Why Are There So Few Female Neurosurgeons?

Emily Shiffer

July 27, 2022

You're a woman in medical school. Your days are packed with lectures, labs, and studying. Nights and weekends: more studying. It's hard but also exciting because you're working toward a life of helping people. Still, one question remains.

Which specialty will you choose?

This isn't just a professional choice. It's deeply personal and will affect what kind of life you will lead.

If you're like many women in medicine, you'll pick a specialty focused on women and children. Women make up the majority in the fields of pediatrics, obstetrics and gynecology, child and adolescent psychiatry, and neonatal-perinatal medicine. They remain a significant minority in urology, pulmonary disease, and surgical specialties.

Hovering at the bottom of the list is neurosurgery ― women account for only 8.4% of practicing neurosurgeons. That's why Johns Hopkins researchers focused on it in a new study.

"We want to highlight and bring attention to the lack of female representation in neurosurgery," says James Feghali, MD, a neurosurgery resident at Johns Hopkins Hospital and co–first author of the study. "Throughout its history, the field has generally been comprised of mostly men, and only in the last few decades has that slowly started to change." Emphasis on slowly.

After evaluating data from more than 1500 neurosurgery residents ― about 1200 men and 300 women ― spanning a 7-year period (2014–2020), the researchers found that the number of female neurosurgery residents is trending up, ranging from a low of 14% in 2016 to a high of 26% in 2019.

That's good news, of course. But we still have a long way to go to right the imbalance.

Why Are There So Few Female Neurosurgeons?

The researchers wanted to know why some schools are better than others at enabling female medical students to join neurosurgery. They made a few observations.

They noticed that schools with more clinical neurosurgeons on the faculty tended to have more women who enter neurosurgery. However, the gender of neurosurgery faculty did not correlate with an increase in female recruitment.

"We were surprised," says the study's supervising author, Judy Huang, MD, program director of the Johns Hopkins Neurosurgery Program. "We thought that female medical students might be more inspired to enter the field if they had faculty more similar to them."

One possible explanation: Female neurosurgery faculty members, even at schools where they make up relatively higher numbers, remain the minority, which leads med students to view them as isolated individuals rather than a unified group, the researchers speculate. That perception may discourage women from entering the field.

Huang notes that since neurosurgery training programs are mostly made up of men, some gender bias may be inherent in the selection process.

What's more, a large "research productivity" gap seems to be holding women back. Male neurosurgery residents wrote 37% more articles and abstracts than their female counterparts, the researchers found. That's 18 articles and abstracts for men, on average, compared to 13 for women.

In addition, the h-index ― a measure of the citation impact of an author's articles ― was higher for men than women. "From our data, male neurosurgery residents had an average h-index of 4.7, and female neurosurgery residents had an average h-index of 3.9," says Feghali.

It may be that female students get a later start at building up their research CV. Previous research has shown that female med students are less interested in surgical specialties when they start medical school, though that gap narrows by the end. "This initial delay may put them at a disadvantage," says Albert Antar, a medical student at Johns Hopkins School of Medicine and co–first author of the study.

Female medical students and residents may also be at a disadvantage navigating a research environment largely cultivated by their male peers, the researchers add.

"This research productivity gap is particularly important in neurosurgery, because research forms an important basis for career advancement in the field, both for acquiring a residency and for future career advancement as a faculty member," Antar says.

Closing the Neurosurgery Gender Gap: What Can Be Done About It?

Solving the neurosurgery gender gap will likely take both a bottom-up and a top-down approach, say the researchers. That means action from medical students and residents as well as senior-level neurosurgeons and neurosurgery program directors.

Advocating for research funding for female trainees and developing programs dedicated to female-led research may help provide more opportunities for female med students to excel in neurosurgery, they say.

And forming female-led neurosurgery interest groups, in which mentoring and networking can take place, may help female students view women neurosurgeons as a unified minority rather than dispersed individuals, the researchers suggest.

Huang suggsts that medical students consider finding a faculty advisor to help start such a group. Another suggestion is to work directly with the school's diversity office. A mentor can also help students build competitive applications for neurosurgery residency.

Another idea is for students to research the issue themselves. The more research that is conducted on these disparities, the better they can be understood them and the more awareness can be raised, Huang says.

Actively working to recruit more women into neurosurgery can benefit the entire specialty. "The field may still be failing to tap into potentially very talented future female neurosurgeons," says Huang.

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