“Don’t apply there. They don’t match women”. These comments were still routinely used to describe a handful of US neurosurgery residency training programs some 15 years ago. In the seminal white paper published in 2008 on the recruitment and retention of women in neurosurgery, there is a table that lists the number of women in each US residency program at the time. Included in this table were a fair number of programs in the 0-2 range, sparking women applicants to discuss the pros and cons of applying to these programs. In 2024, the landscape for women in neurosurgery has drastically changed, and women are no longer advised to not apply to certain programs.
In 2020, the American Association of Neurological Surgeons (AANS), in an effort led by Drs. Shelly D Timmons, Regis W. Haid and Nicholas M. Barbaro, developed and launched a Diversity Task Force, with the goals of (1) optimizing opportunities for organizational engagement for all, regardless of gender, racial and cultural identity, and (2) serving as the core resource for organized neurosurgery through ensuring that AANS leadership, profession and membership reflect the diversity of our society to promote the highest quality of patient care and to advance the specialty. The specific charges of the task force were to assess diversity with respect to all affairs of the AANS, including, but not limited to, governance, workplace environment, leadership development, pathways to election and membership and to develop recommendations to address barriers to achieving the diverse and inclusive organization that adheres to the AANS mission. In recognition of the fact that achieving and sustaining a more diverse workforce was a process and not immediately attainable, the AANS Diversity Task Force was transitioned into a standing committee of the AANS in 2021, chaired by Aviva Abosch, MD, PhD, FAANS. Efforts to promote diversity generally entail creating an environment in which people from all backgrounds are provided with opportunity and feel welcome. Although exhaustive lists are not possible, diversity is broader than gender, race and ethnicity, which are the categories commonly associated with diversity efforts. For instance, diversity also entails having representation from people of various religions, nationalities, sexual orientation and socioeconomic status.
Historically, many groups (e.g., women, Jews, American Indians, Blacks) were excluded from training in medicine in the United States. Some of these historically marginalized groups created their own hospitals, for instance Chinese Hospital (San Francisco), Mount Sinai Hospital (NYC) and Provident Hospital of Cook County (Chicago), were founded by Chinese, Jewish and Black community members, respectively, and focused on the care of patients in their communities. Advocating for workforce diversity has been another avenue for communities to address health care disparities. For example, the first class of medical students trained in a Cherokee reservation medical school will graduate in Spring 2024; it will provide indigenous doctors to tribal, rural areas. Historically black colleges and universities have long been the primary means of supporting black undergraduates on their journey to become physicians. In a recent effort spearheaded by Allan Levi, MD, PhD, FAANS, chair of neurosurgery at the University of Miami, seven neurosurgery departments across the country have developed summer scholarships programs to support black undergraduate medical students with interests in neurosurgery and neurosciences. More work is needed to assess the representation of other marginalized groups in order to provide necessary support for recruitment and retention.
Neurosurgeons are unequally distributed within the United Stateswith a smaller neurosurgery presence in economically disadvantaged regions. Students from low-income backgrounds are underrepresented in medical school across all race and ethnicity groups. To our knowledge, the socioeconomic diversity of those choosing careers in neurosurgery has yet to be studied, including the impact on location and type of practice selected. Considerations of how diversity initiatives can improve neurosurgical access to vulnerable populations are actively ongoing.
Embracing diversity has been shown to improve innovation, outcomes and performance in various fields, including basic science, economics, ecology and business. Neurosurgery is one of the youngest surgical disciplines but has a history of important contributions from diverse practitioners. Our specialty is known for its precision, work ethic, innovation, teamwork and patient advocacy. The AANS Diversity Committee is invested in continuing this tradition, by recruiting the best and the brightest minds into neurosurgery and by ensuring that we are a beacon of opportunity for all.
Dr. Abosch is professor, Nancy A. Keegan and Donald R. Voelte, Jr. chair and the inaugural chair of the department of neurosurgery at the University of Nebraska Medical Center and the co-director of the neurosciences services (neurology, neurosurgery, mental health, pain management). She serves as the AANS Secretary.
