Women in surgical academic Careers: What is needed to get there?

Despite comprising the majority of medical students, women remain significantly underrepresented in senior academic surgical positions. In the Netherlands, only 15.6 % of surgical professors are female. This article examines cultural and structural barriers, including unequal access to networks, underrepresentation on editorial boards, academic "housework," implicit bias, and unequal caregiving responsibilities, that hinder women's advancement in academic surgery. Targeted interventions such as mentorships, flexible work policies, salary transparency, and gender-conscious recruitment (e.g., Eindhoven University of Technology's preferential hiring strategy) have shown promise in promoting equity without compromising academic output. The "critical mass" threshold of 28 % female representation emerges as a tipping point for cultural change. Achieving gender equity in academic surgery requires both systemic reform and cultural transformation to ensure equal opportunity, career sustainability, and inclusive institutional environments.