Women in U.S. Neurosurgery Residency Programs: Trends, Leadership, and Program-Level Associations.

INTRODUCTION Women's representation in neurosurgery residency has increased over the past decade. To our knowledge, this is the first study evaluating program-level characteristics association with variation in the proportion of women residents.

Methods

Data were collected in 2024 from program websites, AMA FREIDA, and Doximity. Resident gender was manually identified for 1,581 residents across 110 of 118 neurosurgery programs. Associations with women resident representation were analyzed for geographic region, cost of living, compensation, subspecialty offerings, alumni subspecialization, and program research and reputation rankings. Chair and program director gender and full-time paid female faculty analyses were limited by small samples and incomplete public data. Post-hoc sensitivity analyses contextualized limited-data or mismatched-group tests.

Results

Women comprised 27% of residents and 7% of chairs and program directors, whereas 13% of full-time paid faculty were female. No program-level characteristic was significantly associated with women resident representation. However, data for many variables were unavailable for up to half of programs, limiting the strength and generalizability of negative findings.

Conclusion

Women's representation among U.S. neurosurgery residents has nearly quadrupled since the 7% reported in 1990, enabling meaningful contemporary evaluation of program-level variation in representation. However, the available cross-sectional data identified no associated program characteristics. Prior literature suggests women applicants prioritize other core aspects of neurosurgical training when selecting programs. Parallel growth among women residents and female applicants may reflect early exposure, mentorship, and engagement with visible women role models. Greater trainee representation may translate into greater faculty and leadership representation, enabling future evaluation of workforce, cultural, and patient care outcomes.