Gender-related barriers to career progression in Indian anaesthesiologists: Perception, structure, and the path forward

Historically, women have played an important role in the development of anaesthesiology in our nation. Dr. Rupa Bai Furdoonji, regarded as one of the first female physician-anaesthesiologists in the country, made remarkable contributions to the speciality more than a century ago. However, even over 13 decades later, gender continues to be perceived as a barrier to career advancement in anaesthesiology.1 This observation suggests that while the representation has improved, deeper structural and cultural challenges may still persist. A nationwide survey by Shah et al. entitled “Gender-related barriers to career progression in Indian anaesthesiologists” published in this issue of Indian Journal of Anaesthesia highlights the challenges faced by women anaesthesiologists in India.2 According to the authors, this is the first study to assess gender bias in the workplace among Indian anaesthesiologists. The survey includes responses from both men and women anaesthesiologists and assesses the difficulties women experience in their careers, revealing valuable insights. The findings highlight not merely gender differences but a striking variation in the perception of bias itself. In other words, there appears to be a “bias in perceiving the bias.” This pan-India survey highlights the following important aspects related to gender-related discrimination in the anaesthesia speciality. PERCEPTION GAP AND WORKPLACE EXPERIENCE The survey found a striking difference in how men and women see gender barriers. It is surprising to know that many female anaesthesiologists considered gender as a career obstacle as compared to men. Many male respondents opined that gender discrimination does not exist as compared to the female respondents who experienced gender discrimination creating a critical perceptual gap.2 This difference in perception highlights the possibility that gender-related challenges may be experienced more strongly by women than they are recognised by their male colleagues. The difference is not unique to India; similar patterns are seen in other countries, where men often believe the workplace is fair while women report ongoing bias. Nonetheless, these different views do matter because recognising a problem is often the first step towards fixing it.3 As regards proficiency and competence in administering anaesthesia and managing critical situations, respondents of both the genders in the survey agreed that there is no perceivable difference.2 However, though the capability and competency are equal, there is a striking difference in both the genders about opportunity and recognition. Anaesthesiologists are expected to lead in the operating room, yet many female anaesthesiologists fear negative attitudes by surgeons or being called ‘bossy’ for displaying competitiveness, ambition, and confidence.4 Further, the Shah et al. survey found that surgeons, nurses, and patients sometimes assume that men are more competent. In fields such as anaesthesiology, people may unconsciously associate authority and technical skills with male doctors.2 Indeed, women in the past have reported more microaggressions, like being mistaken for junior staff or having to prove themselves repeatedly. This is a common experience reported by women doctors worldwide.5 Recent surveys have reported experiences of workplace mistreatment or disrespect faced by female anaesthesiologists, often during interactions with surgical colleagues.6 Such professional dynamics can contribute to workplace stress, reduced job satisfaction, and barriers to career advancement. In further continuation of workplace experience, some respondents of the survey by Shah et al. said that workplace safety during late or unusual hours is a challenge. This points to bigger issues in society. Workplaces need effective safety measures, reliable transportation options, and supportive management. DOMESTIC RESPONSIBILITIES AND CAREER IMPACT Family responsibilities emerged as a significant barrier to career progression as per the responses of the survey. Most female anaesthesiologists identified domestic responsibilities as impediments, and notably, most male respondents agreed.2 Nevertheless, in the Indian sociocultural context, women often shoulder disproportionate household and childcare responsibilities, which can compound the demanding nature of anaesthesiology practice. In fact, extra responsibilities at home are the biggest barrier for women advancing in their careers. Women anaesthesiologists reported that these domestic duties had a much stronger negative impact on their chances for leadership, research, networking, and job options than men experienced. This reflects the so-called “motherhood penalty” seen in medicine, where women’s careers often slow down after having children due to childcare responsibilities.7 Needless to say, strong support systems are pivotal for successful professional careers. Spousal support, equitable sharing of household responsibilities, accessible childcare, and flexible workplace policies can dramatically influence career trajectories.3 LEADERSHIP AND ACADEMIC REPRESENTATION Current estimates indicate that approximately 45% of Indian anaesthesiologists are women.8 Women contribute actively to academic work, research, and publications. A growing number of women are first authors on research papers, demonstrating their strong involvement in academia. Globally, the contribution of Indian female anaesthesiologists as first and corresponding authors in Indian anaesthesiology journals is 45% and 44%, respectively, which is quite inspiring.8 Despite these positive signs, women are still underrepresented in senior academic and leadership positions. Even though many anaesthesiologists are women, only a few lead their departments. This is known as the “leaky pipeline”: Many women enter the field, but few reach top leadership positions.9 The nationwide survey by Shah et al. raises important points to consider regarding leadership. The survey found that men are seen donning dominating leadership roles at conferences, in editorial boards, and in professional societies. More women are now first authors on research papers, but they are still underrepresented as senior authors and editorial leaders. Further, it has been observed that at the global level, the leadership of the World Federation of Societies of Anaesthesiologists (WFSA) was predominantly male (80% vs 20%). Recognising the potential gender gap in anaesthesiology, WFSA established the Ad-Hoc Gender Committee in 2018 to increase the number of women in leadership positions and facilitate participation in gender panels and forums.10 Importantly, gender-related barriers do not appear to reduce women’s aspirations for leadership. Evidence from a recent European survey indicates that female anaesthesiologists are equally interested in leadership positions as their male counterparts, despite recognising the challenges they may encounter.3 This finding suggests that the issue lies not in ambition but in the structural barriers that limit opportunities. Leadership expert Sheryl Sandberg has quoted, “In the future, there will be no female leaders. There will just be leaders.”11 Achieving such a bright future requires active efforts to remove all the barriers which are causing gender discrimination in anaesthesiology. IMPLICATIONS FOR POLICY AND PROFESSIONAL BODIES Efforts need to be taken at many levels to overcome these barriers. Hospitals and training institutions should create inclusive workplaces where promotions are based on merit and ability, not gender. Mentorship programmes, clear promotion policies, and supportive work environments can help reduce gender inequality. Institutions and society both need to work together to reduce gender inequality in Indian anaesthesiology. Some steps that can enable this include: Transparent promotion and appraisal frameworks to reduce evaluative bias. Structured mentorship and sponsorship programmes, particularly for early-career women. Flexible scheduling and co-parental leave policies to mitigate domestic burden. Child care and lactation facilities within large institutions. Leadership training workshops aimed at underrepresented groups. Awareness programmes on implicit bias for faculty and administrative leaders. Professional societies, including the Indian Society of Anaesthesiologists, can play a catalytic role by promoting gender-balanced conference panels, encouraging nominations for female leadership, and facilitating peer-support networks. CONCLUSION As Malala Yousafzai has quoted, “We cannot all succeed when half of us are held back.”12 Fairness in anaesthesiology is not just about doing the right thing—it is necessary for building a skilled, motivated, diverse, yet unified workforce. With supportive policies, fair opportunities, and active efforts to address challenges, true gender equality in anaesthesiology can be achieved. Identifying gaps, raising awareness, and making evidence-based changes are the keys to creating a more equal profession. Presentation at conferences/CMEs and abstract publication No. Study data availability Nil. Disclosure of use of artificial intelligence (AI)-assistive or generative tools No AI tools were used. Declaration of use of permitted tools Declaration done. Author contributions MK Concepts, design, definition of intellectual content, literature search, manuscript preparation, editing, review and approval. DD Concepts, design, definition of intellectual content, literature search, editing. AP Concepts, design, definition of intellectual content, literature search, editing. PN Concepts, design, definition of intellectual content, literature search, editing. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.