Change is Hardest Right Before the Glass Ceiling Breaks: An Update on Women Pursuing Careers in Academic Surgery at a National Level.

Objectives: This study aims to provide a comprehensive update on the representation of women in academic surgery by specialty, measuring progress and opportunity with regard to women "breaking" the glass ceiling at the trainee, faculty, and department chair levels.

Background: Over the past two decades, initiatives have contributed to educational awareness, culture shifts, and a focus on inclusive excellence in surgery, leading to an increase in the number of women surgeons. Despite progress, a persistent gender gap in surgical faculty positions remains, and projections suggest that it will take more than a century to reach parity at the highest levels of academic surgery.

Methods: Data from the Association of American Medical Colleges FACTS and Faculty Rosters and the American Medical Colleges and Graduate Medical Education reports from 2006 to 2023 were analyzed to assess gender representation in surgery. Linear regression analyses were used to describe trends in the proportions of women who are promoted along the professional development pathway (resident to faculty to department chair) from 2006 to 2023.

Results: Over our 17-year study period, all included surgical subspecialties increased in the proportion of women trainees, with the largest average annual increase in the proportion of women trainees observed in pediatric, plastic, and vascular surgery training programs. Although all surgical faculty levels experienced growth in the proportion of women, the average annual change in the proportion of women decreased as seniority increased. At the observed trend, it is projected that surgical department chairs will not achieve equal proportions of men and women until the year 2102.

Conclusion: Across the board, the proportion of women in surgery has increased. However, there remains opportunity for improvement, particularly at the senior faculty and department chair levels. There continues to be significant opportunity around retention and promotion of women.