Should we take a stand to increase diversity? Yes! As neurosurgeons, we should talk about diversity in neurosurgery. If we don’t urge, even force change, it will not happen, or it will happen unbearably slowly. One hundred years into the history of neurosurgery, only 5% of all board-certified neurosurgeons are women. African-Americans are also underrepresented. The Association of American Medical Colleges (AAMC) calculates that African-Americans represent 4% of all active neurosurgeons in the U.S.
Why does diversity matter? There is a compelling business case to be made for supporting equity and striving for inclusion. Companies with 30% or more women in the C-suite have reported higher profits than companies without women in their leadership team. A diverse workforce brings diverse perspectives, experiences and skills to the table, and it pays off.
The benefits of diversity aren’t limited to the corporate world. Diversity of opinion leads to better outcomes and fosters innovation and creativity across a variety of disciplines. The diversity of our patients should be reflected in the physicians who provide them care. Although we are all the same under the scalpel — cultural, religious, socioeconomic, ethnic and racial differences play a significant role in patient-physician relationships and impact patient satisfaction, patient compliance and health care outcomes. As surgeons, we need to continually enhance our awareness of and ability to manage our biases and racial/ethnic identity. We need to apply our critical appraisal skills, honed to perfection, to treat our seriously ill patients, to recognize that both explicit (conscious) and implicit (subconscious) biases can stand in the way of increased diversity and inclusion and prevent some of our patients from having the best outcomes possible.
Although neurosurgery has a more diverse group of residents than ever before, we need to work hard to retain these residents long-term and make sure they succeed. Female gender is one of the leading factors associated with burnout and attrition in our specialty. This is not due exclusively to the long and unpredicted work schedules related to the specialty. Microaggressions, lack of collegial relationships and tolerance of unacceptable behavior by faculty should be considered as well. These insidious factors can fester in a workplace culture because of a lack of mechanisms and implicit barriers for reporting, such as fear of shame, retaliation, or not advancing. Many minorities experience overt and implicit forms of discrimination. This may be exhibited openly from patients who mistake someone for a nurse of a janitor or refuse care from a minority physician. Sadly, this can come in more hidden ways from peers who won’t put a resident in a challenging case because of race or gender.
It is not enough to focus on micro-level interventions — we also need to look at organizational structures and attitudes that push women and minorities away from neurosurgery. It has been shown that interventions focused on cultural competencies in health care organizations improved the hospital’s diversity climate. These interventions have focused, among other aspects, on diversity attitudes, implicit bias and racial/ethnic identity status. However, too many health care organizations and departments approach diversity with a sense of tokenism instead as a business imperative and driver of strategy.
In his 2004 bestseller, “Moneyball,” Michael Lewis wrote: “What begins as a failure of the imagination ends as a market inefficiency: when you rule out an entire class of people from doing a job simply by their appearance, you are less likely to find the best person for the job.” All medical specialties want to attract the best and brightest young people. Diversity strengthens neurosurgery. Attracting people with different strengths
and backgrounds to our profession can help unleash new sources of talent and creativity that can only benefit our profession and our patients.
Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #WomenInNeurosurgery and #CelebratingWINSat30.
Martina Stippler, MD, FAANS, FACS
Beth Israel Deaconess Medical Center
Boston, Mass.
media platforms, neurosurgeons can participate in 
Angela M. Richardson, MD, PhD
Sheri Dewan, MD, MS, FAANS
unique and close working relationship with Harvey W. Cushing, MD, who is regarded as the father of modern neurosurgery. Dr. Eisenhardt was considered Dr. Cushing’s “right hand.” Before deciding to go to medical school, she began work in 1915 as an editorial assistant for Dr. Cushing. She continued to work for him while enrolled at Tufts University School of Medicine. Dr. Eisenhardt later rejoined Dr. Cushing as a neuropathologist and served as his surgery associate from 1928 to 1934, making on-the-spot diagnoses of tumors and tissues as Dr. Cushing removed them. While continuing to make pathologic diagnosis of tumor tissues, she kept a cumulative case log, co-authored papers with Dr. Cushing and 
significant impacts in the field of neurosurgery. In 1986, 
Neurological Surgery (ABNS) in 1961. In addition to her many other accomplishments, she served as president of the Washington Academy of Neurosurgery in 1972. In 1986, she became the first female neurosurgeon to become a lawyer. In 1981, 
Slowly over time, I became aware that I was not alone, and my experiences were similar to others. Unfortunately, others experienced far worse. (See Table 1). Those of us in the first wave of women in neurosurgery — training in the 1970s to early 1990s — naively hoped that our increasing numbers, sheer presence and leadership positions would lead to change. We had hoped that such behavior belonged only to the past. Sadly, we realized that was not the case. When those efforts seemed ineffective, many of us quietly tried to rally neurosurgical leadership around efforts to try and improve the situation. Yet we were often met with disbelief there was a real problem.
I am proud to have co-authored the manuscript 
