Women as surgical leaders: from fixing women to fixing systems.

Advancing women in surgical leadership has traditionally focused on individual adaptation, mentorship, resilience, and personal skills rather than addressing systemic barriers. Despite improvements in awareness, representation, and support networks, meaningful change remains limited due to persistent institutional biases, structural constraints, and cultural norms. Female surgeons face additional challenges related to recruitment, mentorship, research access, and work-life integration, particularly around motherhood, which can penalize career progression even in supportive systems. Leadership programs and sponsorship opportunities remain unevenly available, and formal recognition of mentorship and informal leadership roles is often lacking. True transformation requires shifting from "fixing women" to "fixing systems" through formal leadership curricula, institutional accountability, and measurable outcomes. By empowering women to actively shape culture rather than merely navigate it, surgery can achieve female leadership that is inclusive, effective, and equitable. Addressing these challenges demands a collective responsibility of surgical societies, academic centers, and hospital leadership to foster structural reform, recognize diverse career trajectories, and cultivate visible female role models.