BACKGROUND: Parity in medical school admissions has improved, yet female representation remains disproportionately low in many competitive surgical specialties. Although initiatives promoting equity by sex in medicine have gained momentum, their long-term impact on surgical residency programs across various specialties remains unclear. OBJECTIVE: This study evaluated 12-year trends (2013-2025) in sex representation among applicants and residents in five highly competitive US surgical specialties: neurosurgery, orthopedic surgery, plastic surgery (integrated), thoracic surgery (integrated), and vascular surgery (integrated). METHODS: Publicly available data from the Accreditation Council for Graduate Medical Education (ACGME) and Association of American Medical Colleges (AAMC) were analyzed to assess sex-based trends among U.S. medical school matriculants and quantify yearly changes in the number and percentage of female applicants and active residents. Longitudinal trends were assessed to evaluate both proportional representation and retention across specialties. RESULTS: From 2013 to 2025, female matriculants to US M.D.-granting schools rose from 47.20% to 55.10%, exceeding 50% since 2017. All five surgical specialties showed an increase in the number of female applications, with orthopedic surgery showing the greatest number of applicants (127-419). Plastic surgery showed the highest percentage of female applicants in 2024-2025 (53.38%), followed by vascular surgery (33.19%), thoracic surgery (31.58%), neurosurgery (27.43%), and orthopedic surgery (23.77%). Representation of active female residents and acceptance rates also increased across all surgical specialties. Upward trends were consistent in neurosurgery, orthopedic surgery, and plastic surgery, whereas thoracic surgery and vascular surgery exhibited more fluctuation. CONCLUSIONS: Despite rising acceptance rates, sex-based inequity remains in competitive surgical specialties. Plastic surgery is an outlier, with female applicants constituting the majority, in line with trends in medical school matriculation. However, women remain underrepresented in orthopedic surgery and neurosurgery. Sustaining progress will require targeted efforts to address cultural and institutional barriers, expand mentorship, and foster supportive training environments.
Sharma et al. (2026) studied this question.