How Women Will Disrupt Neurosurgery

Martina Stippler

Dr. Maryam Rahman in action in the operating roomThere are very few neurosurgeons (3,600) compared with the number of physicians in other medical specialties. For example, there are more than 46,000 anesthesiologists and 25,000 orthopedists in the U.S. There are even fewer female neurosurgeons. The most recent data show there are 219 women in the United States who are board certified in neurosurgery, for about five percent of all neurosurgeons, which makes us a superminority. But this will change, as the percentage of female neurosurgery residents has increased from 12% in 2011 to 19% in 2017. This trend is and will continue to disrupt neurosurgery for the better.

This is not an article about who is better; this is an article about diversity and how it can lead to positive change. Is there an inherent difference between genders? A recent article in Harvard Business Review argued that there are wild variations among women and men, but studies have shown that on average the sexes are far more similar in their attitudes and abilities than we think.1 The perceived differences in women compared with men—poor negation skills, low confidence, risk–averse behavior, not putting required hours in at work, valuing their family more than their careers—do not stem from fixed gender traits but rather are in response to a biased organizational structure.2

For example, a sole woman in a room with no other women present to support her might not speak up. This is often perceived as being less outspoken or lacking confidence. The problem of assuming women are less capable or have intrinsic weaknesses leads to workshops and interventions to “fix” women instead of changing the circumstances that give rise to the behavior in the first place.

Surgery is a team sport, and diverse teams perform better than homogenous ones. Diverse teams are proven to be more successful. Fortune 500 companies with diverse leadership are more profitable.3

Women have been differently socialized and offer distinctive strengths, views, and problem-solving strategies. Self-awareness, support for employees, hands-on leadership, embracing leadership as a learning opportunity, toughness, compassion, and empathy are hallmark characteristics of effective leaders. Women, due to different upbringings and experiences, might have a leg up on some of these traits. Anna Terry, a fellow neurosurgeon at Duke University School of Medicine stated, “These perspectives, skill sets, and backgrounds generate the collective wisdom that translates into real-world effectiveness.” This is how women will disrupt neurosurgery and other male-dominated fields.

What ensues when a super-minority grows into less of a minority, or even becomes a majority? This happened in my institution. There were a couple of years when there have been more female general surgery residents than male residents. I asked one of the female residents what changed once they morphed from a minority to the majority. She said, “We are not afraid anymore. We don’t tolerate abuse anymore. We stand up for each other.” It struck me that this is what men have been doing for each other for centuries. This lack of support is a core problem that women face in male-dominated fields.

Gail Rosseau visiting Dar Es Salaam Department of Neurosurgery in Nigeria

To disrupt the status quo, women need to ask for, even demand, support from male colleagues. Chairs and program directors need to go out of their way to make social interaction gender neutral (i.e. have social gatherings at lunch, not around dinnertime). Sponsor female-only gatherings if there is more than one female resident. Dr. Ashwini Sharan, the Neurosurgery Program Director at Thomas Jefferson University Hospital, told me that he is doing just that. He noticed, “[Women] are coming out of their shell when they are among themselves; they are more confident.” Dr. Sharan was the first President of the CNS who recognized that, “minorities need people that look like them” on a board. Under Dr. Sharan’s and Dr. Scarrow’s leadership, there are now four women on the CNS EC.

This isn’t just about gender, it’s also about dual-career couples. The way neurosurgery currently is practiced lends itself to the fully supported worker or “unbounded” talent.1 Once upon a time, spouses—mostly female—did not have competing careers, so they managed home and family life, freeing up the neurosurgeon to meet the demands of a 24-7 job. Today in almost half of the two-parent households in the United States (compared with 31% in 1970), both parents work full time. Over the past three decades, assortative mating—the tendency of people with similar outlooks and levels of education and ambition to marry each other—has risen by almost 25%. Although more households are now dual career/dual income households, women still perform the lion’s share of household duties and child responsibility.4 Therefore, women must pave the way to change neurosurgery by making it more attractive for women and dual-career couples.

This will be disruptive—surgeons will have to be willing to cover for their partners, and departments will have to offer flexile work hours, give credit for work done after hours, and change the culture so the stigma of “leaving early” does not hold women surgeons (who are not fully supported workers) back. And as more neurosurgeons come from dual-career couples, many men might find themselves in similar shoes of not being a fully supported worker. In the end, all genders will profit from these efforts and institutions will benefit from being able to retain and recruit the best and brightest.

Women will help neurosurgery evolve into a more balanced and diverse specialty with the best talent who will improve the outcome of our patients.

References

1) The Talent Management of the dual career couple by Jennifer Petriglieri. Harvard Business Review. May-June 2018.

2) What most people get wrong about men and women by Catherine H. Tinsley and Robin J. Ely. Harvard Business Review. May-June 2018.

3) Is Gender Diversity Profitable? Evidence from a Global Survey by Marcus Noland, Tyler Moran, and Barbara Kotschwar. Working Paper. Peterson Institute for International Economics.16-3, February 2016.

4) Drop the Ball: Achieving More by Doing Less by Tiffany Dufu. Flatrion Books. February 2017.