Getting more women into neurosurgery: ‘You do belong here’

While women are entering more fields of medicine, neurosurgery remains one area very much dominated by men.

Kelly Mahaney of Stanford Medicine Children's Health

Women account for 36.7% of all the nation's doctors, and more than half of all medical students are women, according to the Association of American Medical Colleges.

Yet women make up about 9% of all neurosurgeons, according to data from the AAMC.

Stanford Medicine Children’s Health serves as an exception, with an all-female pediatric neurosurgery team. The team has regularly included fellows and trainees who are women.

Kelly Mahaney, interim chief of pediatric neurosurgery at Stanford Medicine Children’s Health, said that the department has a strong history of training women.

In an interview with Chief Healthcare Executive, Mahaney discussed the efforts to get more women into neurosurgery, the barriers that women have encountered, and what healthcare leaders can do to make a difference.

“I think that a department where women are well represented is attractive to women trainees,” Mahaney said.

“Every year, we have a number of very strong candidates from the medical school applicant pool,” she said. “And I'm proud to say we have a large number of women faculty in our department. So I think just having that representation, and having a very supportive, collegial environment, makes a positive difference.” (See part of our conversation with Kelly Mahaney in this video. The story continues below.)

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Changing the culture

Neurosurgery is a demanding specialty, and Mahaney doesn’t sugarcoat the difficulties involved in a career in neurosurgery.

“The work hours are, I guess, inhospitable to the many responsibilities that women find themselves on during the early stages of their career. So many women during the years of your life that you would go through neurosurgery training, those are also the years that many women are having families, or doing other things in their lives,” Mahaney said. “And so it's challenging to be able to do both.

“When you're working 100 hours a week, it's challenging to have a family,” said Mahaney, “So I think that that's one deterrent.”

Mahaney is married to a surgeon, a rhinologist, and is raising two young children, so she’s well versed in managing a demanding career with family life. But she said the daunting workload isn’t the primary obstacle that has prevented more women from entering neurosurgery.

“I think a bigger deterrent is just the fact that it's been a historically male dominated field. And for many years, that was the culture of neurosurgery,” Mahaney said.

“I know that aspect of neurosurgery was so one with the culture of neurosurgery that it probably discouraged many women from an interest in this field who otherwise might have been very valuable contributors to the field.”

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Mahaney recalled discouraging treatment she received when she was training.

“When I was a medical student, it was not uncommon to hear from neurosurgery residents or faculty, that women were not welcome in the field,” she said. “I was told I would never be part of the old boys club. I would not be welcomed as a team member.”

“And I had faculty question why I felt that I was justified in applying for a neurosurgery resident as a woman. I was asked that specific question as a medical student,” Mahaney said. “And hopefully these things are unheard of nowadays. But the truth is that there are still people out there who embrace that ideology. And it's only going to change by having more women in the field. And having more women in the field will change the culture of the field.”

It’s worth noting that Mahaney was a medical student in the 21st century. She isn’t recalling memories of training in the 1950s.

“The people who said these things are people who are still around and probably still saying these things,” she said. “It’s just that there are fewer of them now, and there are more voices like mine who are celebrating women in neurosurgery.”

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Reducing barriers

More women are entering neurosurgery, and more women from minority groups are also joining the field, which Mahaney said is long overdue.

She said she’s gratified to see that Stanford Children’s has diverse faculty, ethnically, racially and socioeconomically. She also said it’s encouraging to see more applicants from diverse backgrounds.

“It’s, for me, always very gratifying, always very exciting to see people of any underrepresented backgrounds coming into this field, because I know that they have a lot to contribute,” she said. “And I look forward to seeing a more and more diverse field of neurosurgeons, and the more diversity that we bring to our field, the more enriched it will be.”

Healthcare leaders need to talk to women in neurosurgery about reducing some barriers making it more difficult to remain in the field.

“People in leadership positions can start by listening to their physicians to their surgeons about what is needed to allow them to be successful and what is needed for women to take on leadership roles,” Mahaney said.

“And you know, sometimes it means just having more childcare support or more resources available to women, because there may be only small barriers that are preventing women from taking on leadership roles,” she added. “But also for women to know that it's a priority of the institution and that they will be valued in leadership roles, I think is also really important.”

‘You can do this’

While the demands of the career are formidable to say the least, Mahaney said she feels that she is doing what she is meant to do.

She said she keeps letters from the families of children that she has helped, and those letters provide comfort during tough days and long hours away from her family.

“It’s a reminder that what we do is so valuable to our patients and that we need to make a difference,” she said. “So that's what keeps me going.”

Mahaney also said she hoped to encourage other women to pursue neurosurgery.

“I personally am grateful for the opportunity that I have to do something important in a young child's life,” she said. “I would like to encourage future neurosurgeons for the awesome opportunities that they have ahead of them, and to not be dissuaded by a lot of negativity that is sometimes felt or sometimes circulating. There are negative things about going into medicine these days.”

“But if you stay true to yourself and stay true to the reason why you're feeling called to this field, then you certainly will have a lot to contribute.”

When asked what other advice she would offer medical students, or her younger self, she said, “I would offer encouragement that, yes, you can do this, and you do belong here. And our field is better for having you in it.

“And you can do it all, maybe just not all at the same time,” she added. “But I would just reiterate that our field is better with you in it. And you do belong here. And don't question that.”