Women ACCOUNT for anywhere from 46 to 60 percent of medical school graduates in the U.S., but only 5 percent of board-certified neurosurgeons, according to the National Institutes of Health. By best estimates, Dr. Ruth Bristol, a pediatric neurosurgeon with Barrow Neurological Institute at Phoenix Children’s Hospital, is one of only four women out of 143 neurosurgeons in the Phoenix area.
The rigorous training, long hours and tough surgeries didn’t scare her off, nor did the naysayers. Her advice to incoming female residents, of which she guesses make up about one of every 10 who cycle through Barrow, is: Stop apologizing. “Don’t apologize for being a woman. The men in our lives – whether it’s our bosses, partners or husbands – they’re going to expect certain things from us, like that we will have the children. There’s no reason to apologize for that because the men can’t do it, so we get to. Making excuses for things like that just draws attention to it. You be you, and as long as you’re doing good work, nobody can find fault in that.”
It wasn’t until 1981 that American hospitals welcomed the first female neurosurgeon, Alexa Irene Canady, also the first African-American neurosurgeon in the country. The first male neurosurgeon in the U.S., Harvey Cushing, earned his medical degree in 1895.
Why such a scarcity of female talent in neurosurgery operating rooms? The training, for one, presents an obstacle, especially for those who want to start a family one day, says Dr. Deborah Benzil, neurosurgeon and vice president of the American Association of Neurological Surgeons (AANS). Neurosurgeons face roughly 15 years of schooling – eight years of undergraduate and graduate studies followed by an average seven-year residency. Comparatively, residency for general surgery is typically four to five years; emergency medicine is three to four.
But Benzil says more women are entering neurosurgery. “We now represent 12 to 16 percent of new resident classes,” though it takes a while to see a change in numbers given the length of training time.
Another challenge facing female residents is a lack of women mentors. “It has long been a male-oriented field, which makes it tough for women to feel that it’s a good fit,” Benzil says. “This is all changing slowly.”
Bristol, 41, one of two female neurosurgeons at Barrow, is proud to say she’s a part of that change. She took the route she did, she says, because of her patients’ optimism. “Kids love to heal. Kids … want to get better and go back to school, so they heal very well.”
She’s used to being asked the stereotypical questions about work-life balance, and gladly tells incoming residents it is “quite doable.” She had the first of her two children when she was a sixth-year resident, but admits, “There is definitely a perception that it’s more difficult [for women] to balance the other desires in your life. It frustrates me sometimes, but I take a deep breath – I choose carefully the things that get my blood pressure up.”
Barrow’s other female neurosurgeon is also, at 30, one of the youngest neurosurgeons in the country. Dr. Laura Snyder, a specialist in minimally invasive spine surgery, says she believes fewer women choose the neurosurgery route because of its lengthy time commitments – schooling, for one, but neurosurgeries are no speedy processes, either. “It’s not like you can just stop [during surgery],” Snyder says. “For a scoliosis spine surgery, I might be standing for eight or nine hours. For a complex tumor, I could be hunched over a microscope for six hours.”
Few other fields of medicine are as male-dominated as neurosurgery. Pediatrics and OB-GYN are split the opposite way, with females entering pediatrics at three times the rate of men and five times the rate of men for OB-GYN. “Orthopedic surgery has percentages similar to neurosurgery, and thoracic surgery is close,” Benzil says. She expects those numbers to slowly rise. “It takes time to get these new folks into the pipeline in order to see changes in practicing numbers. We hope to grow steadily in the decade ahead.”
Head Trip
Barrow Neurological Institute neurosurgeons Laura Snyder and Ruth Bristol talk brains.
Do you remember the first time you saw a brain inside a real, live patient?
Bristol: Yes! It’s not dry and pink; it’s oozing blood and it’s pulsating and it’s really real. I was like, “Wow, that is so cool!”
Snyder: The brain pulsates. To us, it’s very beautiful; to others it might be gross.
What’s most exciting in neurosurgery right now?
Bristol: The world of genetics and prenatal testing – there are a lot of things we’re learning before babies are even born. We can operate on a baby in utero and close spina bifida before a baby is even born.
What percentage of the brain have we figured out?
Bristol: I would guess… the 1 to 5 percent range. So much comes down to electrical signaling. It seems the more we understand about [it] the more we realize how much there is to understand. In my lifetime, I know we’re not going to figure it out.
