-1752. doi:10.1056/NEJMsa1903759.
Mavedatnia D, Ardestani S, Zahabi S, et al.. The Experiences of Motherhood in Female Surgeons. Ann Surg. 2023; 277 (2): 214-222. doi: 10.1097/SLA.0000000000005730.
