Women in NeurosurgeryGender Differences Between Male and Female Neurosurgeons: Is There Equality for All?
Introduction
Historically, medicine has been a male-dominated world.1 More women than men enroll into medical school, which will cause a shift in the distribution of male and female doctors in coming years. However, although 51% of medical students in the United States in 2018 were female, only 8% of practicing neurosurgeons were.2 Along with other surgical disciplines, neurosurgery has lower rates of female applicants compared with other disciplines such as dermatology or ear nose and throat.3 A 2018 study analyzed 3426 applicants to neurosurgery from 1990 to 2007 and looked into different factors associated with successful matching (successfully enrolling into a neurosurgical residency).4 The strongest predictor was the score on the U.S. Medical Licensing Exam Step 1, but being an applicant from a high-ranked medical school and the applicant gender may also play roles in matching successfully. A critical review of gender issues in neurosurgery, published in 2006, examined factors related to why female doctors fail to advance into subspecializations.5 Among others, lifestyle concerns, limited mentorship, outdated career programs, and societal beliefs are relevant factors, alongside discrimination and harassment.
In 2008, a white paper (a report giving proposals on a complex issue) was issued on the recruitment and retention of women in neurosurgery.6 Apart from identifying obstacles such as harassment and unconscious bias, the White Paper Committee also recommended a strategic approach to overcoming these obstacles. This approach included characterizing barriers, identifying and eliminating discriminatory practices, promoting women in leadership positions, and promoting the development of female role models. Together with proposed solutions such as on-site day care facilities and job sharing paradigms, a recent editorial targeted a goal of achieving that by 2020, 20% of the neurosurgical trainees in the United States will be female.2,7 This goal of 20% does not imply that female applicants should be preferred to increase the proportion of female trainees, but that female applicants should have similar career prospects to male applicants, given that they qualify equally.
Some attempts have been made to increase the rate of enrollment and retention of women in neurosurgery, and these attempts have shown some success. The percentage of women matching into neurosurgery in the United States increased from 10.7% in the 1990s to 12% in the 2000s and 15.5% in 2013, and the percentage of women finishing their residencies increased from 76% in the 1990s to 83% in the 2000s.8 Furthermore, female neurosurgeons were also able to hold leadership positions in professional associations. The Council of State Neurosurgical Societies had 2 female presidents, and 2018 was the first year that a female neurosurgeon was elected to be the president of the American Association of Neurological Surgeons.2,9
Despite these positive trends in gender equality in neurosurgery, less is known on gender disparities in the career and private life of neurosurgeons. Furthermore, reported experiences of male and female neurosurgeons on these issues are lacking. Mapping out differences between male and female neurosurgeons may help to show the state of gender equality in neurosurgery as well as helping to show which aspects of gender equality may need interventions to improve. Therefore, the aim of the current study is to identify gender differences in the professional and private life of neurosurgeons.
Section snippets
Methods
Based on previous literature, a survey was developed.10, 11, 12, 13 After pilot testing the survey, a final version was created. The final version is available in the Supplementary Material. The survey consisted of 38 questions and covered:
- 1)
Respondent demographics such as age, tenure, and scope of practice
- 2)
Career fulfillment, such as highest rank achieved and recommending a career in neurosurgery to others
- 3)
Private life, such as marriage, divorce, and the influence of career
- 4)
Parenting, such as
Demographics
A total of 7573 e-mails were sent, of which 870 were filled in, leading to a response rate of 11.5%. All continents were represented, with the most respondents from North America (80.6%, N = 701) and Europe (8.9%, N = 77), whereas Africa had the fewest respondents, with 0.7% (N = 6) (Figure 1). Respondents were employed in a total of 50 countries with the most from the United States (N = 653, 75.1%) followed by India (N = 33, 3.8%) and Canada (N = 29, 3.3%).
Of the respondents, 665 (76.4%) were
Summary of Findings
In this study, the results are presented of a survey among 870 CNS members regarding differences in the private and professional lives of female and male neurosurgeons. Regarding working schedule, days worked weekly, and current gross salary, no intergender differences could be identified. In their professional lives, female respondents rated their career fulfillment worse than did their male colleagues, and looking back, female respondents were less likely to choose a career in neurosurgery
Conclusions
Despite efforts to increase the amount of women enrolling into neurosurgery, despite efforts to strive for equality, and despite some success of these efforts, the results of the current study show gender disparities in professional and private careers among neurosurgeons. Practice patterns did not differ between male and female neurosurgeons, but perceptions on career and characteristics of private life did. Program directors and chairs should focus on measurements to decrease gender
Acknowledgments
The authors would like to thank all respondents for sharing their opinions.
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Conflict of interest statement: C.V.-L. received a grant from Braun Medical (paid directly to her institution); speaking/teaching arrangements with CSRS; research support (investigator salary, staff/materials) from Medtronic, Paradigm, Covidien (paid directly to institution), and the Dutch National Organization (paid directly to her institution), and fellowship support from the Chinese Student Council (student support/sponsorship).