Beyond the scalpel: Barriers to advancement for Asian women in academic surgery - 11/12/25

Doi : 10.1016/j.amjsurg.2025.116769

Nritya Nair ^a,^b , Jaspinder S. Sanghera ^a,^b , Ioannis Liapis ^a,^b , Marcus Sirianno ^a , Manish Tripathi ^b,^c , Michelle Holland ^a , Smita Bhatia ^b , Krista Mehari ^d , Annabelle L. Fonseca ^a,^b,^⁎
^a University of Alabama at Birmingham, Department of Surgery, United States
^b University of Alabama at Birmingham, Institute of Cancer Outcomes and Survivorship, United States
^c University of Alabama at Birmingham, Collat School of Business, United States
^d Vanderbilt University, Department of Psychology, United States

^⁎Corresponding author. Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue S, BDB 571 Birmingham, AL, 35233, United States.Department of SurgeryUniversity of Alabama at Birmingham1808 7th Avenue SBDB 571BirminghamAL35233United States

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 11 December 2025

Abstract

Objective

Asian women remain underrepresented in surgical leadership despite increasing numbers in the workforce. Their intersectional experiences in academic surgery are poorly understood. This study explores barriers to career advancement faced by Asian women in academic surgery.

Methods

Semi-structured interviews were conducted with Asian women surgeons recruited via a national surgical society. Transcripts were analyzed using grounded theory.

Results

Twenty Asian women surgeons participated; 70% faculty, 35% international medical graduates. Six barrier domains were identified: (1) career advancement-opaque promotion criteria, exclusion from informal networks, disproportionate invisible labor, leadership stereotypes, and mid-career stagnation; (2) mentorship and sponsorship-limited mentorship beyond training, cultural and gender barriers to mentorship, and scarcity of sponsors; (3) bias and discrimination-racism, sexism, undermining of authority, heightened scrutiny, inequitable referrals, and double standards; (4) institutional barriers-favoritism, unsupportive leadership, tokenistic diversity efforts, and productivity-based compensation; (5) personal impact-social exclusion, burnout, disillusionment, and attrition; and (6) barriers related to IMG status, reflecting challenges uniquely reported by international medical graduates.

Conclusion

Structural reforms to improve promotion transparency, ensure leadership accountability, and formalize mentorship and sponsorship are essential to foster equity and retain Asian women in academic surgery.

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Highlights

•	Asian women in academic surgery reported opaque promotion pathways shaped by bias and favoritism.
•	Limited mentorship and near absence of sponsorship hindered career advancement.
•	Participants described frequent gender and racial bias, undermining of authority and lack of support.
•	Systemic barriers, including inequitable resources and tokenistic DEI efforts, were pervasive.
•	Professional barriers had profound personal impact, contributing to burnout and attrition to private practice.