Authorship Equity in Academic Surgery: Barriers and Pathways to Parity

Authorship equity refers to the fair and transparent assignment of credit and responsibility for intellectual contributions within a publication. The career impact of missed authorship recognition leads to significant career trajectory divergence. This paper aims to review key inequities in scientific authorship in academic surgery, explore possible solutions, and propose a set of ethical recommendations to address authorship equity in academic surgery across intersecting dimensions of gender, academic hierarchy, and geography.

We describe a multi-level strategy framework at the individual, institutional, and scientific journal levels to promote authorship equity.

Disparities in female authorship within the field of surgery due to the "glass ceiling," "sticky floors," and the "leaky pipeline" lead to systematic exclusion of women from first, middle, or senior author and editorial board positions. Honorary authorship and ghost authorship disproportionately burden junior researchers, because of unequal power dynamics. Authors from low- and middle-income countries (LMICs) experience a paradox: while international collaborations provide resources, they often diminish the roles of LMIC authors. Innovative strategies that enhance transparency, foster early communication, and standardize contribution reporting are essential to promote equitable authorship.

Addressing gender-based authorship inequity requires predefining inclusive authorship goals with a gender-lens from the outset, ensuring dedicated mentorship for female surgeons, and improving female representation on editorial boards. Addressing hierarchical challenges requires the implementation of integrated strategies on personal, departmental, and institutional levels. Inclusive utilization and effective application of authorship equity guidelines and mutually respectful partnerships that reflect and addresses barriers for LMIC partners is essential.