I met my fiancé, Owen, almost seven years ago in Sacramento. At the time, he was 27 and juggling a sales career and thoughts of returning to school to complete his undergraduate degree. I suspect that the last thing he was looking for was a guy with an aging Weimaraner, who was never home before 8 pm, and who might steal away at 2 am in the dark of night. However, our mutual respect and admiration just “worked,” and he felt safe and secure enough to sideline his career to finish an undergraduate degree in sociology, and next month his Master’s degree in Communication Studies with an emphasis on diversity, equity and inclusion, with aspirations for a career focused on assisting professions like ours to recognize the value of diversity in the workforce. Our evenings now mostly center on hours of food preparation, good wine, managing three Weimaraners and robust conversation that comes from two men growing up in different times, in different ways, and with different views of what the world must look like in the future. But we always seem to come back to a common thread – MY professional world needs to decide how it will put in the conscientious effort to diversify and grow, to ensure neurosurgery’s collective future success and continued relevance in a social world that increasingly demands variability and the inherent value that comes from it.
Having grown up in the Midwest and studied in the South, all I ever saw around the operating table were a bunch of straight white dudes, other than my early neurosurgical mentor at Emory University, Dr. Suzy Tindall. As head of Emory’s residency program in the 1980s, Dr. Tindall was an inspiration to young recruits who could feel her passion for neurosurgical training. While I didn’t know why she took such a keen interest in my career at the time, I suspect that, in retrospect, her own desire to fit into a straight white man’s profession as a gay woman married to a man, and her ability to “read the room” led her to know what I might be up against as I entered my residency. While she had hoped that I would stay on at Emory to complete my training, she counseled me at the time that I should consider heading out to San Francisco to Dr. Charlie Wilson’s program at UCSF, which she confided was the best in the country at that time.
I took her advice and was sold immediately on the prospect of training in San Francisco, mostly for the incredible dining opportunities (not that one could afford much on a resident’s salary back then), Napa Valley wine country, and mesmerizing fog that rolled daily across the iconic Golden Gate Bridge which the residency room overlooked. It also happened to be, as my fellow medical students at Emory quickly pointed out to this naïve Midwest boy on match day, the Mecca for gay men and women on the West coast, a fact that clearly had been overlooked in my previous education in Ohio. My first experience witnessing the “Dykes on Bikes” at the LGBTQ parade in 1986 immediately made me realize that I was, “not in Kansas anymore!”
While I did not talk much about my sexual orientation at UCSF, my colleagues and mentors all came to know that I was partnered to a man with whom I lived throughout the majority of my time in San Francisco. Despite my concern that my sexuality might be cause for dissension, I never saw anything but support and acceptance from members of the neurosurgery department and among my co-residents there. I was also privileged to work with five outstanding female neurosurgical residents and fellows during my time there, which was almost unheard of in a competitive academic department 30 years ago. I ultimately left UCSF and took over as head of the Neuroscience Department at Sutter Health Valley Division in Sacramento in 2003, where we now have over 60 neuroscience clinicians throughout Northern California who care for almost 250,000 patients, including 40,000 new patients, annually.
Diversity in the workplace is a desirable component of all successful professions. Studies have shown that companies that embody a cross section of the population demonstrate better problem solving capability, increased creativity, more robust policy development and improved profitability (1), while allowing for employee satisfaction through a perception of increased representation. We see that diversity play out to a great degree in healthcare among our clinical support staff, administrators, technicians, and nurses. However, if one looks specifically at organized neurological surgery on a national level, it is still quite clear that neurosurgery in this country remains a white man’s world, with only eight percent of ABNS certified neurosurgeons identifying as female (2, 3), and less that four percent black, despite the fact that over 50 percent of medical school graduates are women. Socioeconomic disparities result in most medical students coming from families that fall in the top 20 percent of income earned year after year, further adding to the homogeneity and monotony of our workforce.
While we are beginning to devote more attention on a national level to this lack of inclusion among our peers, most articles have mainly centered on gender and race, with no attention paid to the challenges that different sexual identities aside from mainstream heteronormativity may play in the success of a neurosurgical trainee or young academic neurosurgeon. We all share the need to face grueling, stressful days and nights on duty as a neurosurgical trainee, often with limited praise, low compensation, serious sleep deprivation and time away from family and friends. However, some of us face an entirely different added pressure as well – the fear that discovery of our sexual orientation could lead to reprisal, ostracism or even termination.
- Kim, EE, Klein, AL, et al. Diversity in Neurosurgery. World Neurosurgery, 2021. Jan; 145: 197-204.
- 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
- Benzil D, Abosch A, Germano IM, Gilmer Holy, Maraire N, Muraszko K, Pannullo S, Rosseau G, Schwartz L, Todor, R, Ullman J, Zusman E. The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. J Neurosurgery 109: 367-375, 2008
