“You don’t look like a neurosurgeon,” is a comment I hear frequently in and out of the hospital. While I am grateful to be in a residency program in which diversity reigns, the comment still demands reflection on what it means to be a neurosurgeon in the 21st century. We have made some progress in expanding representation in our field. The rate of women entering neurosurgery residency has increased from 13% to 18% in the past 10 years. However, we have a long way to go. The rates of Hispanic and Black individuals entering neurosurgery resident is stuck at about 4% in the same time period.1
So, how can we continue advancing diversity in neurosurgery? A recent article by Feng et al2 found a substantial, though improving, gender gap in our field. One of the bright spots was the Brigham and Women’s department, in which 22% of faculty are women. I had the pleasure of interviewing the department’s chair, Dr. Antonio Chiocca, to understand his perspective on diversity and thoughts on how to achieve it in academic neurosurgery:
What changes have you noticed in our field in terms of diversity?
“When I entered training, neurosurgery was an extremely male dominated field. In my residency program, there were 3 women. In the last 20-25 years, the pipeline for women in neurosurgery has increased dramatically and significantly, but we still need to do a better job. We need more chairwomen and more women in neurosurgery leadership nationally. Groups underrepresented in medicine (URiM) have a very small representation in our field, and this shortcoming is present across all of medicine and needs to be improved.”
Why is diversity important?
“We benefit from diversity. Throughout human history, diversity has brought out the best in everything. Sometimes I think the argument becomes about diversity versus meritocracy. Some argue that you do not want to sacrifice meritocracy for diversity. I would make the argument that you can find perfectly equal or sometimes even higher-merit URiM candidates than the more traditional types of candidates. I think it is time to move on from the diversity versus meritocracy argument.
“I see examples of people with diversity advancing the field every day. Women are just as committed in our department to research, technical and surgical advances as men are –sometimes even more so. This is great to see.”
How did you achieve high levels level of diversity in your department? Was there a strategy behind it?
“I wish I could tell you that there was a grand plan or secret sauce behind it. For me, it was just about keeping an open mind. I had to keep the traditional thinking that neurosurgery is comprised of men of a certain race, which is biased, out of the equation. I look at the merits without that lens of bias. Additionally, if you have a diverse residency program, which we do, then you already have a rich pipeline of future faculty candidates that are diverse and well-trained.
“I would advise other programs hoping to increase their diversity to make sure to have a diverse pool of applicants across all positions, including for residency, fellowship, and faculty positions. That might necessitate reaching outside traditional channels and calling and asking about certain candidates. In terms of residency applicants, there are specific guidelines on recruiting so there exist some limitations. However, if you have women and URiMs in your residency program, they could be helpful role models for interested medical students.”
Are there unique challenges that you have noticed women and/or URiM faculty face?
“Each faculty member has a different need. You must remember that people are at their best when they feel content, satisfied and in a state of wellbeing. As a chair, you must listen to people and their needs, and you must be flexible in providing what your staff needs. I do annual faculty meetings, but most often I have impromptu chats with my colleagues in the clinic, the operating rooms or at the office.”
Any final advice for us who are women or URiM?
“I say to women and people of diversity: keep it up! Be persistent. It’s a tough road. But what we do is a privilege, and it is worthwhile. We benefit from diversity, and the field is changing to that end.”
We will keep it up! Diversity will make neurosurgery better. And neurosurgeons have always striven to improve.
References
- 18. Yaeger K, Munich S, Byrne RW, Germano IM. Trends in the United States Neurosurgery residency Education and training over the 2009-2019 decade. JNS Neurosurg Focus 48(3):E6, 2020. PMID: 32114562
- Feng R, Hoffman SE, Wagner K, Ullman JS, Stippler M, Germano IM. Women neurosurgeons in academic and other leadership positions in the United States. World Neurosurg 147:80-88, 2021 PMID: 33358734
