The 8%: Hear What It’s Really Like for Female Neurosurgeons

“I was not about to let others limit my dreams,” Frances Conley, the first woman to be appointed to a tenured full professorship of neurosurgery at a medical school in the U.S., writes in her 1998 novel Walking Out on the Boys. “Women were just not expected to have any interest in surgery, and certainly did not belong there. No one thought to tell me I could not be a neurosurgeon—the very idea had not been considered.”

Such limiting beliefs were the norm in 1966, when Conley matriculated into her surgical internship as the first female in the program at Stanford University Hospital. [Read about Conley and other pioneering women in neurosurgery here.]

Today, more than 50 years later, the idea of a female neurosurgeon is no longer something unimaginable and yet the number of women in neurosurgery remains very low.

In a landmark white paper published in 2008, the Women in Neurosurgery Society (WINS) set a goal that women would comprise 20% of practicing neurosurgeons by the year 2020. At the time, females only accounted for 5.9% of all neurosurgeons in the U.S.

But when researchers analyzed the Physician Compare National Database in a 2021 study, they found that just 8.2% of the neurosurgeons registered to practice in the U.S. were women.

Despite this, however, female neurosurgeons have made “groundbreaking progress” towards reaching WINS’s initial goal, says Plonsker et al. in their 2022 paper addressing this issue.

Below hear from four women in neurosurgery as they discuss gender-related challenges in their field, their passion for the specialty and what advice they’d give to those who hope to join them one day.

Dr. Linda Liau

Dr. Liau is a professor and Chair of Neurosurgery at UCLA.

She was the second woman to graduate from the neurosurgery residency program at UCLA. She was the first woman chairperson of the American Board of Neurological Surgeons and is currently the only Asian-American female neurosurgery chair in North America.

Q. What made you decide to specialize in neurosurgery?

“I’ve always had a passion for neuroscience since I started medical school. Wanting to do something related to neuroscience, I actually worked in a neuroscience lab looking a serotonin receptors. And then during my third year of medical school, I met a woman neurosurgeon. She was actually one of the first board-certified woman neurosurgeons in the country, Fran Conley.

Having her as a role model was very inspiring and the combination of my passion for neuroscience and the fact that you could apply neuroscience to a surgical subspecialty was very appealing.”

Q. Did you encounter hurdles as a woman in medicine pursuing neurosurgery?

“Yes and no. I think certainly there were some hurdles for women going into neurosurgery and I think there still are. But actually, I never really thought of them as hurdles. I just kind of knew what I wanted to do with my life, and I went for it.

Looking back, were there hurdles? Yes, I recall interviewing at a neurosurgical program and meeting the department chair there and doing all the interviews. And at the end he came up to me and shook my hand and said, ‘You’re a lovely young lady but I don’t think this profession is for you.’

But I didn’t really get too discouraged by that. I just thought that’s the way he felt and moved on. I think I just love this subspecialty so much that I was willing to overlook those kinds of things.”

 Q. What are some of the challenges that you face as a woman in your department?

“I really love my department. I feel very fortunate to be where I am at UCLA. There are certainly the day-to-day challenges, but I don’t really think they’re unique to me or to me as a woman. I think all neurosurgeons have challenges at some points in their careers and they may be different depending on who you are.

But I think those who have stayed in the field for many years have done so because we love what we do and we’re very inspired by our patients.

Every time I have a challenge, the one thing I go back to is thinking about the patients we serve. I must say I’ve had some incredibly inspirational experiences with patients over the years, which have really kept me going.”

Q. Do you feel that you are treated differently as a woman by colleagues?

“Yes, and it’s the same things I think a lot of women face, particularly women in male-dominated fields and I think it becomes more prevalent as you move up the ranks.

For instance, I notice oftentimes in board rooms I’d make a comment but then a male colleague would make the same comment, and they get credit for it. I think that’s the thing a lot of women feel and notice.

At the end of the day that’s still something that happens unfortunately. I don’t think it’s intentional, for the most part. I think these are just subtle behaviors.

I recall recently that I went to meet a hospital CEO at another hospital. We were talking about negotiating some collaborations. I went with my chief administrative officer who happens to be a male. And I remember when we were introduced, he immediately talked to my administrator and shook his hand. And he didn’t really look at me until he was directed to, like, ‘no, no she’s the department chair!’

At this point in my career, I find these moments more humorous than anything else.”

Q. Do you feel like you are treated differently by your patients?

“When I started on the faculty as an attending, I happened to be pregnant at the time. This was 24 years ago, and I could definitely tell that when patients came in, they were not expecting a small, pregnant Asian woman to be their neurosurgeon. I definitely got some strange looks and comments when I was starting out.

But over the years I’ve built my practice and my career by just kind of staying true to what I love to do and to the reason I went into this field—to help and serve patients. So when you ask if patients have treated me differently, looking back, I would say yes, but I don’t really take that as a negative per say. I actually look at is as just part of the job.”

Q. What is one piece of advice you would give to an aspiring female neurosurgeon?

“Follow your passions. I know that sounds kind of cliché, but for either males or females, neurosurgery is a tough subspecialty. It’s a tough profession. You really have to dedicate a lot of yourself in order to succeed. But if this is truly what you want to do, you shouldn’t let anything stop you.”

We need more women in our field. We just need to have a more diverse workforce within our subspecialty and I’m hopeful that will happen.”

Dr. Aviva Abosch

Dr. Abosch is the Nancy A. Keegan and Donald R. Voelte Jr. Chair and the inaugural Chair of the Department of Neurosurgery at the University of Nebraska Medical Center. She is also the Co-Director of the Neurosciences Services (Neurology, Neurosurgery, Mental Health, and Pain Management).

She was the first female President of the American Society of Stereotactic and Functional Neurosurgery, past President of Women in Neurosurgery and third female chair of a North American neurosurgery department.

Q. What made you decide to specialize in neurosurgery?

“I was absolutely fascinated by neuroscience and the development of the brain as an undergraduate, and then I pursued that in medical school while I was getting my PhD. I took a break from medical school and went into the lab to look at the development of the brain, which was fascinating to me. I assumed that when I went back to medical school I would go into neurology, because all of my mentors when I was in the lab were neurologists.

But the University of Pittsburgh, where I was a medical student, had us do surgical subspecialties as part of our third-year requirements, and I ended up doing a couple weeks of adult neurosurgery.

After having spent three years in a laboratory trying to culture neurons and coax them to grow and make connections, being in the operating room and looking at somebody’s brain was absolutely amazing to see. It was amazing to see another living human’s brain. Being able to relieve disease processes in those humans was absolutely extraordinary. It was an epiphany. I decided that I was going to be a neurosurgeon, and I never looked back.”

Q. Did you encounter hurdles as a woman pursuing neurosurgery?

“Were there patients who, during my training, wanted to dismiss me out of hand because I was a woman? Absolutely. But you still have to get the job done.

Has that changed in the 22 years that I’ve been in practice? Some things have changed, and some things have regrettably stayed the same. I was talking with female neurosurgery residents at the University of Rochester recently, and unfortunately they said that despite the fact that they go into a patient’s room and introduce themselves as the neurosurgeon, what people hear is the “nursing surgeon.” And as one of the residents said: ‘What even is that?’

I hope that as the field becomes more diverse, people—the patients that we take care of, the university search committees who select us, the practices that hire us—begin to embrace a version of a neurosurgeon that doesn’t necessarily look like a Caucasian man. Neurosurgeons should be more representative of the diverse populations we serve.”

Q. Do you face any gender-related challenges as a practicing neurosurgeon? Do you feel like you are treated differently by colleagues, staff, patients, or their families?

My colleagues are much more race and gender blind than society at large, in my experience, which is interesting and kind of reassuring about the profession.

Where I trained, the male surgeons’ locker room was upstairs from the main operating room. The female surgeon and nursing staff locker room was past the main desk of the operating room because it was combined. I remember being up all night doing a craniotomy with one of the faculty and we were both exhausted. We were coming out of the operating room, and he was talking to me about the way the case had gone, and he started to walk up the stairs to the men’s locker room, and I had to point out to him that I couldn’t actually follow him there. But I figured that he was accepting of who I was because he had totally forgotten the fact that I couldn’t follow him into the locker room.

There’s other little things like patients who call you “honey;” none of my male colleagues ever got called that. My male colleagues were never mistaken for the nurse. If I walk into the room with a male physician assistant, they’re more likely to look at the physician assistant than they are to me initially.

There was a study done a few years ago where elementary school children were asked to draw a picture of a scientist and 50% of them actually drew a woman in a lab coat, and 50% of them drew a man in a lab coat. By the time people finish high school, the number of people who draw women in a lab coat drops radically. That makes you wonder, how are we altering people’s perception through training and exposure to media, to the arts, etc., so that fewer people see a woman as a scientist as they grow up? It’s an interesting question.”

Q. Looking back, is there any particular patient case or a professional achievement that made any barriers you encountered as a woman in neurosurgery feel worth it?

“It feels really good when more female neurosurgeons are appointed chairman. Karin Muraszko was the first female chair of an academic neurosurgery department in the United States. She had a long and productive career as chair of neurosurgery at the University of Michigan.

After her, Linda Liau became chair of neurosurgery at UCLA. Two years after her, I became chair, so it was kind of reassuring that the pace was picking up. Six months later, Shelly Timmons became chair at Indiana University; she subsequently left that position, but Gelareh Zadeh became the first female neurosurgery chair at University of Toronto, making her the first Canadian female chair of a neurosurgery program. So the pace has accelerated. But there’s far more progress to be made.

However, more than 50% of every graduating medical school class is now female. That’s in stark contrast to the fact that there are so few women in neurosurgery at various levels of training residency—assistant professor, associate professor, full professor, chair, etc. But we’ll get there.”

Q. What is one piece of advice you would give to an aspiring female neurosurgeon?

“I think that there’s now far more examples of people who can serve as mentors. We’ve had two female presidents of the American Association of Neurological Surgeons. That’s fantastic. It took 75 years, but it happened.

Shelly Timmons was the first female president of that society, and now Ann Stroink is president of that society. So you can now look up and see what it would be like to be a woman in neurosurgery, to have a family, if that’s what you’d like to do. And there are women on faculty at multiple institutions around the country.

If this is something that you passionately want to do, there really isn’t a good reason not to do it. It’s been done. That takes the anxiety out of it. If you’re the first person to do something, you don’t always know how you are going to be received. Are there going to be opportunities to advance? How are people going to treat you? But women have done it and are doing it.

If this is something that you really think is for you—and I say really think it’s for you because the work is hard—there are things that you will have to give up for a job that’s as demanding as neurosurgery. Having said that, anything that you’re really passionate about requires sacrifices, so the advice I would give is to ask for advice; stick by your guns, and don’t look back.”

Dr. Jennifer Moliterno

Dr. Moliterno is the Associate Professor of Neurosurgery; Chief of Neurosurgical Oncology; Director of the Susan Beris, MD, Neurosurgical Oncology Program; Clinical Director of the Chênevert Family Brain Tumor Center; Director of the Neurosurgical Oncology Fellowship Program at Yale University School of Medicine. Dr. Moliterno received the award for Excellence in Clinical Care for the Yale Cancer Center in 2022.

Q: What made you decide to specialize in neurosurgery?

“I think I always wanted to be a surgeon, even though I had a childhood fear of blood and needles! I always envisioned that I would enjoy the technical aspect of being a surgeon, which was exactly what I later came to realize as being the delicacy of microsurgery and the challenges associated with the need for such precision. Every move matters. I developed an interest early on in medical school in neuroanatomy, and I found it so interesting that we could know exactly where the lesion was located in the brain, just based on the symptoms and signs of the patient. My love for neurosurgery was very organic in that it allowed me to combine these two interests. I also came to really enjoy working with the particular patient population, especially those with brain tumors, as these are people who very clearly need their doctors when they come to attention and need them to be at their very best to help them.”

Q: Do you think men and women have unique challenges achieving work/life balance as neurosurgeons?

“Absolutely. There are very different challenges for men and women as neurosurgeons. One of the more obvious ones is that we usually complete our rather lengthy and demanding training during prime childbearing years for women, which can have different implications for women and men. For me, I got married during residency, but intentionally waited to start a family until after I had completed my residency. I wanted to be able to have some control over my schedule when I was pregnant and became a mother. I had skipped a grade and went all the way straight through school and so I was always relatively younger, and this served as the best strategy for me, but may not be for everyone.

Balance also depends a lot on how you define it, and this can also be impacted by the partner you choose. My husband is a neurosurgeon, scientist and chair, and therefore quite busy himself. In our family, most of the domestic obligations fall to me, which can be challenging as I have the busiest brain tumor surgical practice in the state of Connecticut. But as I prioritize my work, I prioritize my family. I always make sure I have sufficient time and attention for my husband and our son. I make sure to not only attend every school event, but to really be “present” there and modify my schedule accordingly. Being efficient and good at multitasking helps tremendously. It is arguably not something everyone can pull off and so picking and choosing, even when you are good at it, is important and usually necessary to varying degrees.”

Q: What is one professional accomplishment that you are most proud of as a woman in neurosurgery and why?

“I have worked really hard to build the incredible practice and team I have today. When I first started at Yale after fellowship, I had very few patients and shared an assistant and a nurse, and my office was literally a utility closet. I now have an incredible clinical team comprised of people I have hired based on their own incredible credentials and work ethics, including two assistants, two nurses, two nurse practitioners and a clinical fellow, in addition to my lab and research team. Collectively, we provide a high level of attention our patients deserve and are able to help even more people in our state and beyond. It’s important to recognize that this incredible support from the hospital was afforded to me because of the clinical growth I worked hard to produce, and that growth was a result and reflection of excellent clinical outcomes and patient care, which came from hard work and dedication. And though the question is “professional,” I have to mention my biggest accomplishment is my family as I am most proud of my husband and son!

Q: Can you describe a case that you have had that made you feel proud to be a neurosurgeon?

“Really, all of my cases make me proud to be a neurosurgeon. Every patient and every surgery I perform are all special to me. As I established my practice, I developed a “surgeons’ surgeon” practice, such that other neurosurgeons routinely refer me patients with tumors that have been deemed challenging or even ‘inoperable.’ As a result, my common surgeries are a bit skewed in that they require more complex microsurgery or more sophisticated surgical techniques, like awake craniotomy. Of course, there is an enormous amount of pride I take in that and the challenges I face. Just last week, I had four such cases among other routine ones where I was able to successfully remove tumors others could not and restore neurological function for those patients. It is a true privilege.”

Q: What is one piece of advice you would give to an aspiring female neurosurgeon?

“Go for it! Do your due diligence to make sure neurosurgery is really what you want to do with your life, and if it is, don’t back down. Being a neurosurgeon, and a female neurosurgeon, is challenging, but it is one of the most rewarding and exceptional things to do with your life. If neurosurgery is for you, and you are for it, you can find the right balance for you.”

Dr. Julie Pilitsis

Dean of the College of Medicine and Vice President of Medical Affairs; Professor of Neurosurgery
Florida Atlantic University College of Medicine

Dr. Pilitsis is the first ever female neurosurgeon dean in the United States. She has held multiple national leadership roles and is the president elect of the North American Neuromodulation society and American Society for Stereotactic and Functional Neurosurgery.

Q. Do you face any gender-related challenges as a practicing neurosurgeon?

“Sometimes people have perceptions of how they expect me to look and so many times, even now, I’ll walk in and have to clarify what my role is on the team.

I think that’s always an internal barrier and so I’m pretty assertive when introducing myself now, whether it’s with patients, other doctors or administrators.

[That first moment matters] because if somebody doesn’t know who you are and has a misperception and then you get upset about that, it starts the interaction off on the wrong foot.”

Q. Looking back, is there a particular case that made any barriers you encountered as a woman in neurosurgery feel worth it?

“I perform deep brain stimulation for people with Parkinson’s disease, which is amazingly rewarding because I give people back their quality of life.

Although you typically think of Parkinson’s Disease as an older adult issue, I had one 16-year-old young woman that had a genetic variant that just wanted to be able to go to her prom. To be able to let her do that through this surgery was something that I’m very proud of. That was a meaningful moment.

I’m thankful every day that I’m a neurosurgeon. There’s no other job that I would have chosen had I done it all over again. I think the ability you have to help people in some of their deepest, darkest times is really rewarding.

Every night—and over the course of your career—you can feel really happy that you gave back to your fellow human.”

Q. What is one piece of advice you would give to an aspiring female neurosurgeon?

“You can do it! I actually have had the pleasure of leading some women’s groups and when you ask them, ‘What was the secret to your success?’ They say, ‘It was that somebody was cheering me along, telling me I could do it.’

Don’t lose faith. If I can do this, you can do this. Surround yourself with people that see your talent and will tell you to persevere.  I had many, many mentors along my journey and I wouldn’t be where I was if it wasn’t for those folks. It really does—I know it’s a cliché—take a village.”