Women in Neurosurgery: A Personal Contemplation
André Grotenhuis Emeritus Professor of Neurosurgery, Department of Neurosurgery Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
When I entered medical school in 1972 there were just ten female medical students of the total number of 300 new medical students that year. When I started my neurosurgical training, 40 years ago, female neurosurgical residents were an absolute exception, although during my six years of training, two female residents entered the program (but only one finished the training). Also, on a European level the situation was the same. At the European Training Courses there were only a handful of female neurosurgical residents and the number remained marginal until the mid-1990’s. Since then, the number is increasing and, in parallel to the preponderance of female students in medical schools across all of Europe for more than a decade now, the number of women entering medical specialist training programs is increasing. Although the number of women entering neurosurgery training programs and the number of board-certified female neurosurgeons is indeed increasing throughout Europe, the specialty of neurosurgery is not even remotely close to gender parity. Even nowadays, only 2,5% of the neurosurgeons in India are female, 5% of the neurosurgeons in the USA are female, 8% of all neurosurgical consultants in the UK are female, and in my home country, The Netherlands, only 11% of the neurosurgeons are female. These numbers will see some increase soon, in Europe at least, since the number of female trainees in the residency programs is increasing faster now. During my time as residency program director, in the first ten years I had only male residents, but at my retirement I could count that 25% of all my trainees that I ever had in my program were female, so still far from gender parity, but in the last decade it came close to an equal number of female and male trainees.
Nevertheless, women are not reaching the highest positions in medicine for a variety of potential reasons. It is not the abilities of female doctors that are in question. It is that study after study has found women doctors tend to spend less time both in clinical and in scientific work than their male counterparts. Experts admit the unfairness of it all but there is a worrying absence of a profound change in our society in terms of responsibility for childcare. Despite many years of feminist discourse society still expects women rather than men to reduce work commitments to look after children and not to return to full time work until the children are older. There is an urgent need to change this culture and some steps have been made because of the change in attitude towards this issue by the current generation of millennials.
Gender inequity in academic medicine is not unique to neurosurgery. Nonetheless, promotion to full professor, to neurosurgery department chair, or to a leadership position in academia or scientific organisations is exceedingly rare within neurosurgery. There are many bright, competent, and committed female neurosurgeons, so why are they not being promoted in numbers comparable to their male counterparts. No female neurosurgeon has ever been president of the EANS or even been an Officer of the Board, no female neurosurgeon served e.g. as Training Committee chair, one of the most prominent positions within the EANS sections and committees. For more than 40 years since the Training Courses started, there had been not a single female neurosurgeon in the teaching faculty of the Training Courses. Prof. Marianne Juhler from Copenhagen was the first and she remained the only female neurosurgeon to teach at these courses for more than a decade and even now the number of female teaching faculty is extremely low, although roughly half of the trainees during the courses are female.
When I discussed this with female colleagues it was rather disturbing to hear that they still experience situations where they are not being taken seriously, during congresses, during discussion, at courses, etcetera. Even in this third decade of the 21st century, there are still male surgeons blatantly telling a female colleague that there could never be equality because “female simply have some streaks behind by nature”. So, again, this is something that needs a broader discussion in society to create awareness about this inherent gender discrimination that is still prevalent in the mind of males and this only can start by educating the next generation and this should start already very early on in life.
However, I doubt that the solution is to have a section of Women in Neurosurgery within the EANS, which would make gender more important than the simple fact that we are all neurosurgeons. Discussing this with my female colleagues, they expressed the feeling that it would even be offensive to be separated by gender because this should not be an issue, but at the same time say that gender inequity is a reality. From such a statement you can sense the ambiguity of their situation.
What we should do instead is to try to involve female neurosurgeons more actively in the leading organisational positions. It was disappointing to realise that during the last elections for EANS sections, committees, and board positions there was not a single female candidate! This must change, and it will change. For this to happen, the position of female neurosurgeons should be managed from another perspective, considering their needs and aspirations, not men’s, so that they can engage and commit themselves in academia and within scientific organisations which will prepare them for leadership positions.
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