Consequences of inequity in the neurosurgical workforce: Lessons from traumatic brain injury

Abstract

Women and minorities leave or fail to advance in the neurosurgical workforce more frequently than white men at all levels from residency to academia. The consequences of this inequity are most profound in fields such as traumatic brain injury (TBI), which lacks objective measures. We evaluated published articles on TBI clinical research and found that TBI primary investigators or corresponding authors were 86·5% White and 59·5% male. First authors from the resulting publications were 92.6% white. Most study participants were male (68%). 64·4% of NIH-funded TBI clinical trials did not report or recruit any black subjects and this number was even higher for other races and the Hispanic ethnicity. We propose several measures for mitigation of the consequences of the inequitable workforce in traumatic brain injury that could potentially contribute to more equitable outcomes. The most immediately feasible of these is validation and establishment of objective measures for triage and prognostication that are less susceptible to bias than current protocols. We call for incorporation of gender and race neutral metrics for TBI evaluation to standardize classification of injury. We offer insights into how socioeconomic factors contribute to increased death rates from women and minority groups. We propose the need to study how these disparities are caused by unfair health insurance reimbursement practices. Surgical and clinical research inequities have dire consequences, and until those inequities can be corrected, mitigation of those consequences requires system wide change.

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

“…In addressing the broader contextual framework within which neurosurgery operates, it is imperative to consider the varied landscape of health systems across Europe ( Ciulla et al, 2023 ). The efficiency, structure, and outcomes of neurosurgical interventions are deeply influenced by the diversity of health care systems, which range from publicly funded models to hybrid systems incorporating elements of private funding ( Kim et al, 2017 ; Pham et al, 2022 ; Venkatesh et al, 2022 ). This diversity impacts not only access to neurosurgical care but also the availability of resources for training and development within the field ( Robertson et al, 2020 ; Sarpong et al, 2022 ).…”