- Department of Neurosurgery, Unifacisa University Center, Campina Grande, Brazil.
- Unifacisa University Center, College of Medical Sciences, Campina Grande, Brazil.
- Maurício de Nassau University Center, Recife, Brazil.
- Department of Neurological Surgery, Hospital da Restauração Governador Paulo Guerra, Recife, Brazil.
Correspondence Address:
Luiz Severo Bem Junior
Department of Neurological Surgery, Hospital da Restauração Governador Paulo Guerra, Recife, Brazil.
DOI:10.25259/SNI_817_2020
Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Luiz Severo Bem Junior1, Nilson Batista Lemos2, Júlia de Araújo Vianna3, Juliana Garcia Silva3, Luana Moury Fernandes Sanchez3, Ana Cristina Veiga Silva4, Hildo Rocha Cirne de Azevedo4. Female insertion in neurosurgery: Evolution of a stigma break. 02-Mar-2021;12:76
How to cite this URL: Luiz Severo Bem Junior1, Nilson Batista Lemos2, Júlia de Araújo Vianna3, Juliana Garcia Silva3, Luana Moury Fernandes Sanchez3, Ana Cristina Veiga Silva4, Hildo Rocha Cirne de Azevedo4. Female insertion in neurosurgery: Evolution of a stigma break. 02-Mar-2021;12:76. Available from: https://surgicalneurologyint.com/surgicalint-articles/10623/
Abstract
Background: Utilizing the Brazilian Medical Demography analysis and a literature review, we evaluated how women choose to become neurosurgeons in Brazil and around the world, specifically citing the Europe, the USA, India, and Japan.
Methods: We utilized the Brazilian Medical Demography prepared by the Federal Council of Medicine and the Regional Council of Medicine of the State of São Paulo (2011, 2013, 2015, and 2018). We also included an evaluation of 20 articles from PubMed, the Scientific Electronic Library Online, and National Health Library databases (e.g., using descriptors “Women in neurosurgery” and “Career”).
Results: In Brazil in 2017, women comprised 45.6% of active doctors, but only 8.6% of all neurosurgeons. Of 20 articles identified in the literature, 50% analyzed the factors that influenced how women choose neurosurgery, 40% dealt with gender differences, while just 10% included an analysis of what it is like to be a female neurosurgeon in different countries/continents.
Conclusion: The participation of women in neurosurgery has increased in recent years despite the persistence of gender inequality and prejudice. More women need to be enabled to become neurosurgeons as their capabilities, manual dexterity, and judgment should be valued to improve the quality of neurosurgical health-care delivery.
Keywords: Carrier, Gender disparity, Neurosurgery, Prejudice, Women in neurosurgery
INTRODUCTION
Many women, ahead of their time, dared to overcome the barriers that limited their access to the neurosurgical field. It took until 1945 to produce the first female neurosurgeon in the world, Sofia Ionescu-Ogrezeanu. In Brazil, in 1976, the first Brazilian neurosurgeon was Cleyde Cley da Silva Vescio.
Still, few females have become neurosurgeons in either Brazil or other countries despite the marked increase in female physicians being trained. Here, utilizing data from both Brazilian and 20 studies in the literature we asked what social, economic, and cultural factors impacted woman wishing to choose neurosurgery.
MATERIALS AND METHODS
We studied the Brazilian Medical Demography publications (e.g., prepared by the Federal Council of Medicine (CFM) and the Regional Council of Medicine of the State of São Paulo 2011, 2013, 2015, and 2018), the Regional Councils of Medicine, incorporated into the CFM database, the database from Brazilian Institute of Geography and Statistics, and collected and analyzed data through questionnaires sent to 4.601 physicians.
We also surveyed other medical specialists, extracting data from the National Commission of Medical Residency and the Societies of Medical Specialties linked to the Brazilian Medical Association.
Literature Review: We also utilized PubMed, Scientific Electronic Library Online, and National Health Library databases to identify the 20 studies included in this analysis [
RESULTS
Brazil
Notably, the total number of Brazilian neurosurgeons is 3298 (248 females and 2638 males), and their average age is 49.4 representing than 1% of all medical physicians in the country.[
In 2017, there were about 813 5-year neurosurgical residency spots offered in Brazil, but only 508 s were filled[
United States
In the USA, in 2016, women represented less than 20% of all residents in neurosurgery, and about 6% (259/4178) of all neurosurgeons certified by the American Board of Neurological Surgery.[
However, Dr. James Beane in 2018 spearheaded the Professional Conduct Committee (PCC) in a discriminatory grievance against the 12th board certified female neurosurgeon in the USA, Nancy E. Epstein, M.D the Editor-in-Chief of Surgical Neurology international, on the Editorial Boards of Spine (since 1990), Journal Spinal Disorders/Techniques now Clinical Spine Surgery (since 1990), The Spine Journal (since 2003), Past President of the Cervical Spine Research Society, and author of over 400 peer reviewed publications.[
Europe
At present, almost half of the doctors in Europe are women.[
India
The number of female neurosurgeons in India is small; only 73 of 2500 certified neurosurgeons including female residents in training.[
Japan
In 2018, only 12% of new members of the JNS were women and their total number was <5% of all members.[
CONCLUSION
Despite advances in gender equality in medicine, neurosurgery is still a male-dominated field. Encouraging women during medical school to face the challenges of neurosurgery are essential to change the field, and only having more women in leadership and mentorship positions will increase their impact on this “old boys” system.
Declaration of patient consent
Patient’s consent not required as there are no patients in this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Awad AJ, Sarkiss CA, Kellner CP, Steinberger J, Mascitelli JR, Oermann EK. Impact of neurosurgery medical student research grants on neurosurgery residency choice. World Neurosurg. 2016. 92: 349-52
2. Bean J. Women in neurosurgery. J Neurosurg. 2008. 109: 377
3. Dixon A, Silva NA, Sotayo A, Mazzola CA. Female medical student retention in neurosurgery: A multifaceted approach. World Neurosurg. 2019. 122: 245-51
4. Durham SR, Donaldson K, Grady MS, Benzil DL. Analysis of the 1990-2007 neurosurgery residency match: Does applicant gender affect neurosurgery match outcome?. J Neurosurg. 2018. 129: 282-9
5. Epstein NE. Discrimination against female surgeons is still alive: Where are the full professorships and chairs of departments?. Surg Neurol Int. 2017. 26: 8-93
6. Gadjradj PS, Matawlie RH, Voigt I, Harhangi BS, VleggeertLankamp CL. Gender differences between male and female neurosurgeons: Is there equality for all?. World Neurosurg. 2020. 136: 348-56
7. Klifto KM, Payne RM, Siotos C, Lifchez SD, Cooney DS, Broderick KP. Women continue to be underrepresented in surgery: A study of AMA and ACGME data from 2000 to 2016. J Surg Educ. 2020. 77: 362-8
8. Kutty RK, Mundhe V. Burden of dengue related neurosurgical emergency. Asian J Neurosurg. 2018. 13: 29682044
9. Maehara T, Kamiya K, Fujimaki T, Matsumura A, Hongo K, Kuroda S. A questionnaire to assess the challenges faced by women who quit working as full-time neurosurgeons. World Neurosurg. 2020. 133: 331-42
10. Renfrow JJ, Rodriguez A, Liu A, Pilitsis JG, Samadani U, Ganju A. Positive trends in neurosurgery enrollment and attrition: Analysis of the 2000-2009 female neurosurgery resident cohort. J Neurosurg. 2016. 124: 834-39
11. Renfrow JJ, Rodriguez A, Wilson TA, Germano IM, Abosch A, Wolfe SQ. Tracking career paths of women in neurosurgery. Clin Neurosurg. 2018. 82: 576-81
12. Sandset EC, de Sousa DA, Christensen H, Cordonnier C, Fischer U, Katan M. Women in the European stroke organisation: One, two, many,-A top down and bottom up approach. Eur Stroke J. 2019. 4: 247-53
13. Scheffer M, Cassenote A, Guilloux AG, Miotto BA, Mainardi GM.editors. Medical Demographics in Brazil 2018. São Paulo: Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Federal Council of Medicine, Regional Council of Medicine. 2018. p.
14. Scheffer M, Cassenote A.editors. Medical Demography in Brazil 2015. São Paulo: Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Federal Council of Medicine, Regional Council of Medicine. 2015. p.
15. Scheffer M, Cassenote A, Biancarelli A.editors. Medical Demography in Brazil: Distribution Scenarios and Indicators, Vol. 2. São Paulo: Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Federal Council of Medicine, Regional Council of Medicine. 2013. p.
16. Scheffer M, Biancarelli A, Cassenote A.editors. Medical Demography in Brazil: General Data and Descriptions of Inequality, Vol. 1. São Paulo: Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Federal Council of Medicine, Regional Council of Medicine. 2011. p.
17. Steklacova A, Bradac O, de Lacy P, Benes V. E-WIN project 2016: Evaluating the current gender situation in neurosurgery Across Europe-an interactive, multiple-level survey. World Neurosurg. 2017. 104: 48-60
18. Trinh LN, O’Rorke E, Mulcahey MK. Factors influencing female medical students’ decision to pursue surgical specialties: A systematic review. J Surg Educ. 2020. p.
19. Benzil DL, Abosch A, Germano I, Gilmer H, Maraire JN. The future of neurosurgery: A white paper on the recruitment and retention of women in neurosurgery. J Neurosurg. 2008. 109: 378-86
20. Wolfert C, Rohde V, Mielke D, Hernández-Durán S. Female neurosurgeons in Europe-on a prevailing glass ceiling. World Neurosurg. 2019. 129: 460-6
21. Yagnick NS, Tripathi M. From conversation to transformation: Mens’ perspective on strange nuances of neurosurgical practice for women in India. World Neurosurg. 2018. 117: 411-2