More than half of medical school students are women, and yet they account for only 10% of neurosurgical residents, a new report shows. That number drops to 6% when researchers factor in how many women go on to become practicing neurosurgeons.
The board of directors for the American Association of Neurological Surgeons (AANS) requested a white paper on the recruitment and retention of women in neurosurgery. The findings, reported by the AANS Women in Neurosurgery (WINS) committee, were released online August 1 in advance of the September issue of the Journal of Neurosurgery.
What the WINS committee has found points to a need for AANS and other neurosurgery organizations to be more active in recruiting women, the authors say.
“What we’ve learned is that this problem can’t be left to a passive process,” lead author Deborah Benzil, MD, from the New York Medical College in Hartsdale, told Medscape Neurology & Neurosurgery. “Things won’t change on their own, and we have to institute a more active approach in collaboratively addressing these issues.”
“Failure to attract the brightest and most talented in the applicant pool by exclusions of subtle and deniable discrimination is unacceptable,” James Bean, MD, president of the American Association of Neurological Surgeons (AANS), said in a statement. “This is an issue that affects the specialty as a whole — and inevitably our patients — and we intend to work together to resolve it.”
Dr. Bean points out that the number of neurosurgeons has been decreasing relative to a growing population. He suggests there is an urgent need to attract more qualified candidates to address this potential shortage.
White Paper Outlines Gender Inequity in Neurosurgery
The Women in Neurosurgery committee reports that gender inequity exists in training programs, in the workplace, and within organized neurosurgery. The authors suggest there is ample evidence demonstrating that mentors and role models play a critical role in the training and retention of women faculty within academic medicine, and yet few females attain such positions in neurosurgery.
The committee points out that a woman has never been president of the AANS, the Congress of Neurological Surgeons, or the Society of Neurological Surgeons. No woman has been chair of the American Board of Neurological Surgery, and no female has even been on the board or on the Neurological Surgery Residency Review Committee. Until this year, they report that no more than 2 women have simultaneously been members of the Society of Neurological Surgeons.
“The absence of a critical mass of female neurosurgeons in academic medicine may serve as a deterrent to female medical students deciding whether or not to pursue careers in neurosurgery,” the committee reports.
Coauthor Gail Rosseau, MD, from the Chicago Institute of Neurosurgery and Neuroresearch, in Illinois, pointed out to Medscape Neurology & Neurosurgery that medical students have important concerns about gender inequities. For example, they question whether they will be accepted into residency and wonder about appropriate pay and opportunities for advancement.
During the1990s, the committee reports that at least 30% of neurosurgical residency programs had never graduated a female resident.
“The barriers may be neither obvious nor even acknowledged, but they exist,” Dr. Bean writes in an accompanying editorial. “We cannot afford the failure to attract the brightest and most talented in the applicant pool when they are excluded by subtle and deniable discrimination.”
But Dr. Benzil is quick to point out that the WINS committee is not angry and does not see the problem as a glass ceiling that is hindering women. Instead, the group suggests there has been a cumulative disadvantage that has often made things harder on women pursuing neurosurgery.
“If anything, we see this as a sort of glass house, where the women in neurosurgery are always being watched. If you are the only woman on a committee or in the operating room, this can be very isolating,” Dr. Benzil said.
Eliminating Disadvantages
“I don’t think men necessarily intend to treat women differently,” she added, “but in some cases, I think they don’t always know how to approach a situation that may be new to them.”
Dr. Benzil added, “I think those of us on the committee would be the first to acknowledge the men in our careers who have been instrumental in helping us reach this point.” And she emphasized that neurosurgery is an exciting and dynamic field, with a huge scope that really has an impact on people’s lives.
The committee is recommending the following broad strategy to the AANS board of directors:
Characterize the barriers to equitable opportunity.
Identify and eliminate discriminatory practices in the recruitment of medical students, the training of residents, and the hiring and advancement of neurosurgeons.
Promote women into leadership positions in organized neurosurgery.
Foster the development of female neurosurgeon role models by the training and promotion of competent, enthusiastic female trainees and surgeons.
In addition, they suggest that:
Women should constitute 20% of each class entering residency by the year 2012.
Women should make up at least 20% of all neurosurgery faculty by the year 2020.
Progress toward these goals should be regularly assessed, and efforts toward them adjusted as required.
These efforts should be encouraged and promoted among all national neurosurgical organizations.
They add that these changes are likely to benefit all neurosurgeons, irrespective of their sex.
Responding to the paper in his editorial, Dr. Bean writes: “We acknowledge the need for active measures to ensure that every neurosurgeon enjoys the same benefits and opportunities by dismantling the barriers and offering a hand across the remaining gulfs that separate the privileged from the deserving.”
Dr. Bean points out that more than 2 centuries ago, the United States was founded on the political and moral principles of equality — equal votes, equal rights, and equal opportunities. The principle of equality was an ideal not immediately achieved, and he notes that even the founders’ vision had to expand over time so that its potential could be realized and include all citizens.
“We have come a remarkable distance on the road to equality,” he writes. “Gender, racial, and ethnic barriers have been gradually eroded — though they are nowhere fully demolished. The struggle to reach the elusive ideal continues.”
The authors of the white paper are members of Women in Neurosurgery. They have disclosed no relevant financial relationships.
J Neurosurg. 2008;109:377, 378-386.
