President's Message

Nathan R. Selden

On July 1 of this year, our new residents began work at Oregon Health & Science University (OHSU). For the first time, we had a majority of women trainees. The nine women in the program are also likely the largest number training at a single ACGME accredited program in history. Increasingly, other program directors, department chairs, and our own OHSU graduate medical education team ask me how we got here and what measures they could adopt to achieve the same ends.

The answer is remarkably simple: we were interested in matching the very best medical students, and we saw women applicants as a significant opportunity. We focused on creating a welcoming environment for all applicants, including women, at our interview weekends and worked hard to do the same for the residents already in our program. Women in the program in turn shared their experiences with students and residency applicants, who were then drawn to an egalitarian training environment.

What we have not done is equally important. We have not implemented different board score cutoffs or program requirements for men and women. And while we have not created a family leave carve out for women, we have created a generous leave policy that is supportive of both women and men starting families. Women matching at OHSU have commented that they primarily sought an excellent training experience but were also attracted to programs with a supportive atmosphere that make no distinctions based on gender.

All fields of medicine demand dedication, intelligence, and high performance. In neurosurgery, the impact of individual practitioners on permanent patient outcomes is profound, validating a requirement for uniformly high standards in residency selection and training. Put simply, it is self-evident that not everyone can become a neurosurgeon. However, to paraphrase the Walt Disney movie, Ratatouille, “A good neurosurgeon can come from anywhere.” This light-hearted Disney parable, about a humble animal who becomes a world-class Parisian chef, calls to mind a highly frequent barrier to professional diversity: our own mental and social image of the paradigmatic professional’s appearance, background, and gender.

With regards to women in neurosurgery, there is good news: the proportion of women entering the profession each year as PGY1 trainees has grown to equal their proportion in the applicant pool (about 20 percent). Unfortunately, the proportion of female neurosurgery applicants is no longer growing to match the proportion of women graduating from medical school. Given the significant technical and performance demands of our field, the answer to this challenge is not to change standards. Rather, we must work even harder to increase the proportion of women seeking a career in neurosurgery. To be sure, progress will not happen spontaneously. Neurosurgical leaders, individually and through our national organizations, must actively offer mentorship to every medical student talented enough to join the next generation of neurosurgeons.

Students choose their mentors, not the other way around. However, the very best students will not approach us for mentorship unless we are exemplary role models. They will not stay unless we respond to those precious initial opportunities with openness, warmth, and attention. Given the rigorous demands of our clinical work, this raises interesting questions. What does our neurosurgical lifestyle look like to today’s medical students? Are we positioned to inspire the next generation of neurosurgeons? I believe we can and must demonstrate an unwavering dedication to patients’ welfare, and expect it of trainees. But we should also organize our practices, and our professional lives, to serve as the best leaders and mentors possible, at work, at home, and in our communities.

Most neurosurgeons are leaders not just in their clinical practices, hospital programs, and operating rooms, but also in their churches, synagogues, clubs, teams, and cities. To secure the future of our profession, we should inspire the best women and men to join us, and set an example they can follow with enthusiasm and pride.