Recently, Young Neurosurgeons Committee (YNC) WINS Liaison Kimberly P. Kicielinski, MD, MPH sat down with WINS chair, Ann M. Parr, MD, PhD, FAANS, FRCSC, to discuss women in neurosurgery and the role WINS plays in promoting women leaders in organized neurosurgery.
Kimberly Kicielinski: Tell me more about your position at Minnesota and your position in WINS (Women in Neurosurgery).
Ann Parr: I’m an assistant professor at the University of Minnesota. I have an appointment as the Director of Spinal Neurosurgery. I also have an appointment with the Stem Cell Institute. I’m 50/50 a clinician and a researcher. In reality, it’s like 100/100. I do 80 percent spine, and the rest general neurosurgery. I run a translational lab on spinal cord injury, and I do stem cell transplantation for spinal cord injury. I also have some clinical trials in spinal cord injury.
I’m currently the chair of WINS. WINS has an ascension structure and holds four positions on the AANS Executive Committee (EC). In the WINS leadership, you start at the treasurer position, and hold each position for a year. There’s an election among the WINS members for the treasurer every year. There are also two members-at-large. In 2014 WINS officially became a joint section, and so now we have a chair rather than a president, and also we have a voice within the AANS and CNS as a joint section.
KK: What attracted you to neurosurgery?
AP: I have been interested in the neurosciences since undergraduate. I did undergraduate research and a thesis in a neuropharmacology lab. That was serendipitous. I was looking around for a research experience, and I ended up in a lab doing fetal alcohol research. It was more that I just felt that the lab was a really good fit for me, and my mentor there was amazing. I thought of doing a PhD and a strictly research career, but then I decided that I thought I was more suited to medicine. I liked the idea of actually treating people. A lot of it was mentorship: I went into neurosciences because I had this great mentor and then the same in medical school. I did seek out a mentor, a plastic surgeon. I almost went into plastic surgery rather than neurosurgery because he was an excellent mentor. He was so encouraging and just really let me do a lot of things so I became interested in surgery. When I was trying to decide my sub-internships, I did some in plastics, but I also decided to do some in neurosurgery because it made sense because I was so interested in neuroscience research and surgery. I got accepted into neurosurgery. I decided that I wanted to do a PhD during my neurosurgery residency which in Toronto is not unusual.
KK: Why do you think there are so few women in neurosurgery?
AP: I think that a lot of it has to do with this myth of neurosurgery. The difficulty of a neurosurgery residency is not a myth. It’s true that it’s very difficult. It really takes a lot out of you. My plastic surgery mentor encouraged me to go into plastics and my research mentor encouraged me to do research, but I can’t think of a single person who encouraged me to go into neurosurgery. A lot of it was discouragement. It was just the idea of, “Why would you really want to do so much work and work so hard. You know you can’t have a family or you can’t get married and you can’t do this and you can’t do that if you’re doing neurosurgery because that has to be your entire life.” I’m not married and I don’t have children, but I could. I think it’s a myth you can’t do all these other things. If you want a huge life where you’re doing all these other things, it’s difficult to do during residency, but I think it’s increasingly easier with the 80 hour work week. It’s still a very difficult residency. I also didn’t know any women who were in neurosurgery when I went into it. I think it’s just this idea that you can’t do it, and I think that’s a myth.
KK: You talked about the challenges of deciding to pursue neurosurgery, but are there other specific challenges you faced in residency or in your career that you felt were more specific to being a female?
AP: We all hear horror stories about overt sexism or misogyny that we all experience as women. Certainly, I’ve had a few of them. The funny thing is that the most discouraging thing is not something that anybody does particularly or that’s focused against you. The thing about being one of the only women in a program is that it’s kind of lonely. It’s like the old locker room story where you feel like everybody else goes into the men’s change room for example, and you’re in the women’s with the nurses. It makes you feel kind of excluded. They [the men] could be the most encouraging or inclusive people in the world, but at the end of the day you still kind of feel like you’re kind not one of them in some sense. And I think that sometimes can be difficult.
My best friends in residency were other female surgeons. In Winnipeg where I started my residency, there was nobody but me. When I moved to Toronto, the program was really big. We had more women in the program than many other programs in the world. We talked about inclusivity and mentorship and how important that really was and is. I became staff here at Minnesota seven years ago, and actually Aviva Abosch, MD, PhD, FAANS, was staff also, and we had a few female residents. Aviva was really good, and she still mentors me a little bit. I didn’t have that ever before in actual neurosurgery. There are other mentors in other aspects of your life but they don’t really understand necessarily what it is to be a neurosurgeon. Aviva is somebody who also has put my name forward for things. I find myself all of a sudden getting asked to speak at events, at AANS, being asked to do breakfast seminars. I’m pretty certain that at least a couple of those things came because she was sitting on the scientific committee, and they said, “Who can speak on this?” and she put my name forward. If we all do it for each other then I think all of sudden we get asked to do things. In some ways I’m on the other side of things now. WINS has given me the opportunity to sit on the scientific committees, and now I realize how arbitrary a lot of the speakers on some things are. Literally they sit around and go, “Let’s have a talk on this. Who is an expert in that area?” If you happen to know an expert then you say that person’s name but if it’s mostly men around the table, they may not know you are an expert in that area. The other thing we have with WINS is the speaker’s bureau that covers things like tumor, CV, pain, and other things like education, mentorship. If you feel like you are qualified to speak in an area, we encourage everybody to join the list. It’s well known that women don’t feel as qualified to do things that they’re generally very qualified in doing. I have to say the list of female neurosurgeons is still disappointingly short, but I think that will change now that a lot more women are graduating – in WINS our fastest growing subsection is the residents and medical students.
KK: Why do you think it’s important to train women?
AP: I think the most important thing is to train the best people. If you just look at the facts, the facts are that 50 percent at least of the medical school classes graduating now are women. As a profession, we want the best people in neurosurgery. If we’re not having 50 percent women applying to neurosurgery, then there is something wrong, because we’re missing out on some of the best and brightest who just aren’t interested. Early exposure and encouragement to women are important. Male mentorship is important. Obviously we want to target women so that we have the best and brightest, not so that we don’t have any men interested – we want the best and brightest men interested as well.
KK: How can we encourage more women to go into neurosurgery?
AP: I think early exposure and mentorship are two key things. There are a lot of people, including men, that don’t think about neurosurgery because they just aren’t exposed to it because a lot of medical schools don’t have neurosurgeons come in. I also screen residency applicants every year and there are a lot of applicants who have been doing a lot of neurosurgery related research for years. There aren’t many people who just decided at the last minute that they wanted to do neurosurgery. I think that’s why early exposure is so important. At the University of Minnesota I’m the faculty liaison for the neurosurgery interest group, so I think that’s really important to make sure everybody is aware of the possibilities and what’s out there. I think mentorship is really important. If a medical student asks me to mentor them or meet with them or shadow me, I will never turn them down. I’ve learned over the last few years, I have to say no now to undergrads, or high school students. I’ve found that there’s not enough of me to go around, because I’ve been the only women neurosurgeon at the medical school for the past few years. The one thing that I’ve tried to do is to match the people requesting mentoring with the female residents and even sometimes with the male residents. They may have a little bit more time for mentoring than I do, and what residents do is far more interesting than what I do. Students have a seven year residency that they have to get through first so I think it’s more practical for them to see what’s coming up
KK: How does WINS support females in neurosurgery?
AP: We have a tripartite mission of education, leadership, and mentorship. Three years ago when we became a joint section, we were granted a scientific session during the AANS and CNS. We tried that once. We realized that actually wasn’t the best strategy because what it did was take female presenters away from their subsequent section because it ran at the same time as the CV section or the Pain section. We really didn’t want that, and we stopped having those scientific sessions. We said, “What’s a meaningful way that we can contribute?” That’s when we decided to really focus on these other three things.
We have integrated programming. We had a leadership seminar and two lunches, one was on education, and the other was on mentoring at the last CNS. In the spring at the AANS, we have the Louise Eisenhardt breakfast, which we have every year. This year we’re had Angela Duckworth, who wrote the book Grit, talk about the power of perseverance and how you can develop that skill. We also have a faculty development seminar that we’re doing in conjunction with another group. We also have a lunch and learn mentoring session where we’re going to send around a request for people that want to be mentored and more senior people who want to mentor, and we’re going to match people up so that one day they can sit down and eat lunch together and talk about different issues, very unstructured, very informal. We’re hoping that leads to more fruitful mentor-mentee relationships.
We’re also doing a different thing where we’re going to have symposia within a rotating subsection. This past year we had the first annual WINS retreat, and there were 60 registrants, in conjunction with the National Neurotrauma Society. We also did this with the Spine section. I do mostly spine, and also Marjorie Wang is the chair of the spine section this year, and she’s only the second woman to ever hold that position. WINS had a symposia on the psychology of leadership where we talked about Myers-Briggs testing and how that impacts your personality and your leadership skills and potential for leadership.
These activities aren’t only for women. We also don’t want to be exclusive of men. Again, what would be best for the profession in general would be to have the best and brightest of both men and women. Men also need encouragement, and they also need mentorship. While we focus on women, it’s not to the exclusion of men. WINS is open to everyone. We have a general meeting at the AANS and at the CNS, and it’s always on the Sunday preceding the meeting at 11:30am at the hotel headquarters. It’s a lunch. It’s informal. People can come in and out if they have conflicting meetings, but everybody, both men and women are welcome. Young people are especially encouraged to come and get involved. If you come, we’ll find a job for you, a way to get involved.