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AANS Neurosurgeon | Volume 27, Number 1, 2018

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The Future of Diversity in Neurosurgery

Will diversity finally shatter the hallowed halls of neurosurgery? If diversity does gain a foothold, what are the implications for neurosurgeons and our patients? Looking ahead, the question of diversity is critical to the future of neurosurgery.

#MeToo and Beyond

Given the #MeToo movement, the most recent conversations around diversity have been dominated by gender issues, for good reason. Neurosurgery remains a male dominated field with just 6 percent of board-certified neurosurgeons being women. Since the first woman gained board certification in 1961, growth of the number of women has been slow, only passing the 200 mark in 2000; however, the need for diversity is much more than a gender issue. All types of diversity are vital components of our continuing education and influence how we interact with patients and help provide the best care.

Diversity’s Far Reaching Impact

There is no doubt that the effect that increasing diversity will have on neurosurgery will be similar to the advent of CT/MRI on intracranial disease: by seeing a more detailed picture and becoming better equipped to understand and treat patients. This concept is highlighted by a recent study that found female heart attack patients are less likely to die when treated by female emergency physicians1. More importantly, male emergency physicians who have female colleagues have improved outcomes for female patients. Exposure to the perspective of female colleagues, and having more experience treating female patients, seems to improve their ability to care for female patients.

Another poignant example is the team of on-call residents at Henry Ford Hospital in Detroit who speak several languages, with particular fluency in Arabic and Spanish. The ability to interact with patients and their families in their native tongue allows one to discover more reliable information and also gives the family a sense of comfort and trust in the physician. This trust is particularly important when it comes to historically under-represented groups in America. Within many such groups, there remains an underlying aversion to healthcare, largely due to historical and organizational barriers that limit access. Hospitals and clinicians have the opportunity to break these barriers with noticeable representation; diversity disarms a patient’s initial thoughts when seeking care.

The benefits extend beyond just having a heterogeneous group of physicians. Over time, more individuals within these communities begin to confidently establish care. In addition, the diverse neurosurgeon is also now better trained – equipped with the experiences to integrate the differences in language, culture, gender and the history of their patient’s beliefs to establish a profound interpersonal connection. In effect, our small group of surgeons are better prepared to learn, adapt and in some way integrate with patients and communities in a meaningful way. However, another important facet of better patient care is borne out of the relationships that physicians have with one another. Come 2030, neurosurgery will hopefully embrace diversity and reap the many benefits these examples demonstrate. 

Beyond Tradition

The same is not only true for who we are as physicians, but also for how we work. Neurosurgery remains a stronghold for the traditional ways in which we provide care. Weekday office hours and regular OR schedules underpin our days, which are otherwise filled with emergencies and unexpected issues to deal with. Even as there is increasing emphasis on work-life navigation, neurosurgeons tend to hold to traditional schedules and jobs. Yet, our patients are trying to juggle their own medical care amidst family and work responsibilities. Flexible work schedules and job sharing have taken-off in the business world not out of corporate altruism, but because it has been shown to improve talent recruitment and retention, as well as productivity.2 While neurosurgery may not seem to easily lend itself to working remotely or shift-work, today’s technology offers remarkable opportunities to move beyond tradition. Just a few possibilities include:

  • Weekend or evening office hours (beloved by patients)
  • Work from home through virtual/electronic clinics
  • Extended teams through robotic rounds
  • Real-time job sharing and collaboration

As neurosurgeons become more diverse in experience and culture, there can be a more reliable and easier transition among providers. Job sharing can provide flexibility, while ensuring clinical coverage.

Challenges Remain

There still remains a large deficit in knowledge and experience of the multifaceted roles and pressures faced by female neurosurgeons and patients, as well as other underrepresented minorities. As this gap in knowledge decreases and the less traditional work strategies are embraced, the future possibilities for a variety of providers remain limitless. The effect of this new direction will also help to fight burnout due to work-life issues.3 Furthermore, this initiative has the potential to reduce the attrition of women in neurosurgery.4  The key to neurosurgery’s future and the secret to withstanding the changing tide in practice and patient care remains in the deliberate recruitment and retention of diverse, talented and driven individuals.

Reference

1. Greenwood, B. N., Carnahan, S., & Huang, L. (2018). Patient–physician gender concordance and increased mortality among female heart attack patients. Proceedings of the National Academy of Sciences, 115(34), 8569-8574.

2. Mann, A. & Nelson, B. (2017). Thinking flexibly about flexible work arrangements. Gallup.

3. Mcabee, J. H., Ragel, B. T., Mccartney, S., Jones, G. M., Michael, L. M., Decuypere, M., . . . Klimo, P. (2015). Factors associated with career satisfaction and burnout among US neurosurgeons: Results of a nationwide survey. Journal of Neurosurgery, 161-173.

4. Benzil, D. L., Abosch, A., Germano, I., Gilmer, H., Maraire, J. N., . . . Zusman, E. (2008). The future of neurosurgery: A white paper on the recruitment and retention of women in neurosurgery. Journal of Neurosurgery, 378-386.

5. Renfrow, J. J., Rodriguez, A., Liu, A., Pilitsis, J. G., Samadani, U., Ganju, A., . . . Wolfe, S. Q. (2016). Positive trends in neurosurgery enrollment and attrition: Analysis of the 2000–2009 female neurosurgery resident cohort. Journal of Neurosurgery, 834-839.

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