Skip to main content
Log in

Factors Affecting Women Surgeons’ Careers in Low–Middle-Income Countries: An International Survey

World Journal of Surgery Aims and scope Submit manuscript

Cite this article



Despite increasing numbers of women surgeons globally, barriers to career advancement persist. While these barriers have been extensively discussed in high-income countries (HICs), the topic has received minimal attention in lower–middle-income countries (LMICs) like Pakistan.


The Association of Women Surgeons of Pakistan (AWSP)—an organization in Pakistan consisting of female surgeons and trainees—carried out this international cross-sectional study over July–Sept 2019. An anonymous online survey was disseminated via social media platforms and various institutions across Pakistan and internationally.


A total of 218 female surgeons responded to the survey, with 146 (67%) from Pakistan and 72 (33%) from HICs. While HIC surgeons were more likely to report gender discrimination/bias (GD/bias) during residency (29.2% vs 11.6%; p = 0.001), more Pakistani surgeons reported that GD/bias negatively affected their job satisfaction (80.7% vs. 64.9%; p = 0.024). GD/bias manifested most commonly as differences in mentoring relationships (72%). A higher percentage Pakistani surgeons reported having experienced a family-related interruption in their career (24.7% vs. 11.1%; p = 0.019). The vast majority (95%) felt that surgery was perceived as a masculine field, and the majority (56.4%) of respondents reported having been told that they could not be a surgeon because of their gender.


Our study highlights keys factors that must be addressed to provide equal career opportunities to women surgeons. It is the responsibility of surgical educators, policy makers, and healthcare organizations to facilitate women surgeons’ career progression by developing systems that support equitable career growth for women surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2


  1. The CPSP publishes the list of fellows who have passed the qualifying examination for the Fellow of College of Physicians and Surgeons (FCPS). This number does not include surgeons who have completed their training and certification outside of Pakistan.


  1. Bickel J, Wara D, Atkinson BF, Cohen LS, Dunn M, Hostler S et al (2002) Increasing women's leadership in academic medicine: report of the AAMC project implementation committee. Acad Med 77(10):1043–1061

    Article  Google Scholar 

  2. Epstein NE (2017) Discrimination against female surgeons is still alive: where are the full professorships and chairs of departments? SurgNeurolInt 8:93 Epub 2017/06/14

    Google Scholar 

  3. Inam H, Janjua M, Martins RS, Zahid N, Khan S, Sattar AK et al (2020) Cultural barriers for women in surgery: How thick is the glass ceiling? an analysis from a low middle-income country. World J Surg 44(9):2870–2878

    Article  Google Scholar 

  4. Newman EA, Waljee J, Dimick JB, Mulholland MW (2019) Eliminating institutional barriers to career advancement for diverse faculty in academic surgery. Ann Surg 270(1):23–25

    Article  Google Scholar 

  5. Schroen AT, Brownstein MR, Sheldon GF (2004) Women in academic general surgery. Acad Med 79(4):310–318 Epub 2004/03/27

    Article  Google Scholar 

  6. Junaidi,I. 50% of female doctors never work after graduation. Published in Dawn, October 22nd, 2014

  7. Moazam F, Shekhani S (2018) Why women go to medical college but fail to practise medicine: perspectives from the Islamic Republic of Pakistan. Med Educ 52(7):705–715 Epub 2018/03/07

    Article  Google Scholar 

  8. Bruce AN, Battista A, Plankey MW, Johnson LB, Marshall MB (2015) Perceptions of gender-based discrimination during surgical training and practice. Med Educ Online 20:25923 Epub 2015/02/06

    Article  Google Scholar 

  9. Janjua MB, Inam H, Martins RS, Zahid N, Sattar AK, Khan SM et al (2020) Gender discrimination against female surgeons: a cross-sectional study in a lower-middle-income country. Ann Med Surg 57:157–162

    Article  Google Scholar 

  10. Hu Y-Y, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT et al (2019) Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med 381(18):1741–1752

    Article  Google Scholar 

  11. Seemann NM, Webster F, Holden HA, C-aE M, Baxter N, Desjardins C et al (2016) Women in academic surgery: why is the playing field still not level? Am J Surg 211(2):343–349

    Article  Google Scholar 

  12. Alers M, van Leerdam L, Dielissen P, Lagro-Janssen A (2014) Gendered specialities during medical education: a literature review. Perspect Med Educ 3(3):163–178

    Article  Google Scholar 

  13. Beebe KS, Krell ES, Rynecki ND, Ippolito JA (2019) The effect of sex on orthopaedic surgeon income. J Bone JtSurg 101(17):e87 Epub 2019/09/05

    Article  Google Scholar 

  14. Cochran A, Hauschild T, Elder WB, Neumayer LA, Brasel KJ, Crandall ML (2013) Perceived gender-based barriers to careers in academic surgery. Am J Surg 206(2):263–268 Epub 2013/02/19

    Article  Google Scholar 

  15. Zhuge Y, Kaufman J, Simeone DM, Chen H, Velazquez OC (2011) Is there still a glass ceiling for women in academic surgery? Ann Surg 253(4):637–643 Epub 2011/04/09

    Article  Google Scholar 

  16. Mayer KL, Ho HS, Goodnight JE Jr (2001) Childbearing and child care in surgery. Arch Surg 136(6):649–655 Epub 2001/06/26

    Article  CAS  Google Scholar 

  17. Sullivan MC, Yeo H, Roman SA, Bell RH Jr, Sosa JA (2013) Striving for work-life balance: effect of marriage and children on the experience of 4402 US general surgery residents. Ann Surg 257(3):571–576 Epub 2012/09/12

    Article  Google Scholar 

  18. Yeo H, Bucholz E, Ann Sosa J, Curry L, Lewis FR Jr, Jones AT et al (2010) A national study of attrition in general surgery training: which residents leave and where do they go? Ann Surg 252(3):529–534 Discussion 34-6

    PubMed  Google Scholar 

  19. Lawal TA, Afolabi AO (2013) Factors influencing the choice of surgery as a career by pre-registration interns. Afr Health Sci 13(3):814–819

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Baptiste D, Fecher AM, Dolejs SC, Yoder J, Schmidt CM, Couch ME et al (2017) Gender differences in academic surgery, work-life balance, and satisfaction. J Surg Res 218:99–107

    Article  Google Scholar 

  21. Rangel EL, Lyu H, Haider AH, Castillo-Angeles M, Doherty GM, Smink DS (2018) Factors associated with residency and career dissatisfaction in childbearing surgical residents. JAMA Surg 153(11):1004–1011 Epub 2018/08/04

    Article  Google Scholar 

Download references


The authors of this study wish to acknowledge the members of the AWSP for their assistance with the creation, piloting, and dissemination of this survey at the national level. The results from this study will be used by AWSP as a framework towards developing policies and strategies for the advancement and equitable representation of females in the field of surgery throughout Pakistan.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mahim Malik.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Malik, M., Inam, H., Janjua, M.B.N. et al. Factors Affecting Women Surgeons’ Careers in Low–Middle-Income Countries: An International Survey. World J Surg 45, 362–368 (2021).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: