Female Medical Student Retention in Neurosurgery: A Multifaceted Approach

Background

Since 2011, more women than men have graduated from medical school, yet there remains a paucity of female physicians in surgical specialties. After the 2018 Neurosurgery Match, only 17.5% of neurosurgery residents are women. Previous literature documented gender inequality, poor medical school exposure, and lack of female mentorship as reasons for this disparity. We sought to further explore factors that deter female medical students from pursuing neurosurgery.

Methods

A comprehensive survey was created and distributed to the 2017–2018 Rutgers New Jersey Medical School student body, requesting anonymous input from female medical students.

Results

Of 104 female respondents, 26.9% had considered neurosurgery as a career and felt dissuaded because of their gender. Of respondents, 88% did not have a senior female medical student pursuing neurosurgery or a female neurosurgical resident as a mentor. More than half of respondents disagreed that they would be dissuaded from a field if they did not have a female mentor. The 88.46% of women who felt that there was a glass ceiling in medicine were also more likely to feel that they would face inequality and adversity that would inhibit training in a male-dominated field. Women who described themselves as seeking challenging and competitive careers strongly felt that they would benefit from exposure to surgical subspecialties during their preclinical years.

Conclusions

Female medical students remain resilient, ambitious, interested in competitive specialties, and eager to explore surgical subspecialties during preclinical years. A multifaceted approach is imperative to recruit and retain qualified women interested in neurosurgery.

Introduction

For the past decade, incoming medical school classes in the United States have been composed of 50%–60% women, yet male physicians continue to dominate certain subspecialties, especially surgery.1, 2, 3, 4, 5, 6, 7 At the present time, approximately 30% of women in medical school are pursuing a surgical residency in the United States¹; however, in neurosurgery, only 17.5% of residents are women as of the 2018 Neurosurgery Match.³ Likewise, most recent attrition data demonstrated that retention of women in neurosurgical residency was lower than that of men, with 17%, 1 in every 6 women, leaving neurosurgery residency before completion.3, 7, 8 In 2018, a glaring gender disparity persists: only 9.2% of all academic neurosurgeons are women.5, 9 Of the 154 female physicians practicing neurosurgery in teaching hospitals across the United States, they hold fewer leadership positions than men with only 18 professors.¹⁰ There are 68 women who hold the title of assistant professor, 48 who hold the title of associate professor, and 4 who hold the title of director of a section within the neurosurgery department. In 2018, there are only 3 female chairs of neurosurgery departments in the United States: Dr. Karin Murazsko of University of Michigan, Dr. Viviane Tabar of Memorial Sloan Kettering Cancer Center, and Dr. Linda Liau of University of California, Los Angeles. Internationally, data similarly reflect women as a minority in this subspecialty. For instance, in Brazil, the percentage of women practicing neurosurgery is 5.5%, and the literature documents even fewer opportunities for female neurosurgeons in the Middle East and India.11, 12, 13

Although there remains an intimidating gender gap in this field, extraordinary strides have been made in recent years, and women excelling in the field pave a way for the future generation of female neurosurgeons. In April 2018, Dr. Shelly Timmons became the first female neurosurgeon to be president of the American Association of Neurological Surgeons (AANS), an accomplishment that set a precedent for women not only in neurosurgery but also in academic medicine as a whole.⁸ Finally, there has been a slight but steady increase in women pursuing neurosurgical residency from 10% in the 1990s⁷ to 17.5% in 2018 (Figure 1).¹⁴ Within this steady increase of residents, there is also a promising equal distribution in every postgraduate year (PGY), allowing for continued and future support by fellow female residents (Figure 1).

Publications, perspective pieces, and op-eds have explored the causes of this gender disparity for decades. Of the many gender-related issues described in the field, those that continue to negatively influence women include lack of female physician role models in academic medicine, lack of female-friendly residencies, and sexual harassment in the medical workplace.8, 11, 12, 15, 16, 17 Unconscious bias also plays a role in the advancement of women in their careers compared with their male counterparts.¹ Lack of exposure to competitive specialties has been a continuing complaint throughout early medical school education.18, 19, 20 More detailed analysis is necessary to specifically evaluate the recruitment and retainment of women.²⁰ We sought to further study these issues by attempting to assess and comprehend the thought processes of female medical students and their opinions about neurosurgery, with special attention to recognizing barriers and providing appropriate interventions.