In light of recent progress made in alleviating gender disparities within the neuromodulation field, Magdalena Anitescu (Chicago, USA), Anne Fennimore (Boca Raton, USA), Kiran Patel (New York, USA) and Julie Pilitsis (Boca Raton, USA) of the Women in Neuromodulation (WiN) group—pictured left to right—provide an update on this progress, as well as outlining remaining challenges.
The presence of women in the field of neuromodulation worldwide is currently predicted to be approximately 10%, with even fewer women practising as interventional pain management specialists. Similarly, women represent only 4% of full professors in neurosurgery,1,6,14 and the number decreases further for female neuromodulators and neurosurgeons in leadership roles within academic medicine. For instance, the first and only female neurosurgeon to also serve as dean of a US medical school in 2022 is Julie Pilitsis.
To aid in fostering diversity, WiN was formed in 2015. The goals at that time were to provide more opportunities for women to realise their professional and personal goals, and to foster a continuation of mentorship opportunities for women throughout their careers. WiN provides a platform to share ideas, discuss challenges in the field, and come together in solidarity despite where they are in their career trajectory. The first woman being elected to the North American Neuromodulation Society (NANS) board of directors occurred in 2015. At this time, the board of directors comprised of 32% women, including two women serving as officers.
Since 2015, the WiN reception has been a highlighted social event at NANS annual meeting; and, this year’s International Women in Neuromodulation (iWIN) event in Barcelona, Spain was the most robust in the committee’s history. The scientific programme committee at NANS and the International Neuromodulation Society (INS) have increasingly ensured speaker diversity with 20–30% of women speakers in recent years. Since its inception in 2015, WiN’s efforts have been amplified locally by women physicians and industry partners.
Work to be done
Despite pioneering efforts, there is still work to do. Although data illustrate more women entering the neuromodulation field, many leave during and after residency.13 Further, as faculty, 23.5% of females, compared to 3.55% of males, were not satisfied with their career progression or prospects of receiving similar leadership opportunities in academic medicine.15 Exposure to role models is but one aspect. Mentorship from an early age in STEM is essential. Further, female medical students should be encouraged to pursue careers traditionally deemed male. Educational exposure must be combined with diverse mentors, including those in leadership roles. Among the most cited reasons for women leaving the workforce in neuromodulation are unequal chances for professional development, unfair salary differences, and problems encountered with departmental leadership.9 Women who manage to advance in male-dominated areas of academia also represent a rarity, which may perpetuate unfair scrutiny and professional isolation.5,12
Focused efforts on mentoring and sponsoring women during early career stages is essential, as this is where the greatest amount of attrition occurs
and where dissatisfaction with career progression is found.
To combat these omissions, both NANS and INS established mentorship programmes, and for the past five years, at least one-third of NANS mentor/mentee pairings have coordinated with NANS-WiN. While mentorship and leadership positions among women in neuromodulation have since increased, continued momentum requires sponsorship for women to expand networking opportunities and advocate for the advancement of women to leadership positions.7 Sponsors can be men or women, and are people that have the authority to advocate successfully for others. Sponsors also stake their own reputations in this role.4 Sponsorship and the WiN committees have afforded professional networking opportunities along with forums that provide experiences outside of conferences, given that conferences can present an additional challenge for women.
For women who balance job and caregiver roles, reluctance to attend conferences is often related to long-distance travel, requiring longer than feasible absence from the home. To successfully perform both of these roles, women are less likely to attend conferences when compared to men.16 In some instances, these barriers have been addressed. The National Institutes of Health and Society for Neuroscience, in particular, has arranged or subsidised childcare at meetings to ensure participation.15 The American Society of Anesthesiology annual conference provides mother’s room resources, and permits babywearing and strollers on the exhibit hall floor, but not in educational sessions.2 However, these concessions must also be offered at neuromodulation society meetings. Further, children of appropriate age and majority should be permitted to attend conferences with their parent, regardless of gender.
Women in the literature
While the proportion of women as first authors in high-impact neurosurgery journals increased from 2002 to 2019, senior authorship has lagged—indicating continued disparity in academic advancement for women in neurosurgery.17 Further, as compared with male authors, female authors have published fewer articles as first authors (518 women compared to 2729 men) and senior authors (352 women compared to 2884 men) in neurosurgery journals.3 And, the proportion of women as last authors tends to coincide with the percentage of board-certified women neurosurgeons i.e. 5.4% in 2010 and 6.8% in 2019.10 Women also represent a lower proportion of invited papers than men.18 In addition to addressing women’s presence in editorials, better clarity is needed for defining women’s career rank as it relates to first and last, or senior, authorship. In particular, an increased likelihood of the first author being a woman when the last author was also a woman should be investigated.19
Women are remiss on the editorial boards of top journals too. Their absence from the literature impacts a journal’s ability to benefit from women’s intellect and expert contributions.8,20 Stated another way, by Kirsti Malterud in a 1993 publication in Health Care for Women International, “knowledge is constructed by voice, yet women’s voices are often silent in the factory where medical knowledge is produced”.11 Noting this disparity, Catherine DeAngelis was appointed senior editorial consultant for Neuromodulation and ten women at the top of their respective fields in neuromodulation were added to the journal’s editorial board in 2014. Prior to this amendment, only two of the journal’s editorial board members were women.
Progress continues to be made with each decade as women in neuromodulation come together to shift the narrative of a male-dominated field. Indeed, three authors of this paper have made great strides serving in leadership roles within their respective fields and within national organisations, such as WiN, NANS, and INS, among others. However, focused efforts on mentoring and sponsoring women during early career stages is essential, as this is where the greatest amount of attrition occurs and where dissatisfaction with career progression is found. Increasing leadership opportunities for women neuromodulators and neurosurgeons in academic medicine will provide diverse perspectives on medical education delivery, and offer future generations of women practitioners and researchers with role models who look like them.
- Abosch, A; Rutka, J T. Women in neurosurgery: inequality redux. Journal of Neurosurgery. 2018; 129(2): 277–81.
- American Society of Anesthesiologists. The 2022 Anesthesiology Annual Meeting. https://www.asahq.org/annualmeeting/attend/familyfriendlyoptions.
- Aslan, A; Kuzucu, P; Karaaslan, B et al. Women in neurosurgery: gender differences in authorship in high-impact neurosurgery journals through the last two decades. World Neurosurgery. 2020; 138: 374–80.
- Ayyala, M S; Skarupski, K; Bodurtha, J N et al. Mentorship is not enough: exploring sponsorship and its role in career advancement in academic medicine. Academic Medicine. 2019; 94(1): 94–100.
- Bickel, J; Wara, D; Atkinson, B F et al. Increasing women’s leadership in academic medicine: report of the AAMC Project Implementation Committee. Academic Medicine. 2022; 77(10): 1043–61.
- Doshi, T L; Bicket, M C. Why aren’t there more female pain medicine physicians? Regional Anesthesia & Pain Medicine. 2018; 43(5): 516–20.
- Ibarra, H. A lack of sponsorship is keeping women from advancing into leadership. Harvard Business Review. August 2019.
- Levy, R M. Women in neuromodulation. Neuromodulation: Technology at the Neural Interface. 2014; 17(2): 111–6.
- Lynch, G; Nieto, K; Puthenveettil, S et al. Attrition rates in neurosurgery residency: analysis of 1361 consecutive residents matched from 1990 to 1999. Journal of Neurosurgery. 2015; 122(2): 240–9.
- Mahajan, U V; Wadhwa, H; Fatemi, P et al. Does double-blind peer review impact gender authorship trends? An evaluation of two leading neurosurgical journals from 2010 to 2019. Journal of Neurosurgery. 2020; 135(2): 352–60.
- Malterud, K. Strategies for empowering women’s voices in the medical culture. Health Care for Women International. 1993; 14(4): 365–73.
- РлРВИ. AAMC project committee on increasing women’s leadership in academic medicine. Med. 1996; 71: 799–811.
- Renfrow, J J; Rodriguez, A; Liu, A et al. Positive trends in neurosurgery enrollment and attrition: analysis of the 2000–2009 female neurosurgery resident cohort. Journal of Neurosurgery. 2016; 124(3): 834–9.
- Renfrow, J J; Rodriguez, A; Wilson, T A et al. Tracking career paths of women in neurosurgery. Neurosurgery. 2018; 82(4): 576–82.
- Sabourin, S; Omoruan, M; Khazen, O et al. Diversity in neuromodulators: where we are and where we need to go. Neuromodulation: Technology at the Neural Interface. 2020; 23(2): 145–9.
- Study looks at effects of parenthood, gender on conference attendance and early career satisfaction. https://www.ascopost.com/News/60273.
- Taha, B; Sadda, P; Winston, G et al. Increases in female academic productivity and female mentorship highlight sustained progress in previously identified neurosurgical gender disparities. Neurosurgical Focus. 2021; 50(3): E3.
- Thomas, E G; Jayabalasingham, B; Collins, T et al. Gender disparities in invited commentary authorship in 2459 medical journals. JAMA Network Open. 2019; 2(10): e1913682–e1913682.
- Timmons, S D. Female authorship in neurosurgical journals: what remains to be done. Neurosurgical Focus. 2021; 50(3): E4.
- Welle, C; Asplund, M. Advancing Science: How Bias Holds Us Back. NeuroView. 2018; 99(4): 635–9.
Magdalena Anitescu is a professor of Anesthesia and Pain Medicine at the University of Chicago in Chicago, USA, and a director-at-large of the NANS board of directors.
Anne Fennimore is the director of Marketing and Communications in the Charles E Schmidt College of Medicine at Florida Atlantic University in Boca Raton, USA.
Kiran Patel is the director of Neurological Pain at Lenox Hill Hospital in New York, USA, and secretary of the NANS board of directors.
Julie Pilitsis is the dean of the Charles E Schmidt College of Medicine at Florida Atlantic University in Boca Raton, USA, and president-elect of the NANS board of directors.
DISCLOSURES: Julie Pilitsis is a consultant for Boston Scientific, Nevro, Medtronic, Saluda and Abbott, and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, Saluda, National Institutes of Health (NIH) 2R01CA166379-06 and NIH U44NS115111. She is the medical advisor for Aim Medical Robotics and has stock equity.