Nancy A. Melville

May 16, 2017

LOS ANGELES — While approximately half of medical school graduates overall are women, sex disparities still persist in neurosurgery, new data suggest.

Men continue to far outnumber women in the highest academic ranks and leadership positions, and there is only a single female neurosurgery department head in the United States, researchers report.

"Women are entering neurosurgery in the same proportion as their male colleagues. However, there still remains disparity in terms of academic ranks and the career paths in this field," said first author, Jaclyn Janine Renfrow, MD, from Wake Forest Baptist Health Department of Neurosurgery, Winston-Salem, North Carolina, in presenting the findings here at the American Association of Neurological Surgeons (AANS) 2017 Annual Meeting.

Despite the narrowing gender gap in medicine, neurosurgery has remained one of the most male-dominated specialties. According to a 2014 study in the Journal of the American College of Surgeons, specialties showing the lowest percentages of female medical school graduates entering as residents from 2006 to 2008 were neurosurgery, orthopedics, urology, otolaryngology, general surgery, and radiology. The most popular specialties for women were internal medicine and pediatrics.

In taking a closer look at the trends of women entering the field, Dr Renfrow and colleagues reviewed data from the AANS and American Board of Neurological Surgery (ABNS) from 1964 to 2013.

Across the 50-year span, 379 neurosurgery residency graduates were female. Of them, 70% received certification from the ABNS, with 2.1% choosing other fields.

One in four female graduates pursued fellowship training, with pediatrics as the most popular field (37%) and skull base as the least popular choice (2%).

Following training, 26% of women entered academic medicine and 71% entered private practice, similar to the paths that men followed.

However, in academic neurosurgery, the data showed 46% of women were at the rank of assistant professor compared with 33% of men; 36% of women achieved the rank of associate professor, compared with 19% men; and only 18% of women achieved the level of full professor, compared with 43% of men.

"These data highlight that there is a gender disparity in the higher academic ranks of neurosurgery," Dr Renfrow said.

In even more striking findings, only 1 of the 106 neurosurgery program department chairs were female. There were 2 female interim chairs, and 3 women were vice-chairs.

Seven of the 106 residency neurosurgery program directors and just 5 fellowship program directors were female.

Of the 110 current neurosurgery medical board or executive committee positions in neurosurgery, only 17 were held by women.

More recent data show some progress, however. Of 269 women receiving ABNS board certification across the span of the study, 105 received certification between 2001 and 2010, and the patterns for this decade suggest even higher numbers, with 66 women achieving board certification between 2011 and 2016.

Nevertheless, only 16% of residents matched for neurosurgery in 2016 were women.

"The career paths of women in neurosurgery highlight the progress they have made but also highlight the challenges for recruiting and advancing women in neurosurgery," Dr Renfrow said.

A key issue commonly discussed in the lack of women in neurosurgery is lifestyle issues, but mentorship for women is especially critical, Dr Renfrow noted.

"Certainly lifestyle choices are a commonly cited reason and are usually the first referenced," she told Medscape Medical News. "Consistently, however, women also report to value mentorship, which may be another reason why they ultimately chose to enter another field. This is a focus in recruiting more women into the field."

While studies show that men and women achieve equally in medical school as far as their grade point average and test scores, there are no incentives to increase the number of women in neurosurgery, Dr Renfrow said.

"Our approach to increasing the number of women in the field has started with simply improving awareness that proportionately fewer talented women medical students decide to pursue a career in neurosurgery and this inability to recruit an equal proportion of the top achievers in medical school is a disadvantage to the field in general."

Gregory J.A. Murad, MD, an associate professor of neurosurgery and residency program director in the Department of Neurosurgery at the University of Florida College of Medicine, Gainesville, said the findings underscore the gender divisions that persist in neurosurgery, for a variety of undesirable reasons.

"Unfortunately, neurosurgery has remained male dominated, partly due to perceived demands of the career, and likely also due to sexism, both conscious and unconscious," he told Medscape Medical News.

"I was heartened to see that women are pursuing academic practice in equal numbers to men, as these role models are the best examples for female medical students whom we are trying to attract to our specialty."

Dr Murad noted that the findings reflect the gender patterns he sees in his own department.

"At our own institution, about 15% of our graduates in the last 10 years have been women, and 3 of our 19 residents are women. This is an improvement from the previous decade."  

The field can only benefit with better gender equality, he noted.

"I do think that attracting the best and brightest medical students requires recruiting women, and neurosurgery will lose out if we don't do a better job of this in the future."

The AANS's Women in Neurosurgery (WINS)  program is working to push forward those objectives, offering programs including mentorship for residents and medical students.  

American Association of Neurological Surgeons (AANS) 2017 Annual Meeting. Abstract 707. Presented April 25, 2017.

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