AANS Neurosurgeon | Volume 29, Number 1, 2020


Women in Neurosurgery: Walking the Balance Beam of Life

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You receive a message from the hospital that your patient with an intracranial hemorrhage suddenly deteriorated neurologically and now requires an urgent decompressive craniotomy. Your son’s fifth birthday party is in an hour.

What would you do?

These daily life conflicts are never-ending in the life of a neurosurgeon. Even though it is difficult to contest the exciting challenges and discoveries neurosurgery has to offer, the field does require a considerable amount of ongoing devotion, perpetual learning, tireless surgical technique perfecting and continual exploration of new research and technological developments.

For those who have decided to devote their careers to this inspiring, yet demanding, field it is easy to see how one might neglect or accidentally forget to incorporate previously important personal interests in one’s life; thereby, resulting in a poor “life balance.” However, by entertaining the possibility that some “life balance” may help guarantee a career that is both successful and lengthy, a common question that many female neurosurgery residents ponder is whether it is truly possible to “have it all,” meaning, having both the career and family one desires.

What Does Balance Mean to You?
The term balance means, “A state in which different things occur in equal or proper amounts or have an equal or proper amount of importance,” as per the Merriam-Webster dictionary. When interpreted as such, it may feel overwhelming to imagine how anyone could even fathom attaining the goal of dividing the different components of one’s neurosurgical career like operating, clinic, research, administration, family and personal time equally. Fortunately, there are existing women neurosurgeons who have not only pursued motherhood while continuing to lead successful and highly revered neurosurgical careers, but have also offered to help provide valuable insight into their perspectives and strategies on attempting to achieve their personal idea of balance.

Isabelle M. Germano, MD, FAANS, professor of neurosurgery, neurology, and oncological sciences, director of the Comprehensive Brain Tumor Program and co-director of the Radiosurgery Program of The Mount Sinai Medical Center in New York, clarified that if she interpreted the definition of balance as per its dictionary definition, she could not possibly admit to having life balance and that if her allocation of time were to be expressed in percentages, she would probably exceed 100 percent! Her life predominantly consists of surgery, followed by research, administration and teaching; however, it is her proactive attitude that allows her to create valuable time with her family. She further clarified:

“I believe it is necessary to be constantly off-balance since it is not possible to treat everything equally but rather important to be flexible and prioritize on a daily basis as to what needs my attention.”

Jamie S. Ullman, MD, FAANS, a neurosurgeon at Northwell Health Physician Partners and associate professor at Hofstra North Shore-LIJ School of Medicine, further elaborated on the challenge of achieving work-family balance by stating:

“We are working hard to treat our patients, trying to be academically productive, staying involved in volunteer work for our organizations and, at the same time, trying to make sure that our children and significant others feel and know that they are being attended to and loved. We really do need to understand our limitations so that the most important thing in our lives — our families — do not get sacrificed.”

Even though the women neurosurgeon participants expressed their appreciation for their supportive current working environments, some admitted there was a necessity to seeing certain barriers change in the future. Aviva Abosch, MD, PhD, FAANS, neurosurgeon and professor at University of Colorado Hospital, stated:

“U.S. academic medical centers have yet to achieve anything close to equal percentages of male and female faculty. U.S. neurosurgery is even further behind. The small numbers of neurosurgeons make it difficult for female trainees to peer into the future and see themselves as valued members of the profession, with opportunities for advancement.”

Family Planning
When asked about the optimal time to start a family, the overall consensus was that pursuing a family during residency or fellowship would have been extremely challenging, and as a result, they decided to start their families during the beginnings of their staff years.

Judith Marcoux, MD, a neurosurgeon at McGill University Health Center commented, “It would have been simply impossible at the time with residency requirements; however, times have changed somewhat, and it would be easier now, although still very difficult.”

She further elaborated that she was fortunate to work among other colleagues who also value family, which made for an understanding and supportive environment. This being said, she emphasized the importance of remaining dutiful and focused at work, so that one can earn the respect of their colleagues, so as to receive their support and understanding when needed.

In addition, Dr. Ullman emphasized, “Certainly there should never be a perception on a part of a women in neurosurgery that having children and raising a family is not an option. Every woman should have this right and opportunity, and it is entirely not acceptable for any practice environment to be unsupportive.”

How Do You Want to Be Perceived by Your Children?
A final, important and personal question that was asked of the sample of neurosurgeons was how they wish to be perceived by their children. Dr. Germano highlighted that she strived to teach her daughters the importance of following their passions, whatever they may be, in addition to understanding the necessity of discipline and devotion that is required when pursuing one’s passions.

Dr. Marcoux stressed how, in addition to wanting to be perceived as a loving and caring mother, she also wants her children to appreciate the life-changing abilities her profession has for helping others in dire need, and in turn, she hopes to develop their sense of empathy for others.

Dr. Ullman expressed a desire for her daughter to understand that even if she may not always be physically present, she is always there to help her through life and can hopefully function as a role model for what is possible. Dr. Abosch emphasized that she wants her children to believe that they can reach any goal and hopes they will “view their chosen professions as both a calling and a privilege — an opportunity to help individuals and society.”

These resonating values undoubtedly not only pass down to their children but also pass onto the numerous residents that rotate through their respective programs as they continue to function as inspirational role models for learners in the field of neurosurgery. Even though the women neurosurgeons who participated in this article believed to have not yet achieved “life balance” as per the standard definition, they all possess a sense of fulfillment and satisfaction from both their professional and family lives, which continue to energize and enable them to tackle their daily challenges in ways that appear effortless.

They have helped demonstrate that the term “balance” can mean different things for different people. There is no formula to determine how one should divide up the various components of their lives in order to achieve “life balance,” nor do all the components need to be given equal attention at all times. The flexibility, ingenuity and unrelenting passion that drive these particular neurosurgeons have undoubtedly ensured their success and serve to teach others that it is more important to achieve one’s personal idea of balance.

As Dr. Germano simply explained, “We have to recognize the importance of prioritization; just because we put things on hold, doesn’t mean they will never happen.”


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jodie levitt | March 20, 2016 at 7:30 pm

I am so thankful for the guidance of Dr.Germano. She has been a mentor by virtue of what she has accomplished, in a world difficult for women. Thank you

Russ Pelton | March 21, 2016 at 4:56 pm

The same thing is true in the practice of law. Although a majority of students in many law schools today are women, and most of them get decent law jobs on graduation,only a very small percentage of them become partners in their firms. The reason is not a bias against women. Rather, in my opinion, it’s the difficulty of the women finding that balance between their personal and business lives that causes many of them to drop out of the mainstream of law in favor of raising their children . In my experience, the arrival of the second child that is the fork in the road, and most young woman attorneys choose to be primarily mothers with perhaps part time layering on the side rather than the reverse.