Over the past five years, female medical school applicants consistently out-numbered males and female general surgery applicants steadily increased, yet female surgical subspecialty applicants have not followed suit. In 2008, the American Association of Neurosurgical Surgeons/Congress of Neurosurgical Surgeons Section on Women in Neurosurgery (WINS) compiled a list of obstacles contributing to the lack of recruitment and retention of women within neurosurgery, followed by the goal of females comprising 20% of all neurosurgical residents by 2012 and 20% of all practicing neurosurgeons by 2020. While historic improvements were made, these goals were not achieved. It is evident work still needs to be done, particularly in the intentional encouragement of female medical students by neurosurgery departments.
During the fall of my first year of medical school at the University of Utah, I sent an email to the neurosurgery residency director expressing interest in the specialty. It was long and drawn out, as I felt I needed to justify my excitement for the field and my career goals. He replied — “we should meet sometime and talk.” I arrived to our meeting the following week in my best blazer, fully prepared to defend my qualifications and aspirations.
No defense needed.
Smiling, he said “if you want to become a neurosurgeon, you have our full support.” Since our meeting, I have experienced mentorship and encouragement that I could have never anticipated. My mentors have advocated to ensure I can pursue research endeavors I am passionate about, have spent a significant amount of time teaching anything from anatomy to statistical analysis, and have never once questioned my ambitions. This is not to diminish the amount of work I have ahead to achieve these goals; rather, I feel supported, contrary to the current literature.
In 2019, a survey of female medical students revealed pregnancy, breastfeeding and inadequate maternal leave policies influenced their career decisions. In 2020, multiple studies characterized many of the obstacles discouraging women from specifically pursuing neurosurgery — challenges related to family planning, pregnancy and microaggressions from male colleagues and leadership. This data suggests, more than a decade later, the barriers illustrated by WINS are still rampant.
A 2022 study in the Journal of the American Medical Association found an association between surgeon-patient sex discordance (male surgeon treating female patient and vice versa) and adverse postoperative outcomes of common procedures. Additionally, the adverse outcomes observed were significantly worse among male surgeon-female patient cases versus female surgeon-female patient cases, but not as striking among female surgeon-male patient cases versus male surgeon-male patient cases. Now, not only do we have data demonstrating why women are not pursuing neurosurgery, we have data confirming the need for women in neurosurgery.
In order to encourage female medical students to pursue predominantly male specialties, the precedent of “everyone belongs at the table” must first be set. The University of Utah Department of Neurosurgery held a dinner for female medical students interested in neurosurgery. Attendings and residents of all genders set the tone maintaining neurosurgery as a field for anyone interested and capable. This is the standard neurosurgery must continue to portray to women. Female medical students need to know they are not going to be mocked, harassed or discriminated against in a field they will spend nearly a decade training for.
Second, female representation within each level of training is crucial. As a medical student and a wife, I hope one day to become a surgeon and a mother. Departments need to demonstrate their ability to support women pursuing all of these societal roles, as the majority of female medical students intend to have families. It is reassuring to see female residents and attendings at the University of Utah simultaneously hold these roles and to see the obvious respect their male colleagues have for them.
Ultimately, I imagine we have truly achieved these goals of encouraging women in neurosurgery not when we reach specific percentages, rather when it is no longer note-worthy to add “female” — when becoming a female neurosurgeon is no more of a feat than becoming a male neurosurgeon, when the expectation is encouragement versus harassment and when having successful marriages and healthy families are priorities to celebrate. We are not there yet, but I am hopeful my experience is becoming the norm for female medical students across the country.
This article was completed through participation in The Rural and Underserved Utah Training Experience (RUUTE) at the University of Utah School of Medicine.
