You are a woman in medical school. Your days are full of lectures, labs and studying. Nights and weekends: more studying. It is difficult but also exciting because you are working on a life where you help people. Yet one question remains.
Which specialty do you choose?
This is not just a professional choice. It is very personal and will affect what kind of life you will lead.
If you’re into medicine like many women, choose a specialty that focuses on women and children. Women make up the majority in pediatrics, obstetrics and gynaecology, child and adolescent psychiatry and neonatal-perinatal medicine. They remain a significant minority in urology, lung disease and surgical specialties.
At the very 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 highlight the lack of female representation in neurosurgery,” said James Feghali, MD, a neurosurgeon at Johns Hopkins Hospital and co-first author of the study. “Throughout its history, the field has generally been mostly male, and only in the last few decades has that slowly begun to change.” Focus on slowly.
After evaluating data from more than 1,500 neurosurgical residents – approximately 1,200 men and 300 women – over a 7-year period (2014-2020), the researchers found that the number of female neurosurgical residents is rising, ranging from a low of 14% in 2016 to a peak of 26% in 2019.
That is of course good news. But we still have a long way to go to rectify the imbalance.
Why are there so few female neurosurgeons?
The researchers wanted to know why some schools are better than others at allowing female medical students to join neurosurgery. They made some observations.
They noticed that schools with more clinical neurosurgeons on the faculty had more women entering neurosurgery. However, the gender of the neurosurgery faculty did not correlate with an increase in the number of female recruits.
“We were surprised,” says the study’s co-author, Judy Huang, MD, program director of the Johns Hopkins Neurosurgery Program. “We thought female medical students would be more inspired to get into the field if they had a faculty more like them.”
One possible explanation: Female neurosurgical faculty members, even at schools where they make up relatively much more, remain in the minority, leading medical students to view them as isolated individuals rather than a unified group, the researchers speculate. That perception can discourage women from entering the field.
Huang notes that since neurosurgery training programs are predominantly male, some gender bias may be inherent in the selection process.
In addition, a large ‘research productivity’ gap seems to hold women back. Male neurosurgeons wrote 37% more articles and abstracts than their female counterparts, the researchers found. That’s an average of 18 articles and abstracts for men, compared to 13 for women.
In addition, the h-index, a measure of the citation impact of an author’s article, was higher for men than for women. “Our data shows that male neurosurgical residents had a mean h-index of 4.7 and female neurosurgical patients a mean h-index of 3.9,” says Feghali.
It may be that later on, female students will start building their research resumes. Previous research has shown that female medical students are less interested in surgical specialties when they enter medical school, although that gap narrows towards the end. “This initial delay could put them at a disadvantage,” said Albert Antar, a medical student at the Johns Hopkins School of Medicine and co-first author of the study.
Female medical students and residents may also be at a disadvantage when navigating a research environment largely cultivated by their male peers, the researchers add.
“This gap in research productivity is especially important in neurosurgery, as research provides an important foundation for career advancement in the field, both for acquiring a residency and for future career advancement as a faculty member,” says Antar.
Closing the gender gap for neurosurgery: what can be done about it?
Resolving the gender gap in neurosurgery will likely require both a bottom-up and top-down approach, the researchers say. That means action from medical students and residents, as well as senior neurosurgeons and neurosurgery program directors.
By advocating for research funding for female interns and developing programs for female-led research, female medical students may have more opportunities to excel in neurosurgery, they say.
And forming female-led neurosurgery advocacy groups, in which mentoring and networking can take place, could help female students see female neurosurgeons as a united minority rather than scattered individuals, the researchers suggest.
Huang suggests that medical students consider seeking a faculty advisor to help set up such a group. Another suggestion is to work directly with the school’s diversity office. A mentor can also help students build competitive neurosurgery residency applications.
Another idea is for students to investigate the issue themselves. The more research that is done on these differences, the better they can be understood and the more awareness can be raised, Huang says.
Actively working to recruit more women for neurosurgery can benefit the whole specialty. “The field may still be failing to tap into potentially highly talented future female neurosurgeons,” Huang says.
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