Sticky Floor, Broken Ladder, and Glass Ceiling: Gender and Racial Trends Among Neurosurgery Residents.

Introduction Diversity and equity in academic medicine are critically important in improving healthcare standards and patient-related outcomes. Gender and racial disparities are some major challenges faced by the health system. This article reviews the gender and racial trends among residents of neurosurgery in the United States (US). Methods We retrospectively analyzed the data extracted from the Accreditation Council for Graduate Medical Education (ACGME)'s annual Data Resource Books from 2007 to 2019. ACGME cataloged gender as men and women and race/ethnicity was categorized as White/non-Hispanic, Asian or Pacific Island, Hispanic, Black/non-Hispanic, Native American/Alaskan, others, and unknown. Counts, proportions, relative, and absolute percentage changes were calculated to highlight trends in resident appointments over time and across the specialty of neurosurgery. Results The number of female residents increased steadily from 10.6% in 2007 to 19.3% in 2019; with an absolute increase of 8.74%, a relative increase of 63.9%, and a simultaneous decrease in male residents. When averaged across the nine-year study period, 51% of the study sample was White (non-Hispanic), followed by Asian/Pacific Islanders at 15.2%. The representation of Hispanics was 4.3%, Black/African Americans were 4.5%, Native Americans/Alaskans were 0.2%, and others were 8% of the total study population. Conclusion Our study concludes that gender and racial disparity persist within the neurosurgery residency training programs in the US. Concrete efforts at all academic levels are needed to provide greater support for the females and for the careers of underrepresented minority (URM) trainees to ensure their increased representation in neurosurgery.