Today, women represent 29% of US full-time academic surgical faculty and 47% of general surgery residents.¹ Yet, women surgeons still lag behind men with an even lower percentage of representation when it comes to serving as a principal investigator of clinical trials registered on ClinicalTrials.gov, delivering keynote talks at national and international meetings, being a panelist at meetings, serving as invited grand rounds speakers, authoring invited articles for publication in peer reviewed journals, being promoted in academic rank, receiving tenure, or serving in academic leadership positions as Division Chief and Chair.^2-4

When exploring why this is the case, a common response is that surgery has a 鈥渓eaky pipeline鈥� for women and that there just are not enough qualified women.^5,6 I write this Editorial today to emphatically state: there are enough qualified women in surgery. To overcome implicit biases and promote and influence change, it is important to recognize that implicit bias exists.

We all have implicit biases. Testing has shown in numerous studies that adults and children associate man with surgeon.⁷ Testing of surgeons has also shown that both men and women surgeons exhibit implicit and explicit bias associating man with surgeon.⁸ To overcome this implicit bias requires intentionality. Hence, last year, I decided to address my own implicit bias with respect to who I requested to author Invited Commentaries for JAMA Surgery. To accomplish this, I conducted a small pilot study. During the first half of 2023 (January-June), I followed my normal process of inviting experienced surgeons to author Invited Commentaries. During the second half of 2023 (July-December), I made a conscious effort to overcome my own implicit bias and intentionally invite more experienced women surgeons to author these Commentaries. Invited Commentaries are opinion articles, written by leading experts in the respective field that place new research into context for readers of the journal. Herein are the results of this small pilot study.

First, I had no problem identifying women surgeons who were experts on the topics. Second, I had no problem securing the expert women authors to write the Invited Commentaries鈥攁ll accepted the invitations. Third, I examined the scholarly impact of the published Invited Commentaries by comparing the number of citations received for Commentaries authored by women with those authored by men. Gender of the corresponding author was determined and reported based on personal knowledge of each invited author and pronouns used by the authors (ie, emails, websites, etc).

During the first half of 2023, JAMA Surgery published 43 Invited Commentaries, with 27 (63%) authored by men and 16 (37%) authored by women. During the second half of 2023, JAMA Surgery published 43 Invited Commentaries with 15 (35%) authored by men and 28 (65%) authored by women. Interestingly, during both 6-month time periods, the mean numbers of citations per article were higher for the Commentaries authored by women authors compared with those authored by men (Table). However, this trend did not reach statistical significance as the sample size in this pilot study was too small. An inherent limitation of this pilot study is that due to the small sample size, a time-based analysis of the citations could not be conducted. Further, it is possible that my process of identifying gender could have resulted in error. However, given the small sample size of 86 authors and my personal knowledge of most all the authors, this limitation is unlikely.

This small pilot study clearly suggests that there are enough qualified women surgeons, as I was able to easily achieve 65% authorship by women, almost doubling the percentage obtained during the first half of the year. Not only are women surgeon authors qualified and able and willing to write Invited Commentaries, but their articles were found to be as important and influential as those authored by men according to the mean number of citations per article.

As I have previously reported, improving the representation of women among the editors and editorial board members is another goal for JAMA Surgery, and efforts to promote women authors will continue.⁹ I hope this small pilot study conveys to those in our surgical discipline that we do have enough qualified women surgeons. Extrapolating these data, I will go as far as stating that we have enough qualified women surgeons to be invited speakers at national and international meetings, to serve on panel sessions, to serve as invited grand rounds speakers, to lead clinical trials as principal investigators, and certainly to be promoted and lead divisions, departments, centers, and schools. As a surgical discipline, I hope that we can get past the belief that we do not have enough qualified women to serve. All of us simply need intentionality to overcome our own implicit biases to effect durable change.

Corresponding Author: Melina R. Kibbe, MD, Departments of Surgery and Biomedical Engineering, University of Virginia School of Medicine, 1415 Jefferson Park Ave, McKim Hall 3009, PO Box 800793, Charlottesville, VA 22908 (melinakibbe@virginia.edu).

Published Online: September 4, 2024. doi:10.1001/jamasurg.2024.3347

Conflict of Interest Disclosures: None reported.