Ansam Khan¹* and Lilian Zevlaris² *

1 – Department of General Medicine, Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King’s Lynn, GBR

2 – Ulverscroft Eye Unit, College of Life Sciences, School of Psychology and Vision Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, Leicester, GBR

* Joint First Authors

Gender imbalance within surgical specialties has long been recognised (1). Despite steady increases in the number of women entering medical school (2), most surgical specialties remain male-dominated, particularly at consultant level. According to the Royal College of Surgeons of England (RCS) and its Women in Surgery (WinS) data dashboard, women account for only around 40% of surgical trainees and approximately 17% of consultant surgeons in the UK, depending on specialty (3,4). These figures have changed little over the past decade, and although initiatives such as WinS have improved visibility and mentorship, gender balance has advanced more gradually in surgery than across medicine overall.

Ophthalmology represents a notable exception to this pattern. Data from the Royal College of Ophthalmologists (RCOphth) Workforce Census 2022 show that women now make up almost half of ophthalmology trainees at around 47%, compared with 36% of consultants (5).This shift suggests that ophthalmology may soon reach genuine gender parity among consultants as today’s trainees progress through the system to consultant level. This article examines ophthalmology as a case study to explore how and why gender representation in this specialty differs from broader surgical trends in the UK. It also considers the factors contributing to this relative balance and the implications for achieving gender equity across surgery. Ophthalmology therefore stands out as one of the few surgical disciplines approaching demographic balance.

Sources: RCS press release on WinS Conference 2025 (3); Royal College of Surgeons of England Women in Surgery statistics (4); Royal College of Ophthalmologists Workforce Census Report 2022 (5).

There may be several explanations for this difference. Ophthalmology combines medical and surgical practice, offers predictable working hours, and has a low frequency of emergency overnight work. These characteristics make it attractive to all genders, particularly for those seeking a sustainable career with good work-life balance. The training pathway is also well structured, with defined competencies and a strong emphasis on clinical outcomes and academic performance rather than purely procedural volume.

However, equality in numbers does not necessarily mean equality in opportunity. For example, in 2021, women represented 39% of applicants for ophthalmology training posts but only 16% of those appointed.⁶ This suggests a lower appointment rate for female candidates, highlighting potential barriers during the selection process.  It also noted that a significant proportion of members and trainees (5%) do not disclose their gender or ethnicity when completing the survey (6). The reasons for non-disclosure are not fully understood, but the report suggests that some individuals may have concerns about confidentiality or potential negative consequences of disclosure.

The DA report also emphasised the importance of recognising and addressing differential attainment within ophthalmology training (6). While current evidence does not show gender-based differences in examination or progression outcomes, the College advocates ongoing analysis to ensure equal opportunities for all trainees. This approach represents a model of good practice that other surgical specialties could adopt as they work toward greater inclusivity.

Viewed against the broader surgical context, ophthalmology’s progress is encouraging. The steady increase in female trainees provides a positive trajectory for future consultant representation, with current data suggesting that the proportion of women at senior levels will rise naturally as these cohorts advance. However, the RCOphth has emphasised that numerical parity does not guarantee equality of experience or opportunity. As noted in The Ophthalmologist’s “Bridging the Gender Gap”, women still face barriers to research visibility and academic advancement, highlighting the need for strong mentorship and institutional support (7).

Supporting women in ophthalmology extends beyond clinical training. Networks such as Women in Vision UK (WVUK) and Women in Eye and Vision Research (WEAVR) provide mentorship, networking, and promote female visibility in conferences and grant panels (8,9).Research also indicates that female principal investigators often secure smaller grants than male counterparts, particularly early in their careers (10). By addressing barriers in leadership, funding, and career progression, these initiatives reinforce the importance of sustained efforts to achieve gender parity across clinical and academic ophthalmology.

In conclusion, ophthalmology is a positive outlier among surgical specialties for gender representation. Its structured training, defined competencies, and balanced workload may serve as a model for promoting equity across surgery. The near parity among trainees provides a strong foundation for future equity at consultant level. However, true equality requires women to have equal access to recruitment, leadership roles and research opportunities. Sustaining this progress depends on transparent selection, targeted mentorship, and inclusive policies.

References

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