The Cost of Holding the Blade: Socioeconomic Barriers in US Surgical Training

INTRODUCTION: Socioeconomic status (SES) plays a critical role in shaping access to surgical training and career advancement. However, the extent to which SES-related barriers influence entry into surgical subspecialties in the United States remains poorly defined. METHODS: A scoping review was conducted across five databases to identify US studies examining SES-related factors, such as income, educational debt, and parental background, affecting medical students, residents, or surgeons. Eligible studies reported SES variables and surgical career outcomes. The review followed PRISMA-ScR guidelines, with independent screening and data extraction. Risk of bias was assessed using the ROBINS-I tool. RESULTS: Fifteen studies encompassing 40,931 participants were included, primarily focusing on medical students. Lower childhood income and reduced parental education were consistently associated with limited access to mentorship, research, and competitive specialties. Medical student debt showed inconsistent associations. Identified facilitators included structured mentorship, virtual interviews, and tuition-reduction initiatives, though few were rigorously evaluated. CONCLUSIONS: Early life SES disadvantage significantly limits access to surgical careers. Targeted interventions addressing upstream barriers are needed to create a more equitable and inclusive surgical workforce.