"There is a target on you": Female neurosurgeons' and cardiothoracic surgeons' experiences of overt and covert discrimination in the workplace.

BACKGROUND: The purpose of this study was to explore how gender-based discrimination manifests in neurosurgery and cardiothoracic surgery by interviewing women surgeons in these fields about their lived experiences. METHODS: Interviews were conducted via videoconference with 22 female surgeons (18 neurosurgeons and 4 cardiothoracic surgeons) practicing in academic and community settings in North America. A thematic analysis based on grounded theory principles was used to code the data for major themes. Results encompass inductively derived themes describing experiences of gender discrimination, professional misrecognition, and discriminatory workplace culture. RESULTS: Three major themes emerged from the analysis. First, participants described overt gender-based mistreatment and institutional discrimination, including sexual harassment, bullying, reproductive discrimination, inequities in compensation, and barriers to leadership opportunities. Second, participants reported professional misrecognition and heightened performance expectations, including being mistaken for nonphysician staff, having their competence constantly questioned, and practicing under intense and increased scrutiny compared with their male colleagues. Third, participants described exclusion rooted in traditionally masculine norms emphasizing competitiveness and tolerance of aggressive behavior, reinforced by informal professional "boys" networks that limited access, opportunities, and advancement for female surgeons. These dynamics contributed to persistent barriers to career advancement and workplace inclusion, which participants described as factors that influence retention and long-term participation in these specialties. CONCLUSION: Female surgeons report persistent gender inequities embedded in workplace culture, institutional structures, and everyday professional interactions. Efforts to improve equity in surgical specialties should extend beyond recruitment and representation to address workplace culture, institutional structures, and accountability mechanisms that influence professional advancement and retention.