Women in NeurosurgeryFemale Neurosurgeons in Europe—On a Prevailing Glass Ceiling
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.
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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.