Abstract
Women continue to be underrepresented in academic surgery, especially at the leadership level. Surgical culture has been historically male dominated and recently received negative attention for higher rates of mistreatment, sexual harassment, and attrition of women compared with other medical specialties. The authors examine factors that contribute to challenges in academic surgery, making it a potentially difficult environment for women and underrepresented minorities; these include surgical culture, work-life balance, and historic promotion timelines. Efforts to change social norms and structural biases are critical to improving gender parity in academic surgery.