Within the medical sciences, the field of neurosurgery stands as a beacon of both awe and challenge, demanding dedication and an intimate understanding of the human brain. However, hidden within this discipline lies an undeniable fact: a glaring gender disparity that persists to this day. 

Indeed, women in medical fields have repeatedly pushed barriers and exposed the systemic challenges present in fields dominated by men. While this fight for equality has increased diversity and access to medical fields, unfortunately, women remain largely excluded from neurosurgery. In particular, a lack of mentorship by women, deep-rooted cultural biases, and institutional obstacles are significant deterrents that dissuade numerous aspiring women surgeons from pursuing their dreams. 

The bleak statistics reveal the problem: despite women constituting a substantial portion of medical school graduates, their presence in neurosurgery remains disproportionately low. For example, a report published by the Canadian Medical Association (CMA) highlights this phenomenon concisely. In 2019, only 11 per cent of neurosurgeons in Canada identified as women.

We had the opportunity to listen to the experiences and insights of Dr. Gelareh Zadeh, a remarkable woman neurosurgeon whose experiences serve both as a testament to the challenges she faced and an urgent call for gender diversity within neurosurgery. 

Lack of women mentors in neurosurgery

A significant barrier in neurosurgery has been the lack of women mentors. Notably, a survey of Rutgers New Jersey Medical School’s female students of 2017–2018 revealed that 88 per cent of the 104 respondents had no senior female mentor in neurosurgery. Mentorship is crucial for guiding prospective applicants to competitive specialties and fostering an inclusive space where applicants do not feel alienated. 

Ultimately, encouraging more women to become neurosurgeons will lead to more women mentors who will help support the next generation of women in neurosurgery. When we asked Dr. Zadeh to share her thoughts on barriers that women face in neurosurgery, she expressed a similar sentiment: “A lack of mentors, role models, and the sense of having allyship and having people that are similar to you in the field… is one of the biggest factors [preventing women from pursuing neurosurgery], so increasing [the] number of people from diverse backgrounds whether it’s females or others is really important.” 

Dr. Zadeh herself is an ardent advocate for change, actively engaged in mentoring young women. 

Systemic barriers for female neurosurgeons

Undeniably, women bring valuable perspectives and skill sets to neurosurgery. Furthermore, women surgeons may better advocate and care for women patients who have trouble connecting with surgeons who are men. It logically follows that more women in neurosurgery will gradually lead to fewer barriers and more equality in neurosurgery. 

However, to achieve this goal, first, we need to remove some of the systemic barriers present to enable women to enter neurosurgery in the first place.

Some of these changes could involve several different modifications to the current system: from having neurosurgery residency spots reserved for women to having mandatory diversity training education for current practicing neurosurgeons.

Dr. Zadeh stressed the imperative to support prospective women surgeons: “A culture shift needs to happen not from the underrepresented or minority group, but they need to have support [from members of the dominant group].” 

Another significant challenge that hinders equality is the prevalence of negative stereotypes that women surgeons face. Many patients have a preconceived notion that women surgeons perform operations worse than their men counterparts. This view discourages women from pursuing surgical subspecialties such as neurosurgery, and is also unfounded. Indeed, a 2023 study led by Dr. Christopher J. D. Wallis, who is involved in the Departments of Surgery at U of T, Mount Sinai Hospital, and the University Health Network, has suggested that patients treated by women surgeons have lower rates of adverse outcomes after surgery compared to patients treated by men surgeons. 

When asked about her personal experience with patients, Dr. Zadeh reflected: “When I was younger, nobody actually thought of me as the neurosurgeon. So I’ve always been asked to do things that, usually, are for nursing staff [such as adjusting the bed]… [I] would explain the procedure and then [patients] would look at me and say ‘when is Dr. Zadeh coming in?’… There were a few patients that didn’t want to have surgery with a female neurosurgeon.” 

Challenges for aspiring or current women neurosurgeons with children

Surprisingly, a major obstacle to achieving equality in neurosurgery comes from medical institutions themselves. These institutions pose numerous challenges to aspiring women surgeons. For example, the long training required for neurosurgery disadvantages women with kids, who are often looked down upon for taking maternity leave.

When asked about unique challenges that women face during their neurosurgery training, Dr. Zadeh provides valuable insights on some of the concerns that aspiring women surgeons might have: “There [are] statistics to show that… the rate of miscarriages in [neuro]surgical residents is much higher than the average population and other medical fields… and of course, after having a child, there are elements of nursing and caring for your baby, and hospital environments aren’t very conductive and supportive of that.”

A 2021 study highlighted that pregnant neurosurgery residents are exposed to toxic chemicals found in research facilities and during surgical operations, which may affect the well-being of a developing fetus. Additionally, many women neurosurgery residents fear discrimination from colleagues for having children, and the lack of access to support resources such as proper maternity leave policies and lactation facilities is well documented. 

The journey to achieving gender equality in neurosurgery is multifaceted, presenting a series of challenges that extend from the lack of female mentors to the deeply ingrained detrimental societal stereotypes to the systemic biases embedded within the medical institutions themselves. 

Overcoming these hurdles requires a concerted effort from practicing neurosurgeons, patients, and institutions. It is the responsibility of society to dismantle barriers to empower every aspiring woman neurosurgeon to ascend the peaks of this field, leading to the best care possible for all patients.