TO THE EDITOR: More women attend medical school than men.1 Yet, female representation in neurosurgery remains low.2 Donaldson and colleagues3 highlight the imbalance between the numbers of male and female residents and faculty members in neurosurgical training programs, offering further evidence of an ongoing discrepancy between the number of women who become physicians and the number who successfully train to become neurosurgeons; we aim to supplement these efforts (Donaldson K, Callahan KE, Gelinne A, et al. Gender diversity in United States neurosurgery training programs. J Neurosurg. 2021;135[3]:943-948).
The relatively small number of women in neurosurgery reflects the “pipeline effect,” which suggests that gender differences within the neurosurgical field can be attributed to fewer females entering the discipline and a consequential delayed elevation in rank.3 However, the evidence does not support this explanation. Although female representation in neurosurgery has continuously increased since the 1990s, it has done so more slowly and gradually than other heavily male-dominated medical fields.2,4 Indeed, neurosurgery remains one of the specialties with the lowest female representation.3 On the contrary, fields such as general surgery have seen substantial gains in gender equity5 in recent years. To promote quality of patient care and advance the field, we need to attract, support, and encourage women to become neurosurgeons.
Understanding how formerly male-dominated fields such as business have addressed underrepresentation of women can be beneficial. In corporate leadership, gender bias and feelings of loneliness are recognized as factors that limit women’s advancement,6 and many women have argued that their experiences as some of the few females working in male-dominated spheres have negatively impacted their successes.3 This is to say that as more and more women enter the field of neurosurgery, their doing so may also increase the odds of succeeding generations of women entering the specialty. Particularly within a field that prides itself on the “see one, do one, teach one” approach, women interested in neurosurgery must be able to model their pursuits after women who have entered the field and succeeded before them.
With a greater number of role models, women will be better equipped to face the challenges of pursuing a career in neurosurgery.7 As the number of women in neurosurgery continues to increase, we expect to see changes in the next decade, including an emphasis on hiring diverse faculty, expanded options for parental leave and on-site day care, a focus on inviting female neurosurgeons as keynote speakers, equal compensation as men, and zero-tolerance harassment policies.2 Additionally, as other fields have found that the solution to curtailing gender bias and reducing gender discrimination lies in providing more equitable educational and professional environments,4,7–10 we anticipate that the formation of more organizations such as Women in Neurosurgery (WINS) may have an impact on recruitment of women to neurosurgery.
Disclosures
The authors report no conflict of interest.
References
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Boyle P. More women than men are enrolled in medical school. AAMC; 2019.Accessed August 6, 2021. https://www.aamc.org/news-insights/more-women-men-are-enrolled-medical-school
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Donaldson K, Callahan KE, Gelinne A, et al. Gender diversity in United States neurosurgery training programs. J Neurosurg. 2021;135(3):943–948.
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Corley J, Kim E, Philips CA, et al. One hundred years of neurosurgery: contributions of American women. J Neurosurg. 2021;134(2):337–342.
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Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A systematic review of simulation-based training in neurosurgery, part 1: cranial neurosurgery. World Neurosurg. 2020;133:e850–e873.
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Howard SD, Lucas TH. The Supreme Court’s recent decision is a call for increased diversity in neurosurgery. Letter. Neurosurgery. 2020;87(6):E715–E716.
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Lubelski D, Xiao R, Mukherjee D, et al. Improving medical student recruitment to neurosurgery. J Neurosurg. 2020;133(3):848–854.
