Women in neurosurgery

Abstract

More than 2 centuries ago our nation was founded on the political and moral principles of equality—equal votes, equal rights, and equal opportunities. The principle of equal ity was an ideal not immediately achieved; even the founders’ vision had to expand over time so that its po tential could be realized and include all citizens. The progress toward equality has been halting and uneven and marred by conflict (sometimes violent), hope disappointed, and promise denied. Yet despite prejudicial and cultural barriers, we have come a remarkable distance on the road to equality. Gender, racial, and ethnic barriers have been gradually eroded, though they are nowhere fully demolished. The struggle to reach the elusive ideal continues. Women comprise more than half of medical school class attendees today, yet only account for 10% of neurosurgical residents and 6% of practicing neurosurgeons. Res ipsa loquitur. The barriers may neither be obvious nor even acknowledged, but they exist. A large proportion of our neurosurgical applicant pool is excluded by the lingering fences of prejudice and discrimination through which we can best break by exposing the barriers and helping those blocked to cross them. The discipline of neurosurgery has never attracted overwhelming numbers. Of the 16,000 graduating medical students, only 300 (2%) apply for the 180 residency positions available, and that number has diminished from 400 in the 1990s.1 Neurosurgery attracts a unique pool of individuals willing to learn complex and esoteric anatomy, endure long years of difficult training, treat high-risk neurological conditions, learn challenging and complex surgical procedures, accept profound responsibility, and face extraordinary levels of liability. It will never be a haven for the timid. However, the rigor of training or practice does not justify arbitrary barriers to women entering or advancing within the specialty. We cannot afford the failure to attract the brightest and most talented in the applicant pool when they are excluded by subtle and deniable discrimination. We can neither discourage the rewards of accomplishment nor block the ascension to positions of leadership and authority in our specialty by ignoring or condoning discrimination, no matter how disguised, without stunting the growth of our discipline or, more importantly, unfairly depriving half our potential members of the promise and moral entitlement of equal opportunity. The American Association of Neurological Surgeons Board of Directors requested the “White Paper on the Recruitment and Retention of Women in Neurosurgery” because we believe that fairness and equality are fundamentally right and vital to the future success of our evolving specialty. In recognition of the findings of this report, we acknowledge the need for active measures to ensure that every neurosurgeon enjoys the same benefits and opportunities by dismantling the barriers and offering a hand across the remaining gulfs that separate the privileged from the deserving. (DOI: 10.3171/JNS/2008/ 109/9/0377)