Perceptions of gender equity in departmental leadership, research opportunities, and clinical work attitudes: an international survey of 11 781 anaesthesiologists


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BACKGROUND: Women make up an increasing proportion of the physician workforce in anaesthesia, but they are consistently under-represented in leadership and governance.

METHODS: We performed an internet-based survey to investigate career opportunities in leadership and research amongst anaesthesiologists. We also explored gender bias attributable to workplace attitudes and economic factors. The survey instrument was piloted, translated into seven languages, and uploaded to the SurveyMonkey® platform. We aimed to collect between 7800 and 13 700 responses from at least 100 countries. Participant consent and ethical approval were obtained. A quantitative analysis was done with χ 2 and Cramer's V as a measure of strength of associations. We used an inductive approach and a thematic content analysis for qualitative data on current barriers to leadership and research.

RESULTS: The 11 746 respondents, 51.3% women and 48.7% men, represented 148 countries; 35 respondents identified their gender as non-binary. Women were less driven to achieve leadership positions (P<0.001; Cramer's V: 0.11). Being a woman was reported as a disadvantage for leadership and research (P<0.001 for both; Cramer's V: 0.47 and 0.34, respectively). Women were also more likely to be mistreated in the workplace (odds ratio: 10.6; 95% confidence interval: 9.4-11.9; P<0.001), most commonly by surgeons. Several personal, departmental, institutional, and societal barriers in leadership and research were identified, and strategies to overcome them were suggested. Lower-income countries were associated with a significantly smaller gender gap (P<0.001).

CONCLUSIONS: Whilst certain trends suggest improvements in the workplace, barriers to promotion of women in key leadership and research positions continue within anaesthesiology internationally.

Original languageEnglish (US)
Pages (from-to)e160-e170
JournalBritish Journal of Anaesthesia
Issue number3
StatePublished - Mar 2020

Bibliographical note

Funding Information:
For piloting the questionnaire, the authors thank the following (i) anaesthesiologists: Andreja Moller Petrun, Mirt Kamenik, Jozica Wagner Kovacec, Domen Kogler, Marko Lokar, Katarina Katja Primozic, Bogdan Zdravkovic, Barbara Pecovnik, Pieter Mertens, Maria Lurdes Castro, Tina Heidi Pedersen, Beatriz Noronha, Ross Hofmeyr, Thomas Chloros, Filip Depta, Jana Sendreyova, Natalia Bogdanova Kavalcikova, and Chris Martini; and (ii) medical educationalists: Debra Lee Klamen, Heeyoung Han, Leslie Clasina Smith, Shelley Parr, Pat O'Sullivan, Paul de Roos, and Sonia Vaida. For translations, the authors thank Beatriz Noronha, Denis Pizhin, Jekaterina Jagodzinska, Laure Robert-Tissot, Tatjana Dill, David Berger, Alicia Del Moral Olmo, Alejandro Bernasconi, Philippe Dubois, and Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva. The authors also acknowledge the following (i) supporting international societies: European Airway Management Society and American Society of Regional Anesthesia and Pain Medicine; and (ii) supporting national societies: Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (Italy), New Zealand Society of Anaesthetists (New Zealand), South African Society of Anaesthesiologists (South Africa), Oman Society of Anesthesia and Critical Care (Oman), Société Marocaine d'Anesthésie Réanimation (Morocco), Nigerian Society of Anaesthetists (Nigeria), Kenya Society of Anaesthesiologists (Kenya), Finnish Society of Anaesthesiologists (Finland), Armenian Society of Anaesthesiologists and Intensive Care Specialists (Armenia), Bulgarian Society of Anaesthesiologists (Bulgaria), Sociedade Brasileira de Anestesiologia (Brazil), Romanian Society of Anaesthesia and Intensive Care (Romania), Turkish Anaesthesiology and Reanimation Society (Turkey), Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin (Austria), Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (Spain), Société Française d'Anesthésie et de Réanimation (France), and Nederlandse Vereniging voor Anesthesiologie (Netherlands). The authors also acknowledge the collaborators, who are listed in the Supplementary material.

Publisher Copyright:
© 2019 British Journal of Anaesthesia


  • anaesthesiology
  • gender equity
  • gender gap
  • global survey
  • leadership
  • physician perception
  • research
  • work attitudes
  • Attitude of Health Personnel
  • Leadership
  • Humans
  • Middle Aged
  • Male
  • Sexism
  • Anesthesiologists
  • Adult
  • Biomedical Research
  • Female

PubMed: MeSH publication types

  • Journal Article


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