Recruitment of women in neurosurgery: a 7-year quantitative analysis

OBJECTIVE The authors aimed to characterize which US medical schools have the most female neurosurgery residents and to identify potential associations between medical school characteristics and successful recruitment of women pursuing a neurosurgery career. METHODS The authors evaluated a total of 1572 residents in US neurosurgery programs accredited by the Accreditation Council for Graduate Medical Education as of February 2021, representing match cohorts from 2014 to 2020. The authors extracted US medical school characteristics and ranked schools based on the percentages of women graduates entering neurosurgery. They additionally studied yearly trends of the percentage of women constituting incoming neurosurgery resident cohorts as well as associations between female recruitment percentage and medical school characteristics using univariable and stepwise multivariable linear regression (including significant univariable factors). RESULTS The cohort consisted of 1255 male and 317 (20%) female residents. Yearly trends indicated a significant drop in incoming female residents in 2016, followed by significant increases in 2017 and 2019. On multivariable analysis, the following factors were associated with a higher average percentage of female graduates entering neurosurgery: total affiliated neurosurgery clinical faculty (β = 0.006, 95% CI 0.001–0.011, p = 0.01), allopathic versus osteopathic schools (β = 0.231, 95% CI 0.053–0.409, p = 0.01), and top 10 U.S. News & World Report ranking (β = 0.380, 95% CI 0.129–0.589, p < 0.01). When the number of female clinical faculty was added to the model, the variable was not statistically significant. Multivariable bibliometric analyses indicated a higher mean preresidency H-index for men, with an even greater gender difference identified in the 2021 H-index. CONCLUSIONS This study characterizes which medical schools are most successful at recruiting female students who constituted the total neurosurgery resident workforce of the 2020–2021 academic year. The overall number of clinical neurosurgery faculty rather than faculty gender was independently associated with female recruitment. Gender differences in research productivity persisted with control for confounders and increased between preresidency and 2021 time points. Such understanding of factors that influence the recruitment of women can help improve female representation in neurosurgery residency training moving forward.