Preparing surgery for Generation Z - Motivation and protective factors for pursuing a surgical career among medical students and early-career physicians: a cross-sectional study

Abstract Background Surgery is facing a substantial shortage of young professionals. In particular, it has become increasingly difficult to attract medical students, especially women, to pursue a surgical career, although women currently represent the majority of medical students. The specialty is often associated with a high workload, hierarchical leadership structures, and limited compatibility between professional and private life. Against this background, the aim of this study was to identify the factors that motivate medical students, early-career physicians and board-certified surgeons to pursue a career in surgery despite these challenges. Methods An anonymous online survey was conducted between October and December 2025. The questionnaire comprised 18 items addressing motivations as well as encouraging and discouraging factors influencing the decision to pursue a surgical career. Responses were recorded using a five-point Likert scale ranging from 1 to 5. Results A total of 179 individuals participated in the survey (11.7% male [ n = 21], 88.3% female [ n = 158]; mean age 31 ± 6.3 years), including 28.5% medical students, 48.0% residents, and 23.5% board-certified surgeons. Overall, 68.7% reported having decided on a surgical career during medical school. Notably, 87.2% of respondents stated that they had been discouraged in relation to their career choice, with discouraging feedback predominantly coming from men and from individuals working in surgical specialties. Women had 6.5-fold higher adjusted odds of reporting that they had been discouraged from pursuing a surgical career compared with men ( p < 0.001). The most frequently reported motivating factors were the operative nature of the work (97.8%), working in a supportive and appreciative team environment (60.9%), and the opportunity to make a meaningful contribution to patient care (60.9%). Conclusions The potential future surgical workforce is predominantly female and largely belongs to Generation Z. Overall, participants emphasize the importance of high-quality and structured training, a respectful working environment, predictable career pathways, and working conditions that allow for a sustainable balance between professional and private life. Addressing these factors should be considered a strategic priority for professional societies, training supervisors, and clinical leaders to attract and sustainably retain qualified surgical trainees.