Elsevier

World Neurosurgery

Volume 129, September 2019, Pages 460-466
World Neurosurgery

Women in Neurosurgery
Female Neurosurgeons in Europe—On a Prevailing Glass Ceiling

https://doi.org/10.1016/j.wneu.2019.05.137Get rights and content

Background

Almost one half of currently practicing physicians in Europe are women. Despite advances in access to training positions and the entry of women into neurosurgery, it has remained a male-dominated field, with an underrepresentation of female leaders. We designed a 2-part study to better understand the current situation of European female neurosurgeons.

Methods

The European Association of Neurosurgical Societies and its member societies were analyzed for female participation in leadership positions. Additionally, an online survey was designed, containing 33 questions about career choice, mentorship, family planning, and perceived obstacles, for women in neurosurgery.

Results

A total of 116 responses were received. Most female neurosurgeons lacked same-gender role models (76%), although most reported that having a female mentor would be important (58%). An overwhelming majority (86%) believe family planning takes on a more important role for women, and 72% reported worrying their career prospects could be negatively affected by their desire to have children. The greatest obstacle perceived was the prevailing inequality in opportunities (30%) and attaining leadership positions (24%). Most (81%) reported that women have different concerns regarding their career from men, and 72% also reported feeling at a disadvantage as a woman. Most (66%) also believe should be a “Women in Neurosurgery” committee within the European Association of Neurosurgical Societies.

Conclusions

Unfortunately, a gender gap still exists in European neurosurgery. The extent thereof has not yet been systematically analyzed. Our project offers a glimpse into the inequalities and obstacles women perceive in our field; however, more comprehensive data are required.

Introduction

Gender parity is fundamental to the prosperity of societies. The appropriate development and use of female talent, which constitutes one half of the world's workforce pool, is key to the advancement of global economies. According to the Global Gender Gap Report, Western Europe was the highest performing region in 2017.1 The latter presupposes low gender gaps in economic, education, health, and political criteria. According to Eurostat,2 almost one half of currently practicing physicians in Europe are women. Between 2005 and 2015, the total number of female physicians in the European Union increased, with the Baltic Member States, Romania, Slovenia, and Croatia reporting ≥60% of their physician workforce were women. Nevertheless, the Global Gender Gap Report showed great imbalances between the number of women employed in the healthcare sector compared with those in leadership roles,1 which is in line with several studies in the United States that have highlighted the presence of a glass ceiling in academic medicine.3, 4, 5

Does this imbalance extend to neurosurgery? Neurosurgery has traditionally been a male-dominated field. Despite advances in access to training positions and the increased entry of women into the field, a gross underrepresentation of women in leadership roles remains. In the United States, the number of women in neurosurgery has remained at <15%. Furthermore, women only account for ∼6% of faculty members.6 However, no data are available on the current gender distribution of neurosurgical trainees and specialists in Europe. Thus, the neurosurgery department of Göttingen University Hospital, in collaboration with their office for gender equality, designed a 2-part study to better understand the current situation of female neurosurgeons in Europe, including their perspectives and attitudes and their perceived professional challenges and obstacles.

Section snippets

Methods

The European Association of Neurosurgical Societies (EANS) website was analyzed for female participation in leadership positions within the organization and its committees.7 Furthermore, the national neurosurgical societies affiliated to the EANS were reviewed regarding female participation in their boards of directors, as noted on their respective websites.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 When the provided web hyperlinks were unavailable,

Female Neurosurgeons in Leadership Positions in Europe

From an organizational perspective, the EANS has never had a female president. Currently, the Board of Officers, which determines the strategic direction of the EANS, is comprised solely of men. Among the 9 EANS subspecialist sections, only 1 is chaired by a woman. Of the 15 training centers accredited by the Joint Residency Advisory and Accreditation Committee and certified by the European Union of Medical Specialists and EANS as a Center of Excellence in Neurosurgical Training, none is

Discussion

The first part of our project revealed that the most influential, policy-determining positions in European neurosurgery are almost exclusively occupied by men. This finding was not surprising, because it has also been exhaustively documented in other medical specialties.31, 32, 33 In U.S. neurosurgery, Benzil et al.34 documented a stagnant entry of women into neurosurgery from 1998 to 2006, despite the increased number female medical graduates. Woodrow et al.35 analyzed the reasons for this

Conclusions

Unfortunately, a gender gap still exists in European neurosurgery. To date, the extent has not been systematically analyzed. Our project offers a glimpse into the obstacles women perceive in our field. However, more comprehensive data are required, especially from Eastern European countries. A problem unacknowledged is destined to remain unsolved. We hope that our study and the proposal submitted to the EANS will constitute the spark that ignites an organizational and multinational change

Acknowledgments

The authors would like to thank Stella Müller from the Göttingen University Hospital's Bureau for Gender Equality for her continued support in the conception and development of this project. We would also like to thank Petra Koubova and Amy Pinchbeck-Smith from the European Association of Neurosurgical Societies for their logistic support in the distribution of the survey, and Carole Turner from the Society of British Neurological Surgeons, and the Dutch Association for Neurosurgery.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Christina Wolfert and Dorothee Mielke equally contributed to the manuscript.

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