Faculty Rank, Biological Sex, and Geographical Distribution in U.S. Neurosurgery Residency Programs: A Cross-Sectional Program-Level Analysis
This cross-sectional analysis of U.S. neurosurgery residency programs reveals a significant underrepresentation of women among faculty members, particularly at the full professor rank, highlighting persistent gender disparities that necessitate targeted efforts to improve diversity and mentorship in the field.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Neurosurgery is one of the most demanding fields in medicine, requiring years of intense training to master the delicate art of operating on the brain and spine. For decades, this world has been dominated by men, a reality that has shaped who gets to lead, who gets to teach, and who students see as role models. In recent years, more women have begun to enter surgical training, yet the numbers at the top levels of the profession remain stubbornly low. This imbalance matters because the people who teach and lead a field often determine who feels welcome to join it. When a student looks for a mentor, they often look for someone who shares their background or experience. If the faculty is not diverse, it can be harder for students from underrepresented groups to find their place, potentially limiting the pool of talent and changing the kind of care patients receive. Understanding exactly where these gaps exist is the first step toward fixing them.
A team of researchers set out to map the landscape of neurosurgery education across the United States to see who is actually teaching in these programs. They looked at the faculty members at nearly every accredited neurosurgery residency program in the country, gathering data from public websites and official medical databases. Their goal was to count how many women and how many doctors with a specific type of medical degree, known as an osteopathic degree, were holding teaching positions. They also wanted to see if these teachers were spread out evenly across the country or if they were clustered in certain regions, and whether their rank—whether they were junior teachers or senior professors—made a difference. The study covered 113 programs and included nearly 1,900 faculty members, providing a clear snapshot of the current state of the field.
The results revealed a stark picture of underrepresentation. Out of the nearly 1,900 faculty members studied, only about 12.6 percent were women. The situation was even more pronounced for doctors with osteopathic degrees, who made up just 2.3 percent of the faculty. When the researchers broke these numbers down by job title, the disparity grew wider at the highest levels. Among the full professors, who are the most senior and experienced teachers, women held only 7.6 percent of the spots. In contrast, women made up a larger share of the junior assistant professors, though they were still a minority. This pattern suggests that while more women are entering the field, they are not advancing to the highest ranks at the same rate as their male colleagues. The study also found that osteopathic doctors were almost entirely absent from the senior professor ranks, with only three individuals holding that title.
The researchers also examined whether having more female teachers led to more female students training in those programs. In other fields, a higher number of female faculty often correlates with more female residents, but this study did not find a strong statistical link between the two in neurosurgery. This suggests that simply having female teachers might not be enough to drive recruitment on its own; other factors like location and institutional culture might play a bigger role. The study did, however, find a strong connection between the type of doctor leading a program and the type of doctors working there. Programs led by osteopathic directors tended to have more osteopathic faculty, and programs with female directors had a higher percentage of female faculty. This points to the importance of leadership in shaping the diversity of a team.
Geography played a significant role in who was teaching where. The study found that female neurosurgeons were not spread evenly across the country but were concentrated in specific areas, particularly in the West South Central and Mountain regions. In contrast, osteopathic faculty were most common in the East North Central area. These patterns likely reflect where certain types of training programs have historically been strongest and where mentorship networks are most established. The researchers noted that many of these faculty members work in large urban centers, while rural areas often lack this diversity entirely. This geographic clustering means that a student's location could significantly influence their exposure to diverse role models.
Ultimately, the study confirms that while the field of neurosurgery is slowly changing, deep structural gaps remain. The underrepresentation of women and osteopathic doctors is most severe at the highest levels of academic rank, where decisions about leadership and curriculum are made. The authors suggest that these disparities are not just about numbers but about the visibility of role models and the availability of mentorship. Without visible leaders who look like them, fewer students may feel encouraged to pursue this difficult path. The findings highlight a need for institutions to actively support the advancement of women and osteopathic doctors into senior roles, ensuring that the next generation of neurosurgeons sees a more diverse and inclusive future.
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