Abstract
Purpose: This study examines the relationships between formal and informal gender bias and
burnout among surgeons, and it assesses whether job satisfaction mediates these associations
differently for women and men. This study is set in Korea, which operates in a highly
hierarchical health care system marked by persistent gender inequality. We conducted a
nationwide survey of practicing surgeons, and the primary exposures were experiences of formal
gender bias (e.g., hiring, pay, promotion, and leadership opportunities) and informal gender bias
(e.g., exclusion from networks, limited access to resources, and derogatory or gendered
comments). Key outcome variables were overall job satisfaction and burnout. Analyses were
stratified by gender, and mediation models were used to evaluate indirect pathways through job
satisfaction.
Results: Women surgeons reported substantially higher exposure to formal (62.5% vs. 11.3%)
and informal (83.9% vs. 19.2%) gender bias than men. For both women and men, formal gender
bias was associated with lower job satisfaction, and its relationship with burnout was fully
mediated through job satisfaction. Informal gender bias was also associated with lower job
satisfaction for both genders; however, for men it retained a direct positive association with
burnout after accounting for job satisfaction, while for women the association was fully mediated.
Conclusions: Gender bias is strongly linked to burnout among surgeons, operating largely
through job satisfaction but with important gender‑specific differences. Organizational strategies
that enhance equity and job satisfaction may reduce burnout, while targeted efforts to address
informal, interpersonal bias are needed to further mitigate burnout risk.