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‘Too Small to be a Surgeon’: Why can't we seem to cut out the gender bias in surgery?

05 August 2025

New Survey by the Confederation of British Surgery, the UK’s sole trade union for surgeons, anaesthetists and the surgical team. 

Featured in the Clinical Services Journal.

The stats should startle, but sadly they are not unexpected. Our survey about gender bias specific to surgery, distributed to everyone from med students to established consultants, highlighted how women are still being told that their gender will hinder their ability to pursue a surgical career.

77.78% of female respondents reported that, yes, they have experienced this particular misogyny – 71.43% explicitly told they were the wrong gender for the profession – at some point in their career. To put this in context, zero percent of men reported experiencing any gender bias whatsoever during their navigation of the same landscape. What does this show us? It demonstrates that, while progress has been made in promoting equity and equality in the workplace in general, we still have a way to go when it comes to surgical careers specifically.

Consultant plastic surgeon and Board member at the Confederation of British Surgery, Miss Philippa Jackson, says, “There’s this constant scrutiny over women’s lives that men simply don’t face. I’ve had people ask me about my menstrual cycle, about when I planned to have children, how many, and how I’d manage that alongside my career, as if it’s anyone’s business.” And, it’s not just men who do this - women are guilty of it too, perpetuating the idea that we have to fit into a system built for male norms. Philippa continues, “I’ve stood in theatres and watched my male counterparts get opportunities I was overlooked for.” Speaking about her experiences upon returning from maternity leave, she continues, “After maternity leave, I genuinely considered leaving surgery altogether because of how hard it was. We call women’s skill ‘soft skills’, the holistic, empathetic approaches, but these aren’t soft, they’re essential. And yet, they are so often dismissed as unimportant, when in reality they’re exactly what we need more of in surgery.”

With 66.67% of female medical students and 88.89% of female consultants reporting having experienced gender bias, we wonder how many students have quit their dreams of a surgical career because of this entrenched misogyny. A stat that backs up this fear is that 87.5% of female surgical trainees were discouraged from pursuing surgical careers, being told to, ‘…think about their “future husband and children” before pursuing surgery’. Others have been told that they are ‘too small’ for orthopaedics and mocked for making the choice to pursue this specialty, whilst some reported being told that they should choose specialties more conducive to family life (e.g. as a GP). One respondent even reported being told that she was ‘useless’; and that part-time surgeons (arguably more conducive to family life) ‘aren’t as good’. It’s a depressing situation - for those women who manage to fight through the initial barriers, a lifetime of hurdles awaits. Female surgeons must be prepared to answer uncomfortable questions, to fend off queries about their fertility, and their family plans. Furthermore, they must be prepared to be told they’re better off finding a male surgeon to marry so they don’t ‘have’ to work, that their children will suffer for their career decisions, that they should freeze their eggs, make choices about life events that they aren’t ready to even consider, or just simply… not be a surgeon.

If they are supported in their choice of career, or manage to navigate through the first set of hurdles, they must then justify which specialty they are going to go into. Not orthopaedics, surely (gasp of dismay from the front of the auditorium). One respondent in our survey reported being refused by a consultant when she arrived to cover a surgery. How could it be possible that a woman is strong enough to work in this very male-dominated surgical specialty? That a woman is strong enough to manipulate and fix bones? Surgical culture wasn’t built with women in mind; it’s still catching up. From the assumption that surgeons must be physically strong, to rigid working structures that ignore caring responsibilities, the system itself excludes women. In a report commissioned by the Royal College of Surgeons, it was found that women were more likely to be addressed by their first names, and correspondence was often addressed ‘Dear Sirs’, as though all surgeons were men.[1] But women shouldn’t have to fit into a model designed for men; it should be redesigned to suit everybody.

In 2015, inspired by the #ILookLikeAnEngineer social media movement, Dr. Heather Logghe encouraged female surgeons to further challenge gender stereotypes by using the hashtag #ILookLikeASurgeon.[2] The hashtag garnered 250 million impressions in its first year, involving over 13,000 participants.[3] Two years later, The New Yorker featured female surgeons on its front cover, giving rise to a resurgence of the hashtag with a further 4.7 million impressions.[4] The likely reason for the hashtag’s popularity is that its link to gender stereotypes hit home, and hit hard. The fact that it’s still being used now, particularly by female orthopaedic surgeons, is testament to the slow evolution of the surgical healthcare landscape.[5] A quick search reveals that, over the last seven days, the hashtag has reached  301.4K; no small feat a decade after its inception.

With steering committees and leadership structures largely made up of men, it’s easy to see why attitudes aren’t changing.; bias is entrenched through leadership models that lack diversity, and without enough women on panels, these voices are simply not being heard. Visible female mentors and in leadership positions, beyond tokenism, is a critical move. Without female mentors to support students to succeed, how will they know how to navigate this daunting landscape? And without females ahead to inspire, that landscape is pretty discouraging.

Accountability is key. Typically, male surgeons are not wittingly biased or misogynistic - far from it. However, they need to know when it is appropriate to be heard. Sometimes, their voices need to be quieter, allowing space for female colleagues to speak, to effect change. And, conversely, in effecting change, their voices need to be louder. It’s about being aware, knowing when to speak and when to step aside. They must support female colleagues in meetings, primarily by not speaking over them, and by calling out those who do. They must recognise that they, as do all of us, have implicit biases, and work on navigating and changing them. They must support and drive the redesign of inflexible working patterns. Yes, there are more female medical students than ever before, but what kind of workplace are they entering? This shows progress, but it is precisely this progress that tells us now is the time for further change.

Perhaps bias isn’t as simple as male surgeons being unaware; could it be that they’re afraid of calling out misogynistic behaviours? In a 2020 article in Scientific American, paediatric trauma surgeon Chethan Sathya muses, “Like many male surgeons, I have been afraid to speak up out of fear that it would destroy my reputation among senior surgeons in power, who are more often than not men.”[6]

This hierarchical culture leaves (some) male surgeons watching on as female surgeons get ‘treated like second-class citizens.’[7] Perhaps this behaviour is so ingrained that it is simply not noticed, or maybe it’s written off as banter. Or, as Zeno Franco, associate professor at the Medical College of Wisconsin, it just is. “Men are bystanders,” he says. “They know something is wrong. They know someone is taking advantage of the situation. But medical training is hierarchical, and most men find it hard to challenge someone with more authority.” Chethan adds, “and frankly, many male surgeons don’t care enough to do so.” It is not enough that some men do not discriminate, and it is not enough to be benign; to simply abstain from discriminating. To move forward, all men must acknowledge, and call out, discrimination in the workplace. This could be challenging someone who makes a discriminatory comment, stepping up in a meeting if a female surgeon is disregarded, and following up with supervisors to make sure work is being done to challenge these negative norms.

The Scientific American article is anchored on a study from the New England Journal of Medicine, which reports that nearly two-thirds of female surgeons-in-training experience gender discrimination, and one in five report sexual harassment.[8]  While sexual harassment is a vital issue (worthy of its own separate discussion), questions like, “When are you having children?” and “How many children do you plan to have?” could be perceived, and written-off, as well-meaning (albeit deeply problematic). We would hope that, after all, very few people actively want to witness someone struggle through their career. But the key point to consider is that nobody asks male surgeons the same questions. Let’s flip the script to see how unusual this might feel. Imagine a group of female surgeons earnestly suggesting a male surgeon plans for the next few decades of his life. Or telling him he must choose between his children’s wellbeing and his career. Or suggesting he sacrifice his career because he has had a family. Unheard of, we imagine!

We know that change is painfully slow, particularly in male-dominated culture - we only have to remember that #ILookLikeASurgeon began ten years ago - a clear demonstration that female surgeons had reached their limit an entire decade ago. Of course, we understand that change is systemic and, truthfully, to truly alter the narrative, we need a dramatic shake-up, a seismic shift. As a trade union, we advocate for change, but realise that this might look like small steps at first. The implementation of an anonymous reporting system would address fears of reprisal, or embarrassment about making a scene in an oppressive ‘old boy’s network’ of ‘alpha male surgeons’.[9] Mandatory bias training could educate both benign bystanders and inadvertent participants in the impact of their behaviours and non-behaviours. Flexible working structures, available to both male and female surgeons, could allow for parenting to be shared. Clear, bias-free and transparent promotion pathways, with diverse interview panels, would give women the same opportunities as men. Decisions made by diverse steering groups and leadership committees ensure representation. For those who may draw an impatient breath about diversity and representation in groups, committees and panels, it needs to be known that this is one of the most effective ways of representing the reality of a multi-faceted workforce, ensuring that we adhere to processes that reflect the reality of this workforce, reducing unconscious bias and even improving and widening solutions and options.[10]

Other small steps for making the landscape easier to navigate would be to level it by offering similar flexibility to both male and female surgeons. Later start times and on-site childcare are just two ways that the workplace could be more parent-friendly. If this is the norm, and being a parent is not something female surgeons feel they must conceal (working as though they’re not parents, parenting as though they don’t work), then being both a parent and a surgeon will be normalised. Your ability to be a surgeon, to undertake surgery, should be judged on merit and competence, not on gender.

Mark Henley, President of the Confederation of British Surgery, says:

"The results of our survey highlight a stark reality in the surgical profession – gender bias is ingrained, and women face barriers that men do not. It's unacceptable that so many female surgeons and medical students are told their gender will hinder their career progression, with some even discouraged from pursuing surgery altogether. The fact that no male surgeons reported experiencing gender bias is a clear indicator of the disparity. We must address these systemic issues with urgency to ensure that all surgeons, regardless of gender, have equal opportunities to thrive in this field."

But, it’s not all doom and gloom. A shift is happening and, Philippa says, it is thanks to Generation Z  forcing a change. “They’re challenging the norms,” says Philippa, “By demanding inclusivity and calling out bias, they are demonstrating that they aren’t afraid of having conversations that perhaps my generation may have hesitated to have, challenging biases that have been unchecked for so long.”

Perhaps there is hope after all. With Gen Z holding the mirror up to the system, they can make a difference that will be their legacy. In this case, the landscape before us will be very different from the one we inherited. But this is not a reason or excuse to be complacent. We must continue calling out inappropriate behaviour, highlighting biases and challenging exclusionary norms. Change requires collective action, and a refusal to accept the status quo. Only then can we create a truly equitable environment in which we can all thrive. #ILookLikeASurgeon.

 

 

 

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