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OBJECTIVE  In 2008, a Women in Neurosurgery Committee white paper called for increased women applicants and decreased women’s attrition in neurosurgery. However, contributing factors (work-life balance, lack of female leadership, workplace gender inequality) have not been well characterized; therefore, specific actions cannot be implemented to improve these professional hurdles. This study provides an update on the experiences of neurosurgeons in 2020 with these historical challenges.    METHODS  An anonymous online survey was sent to all Accreditation Council for Graduate Medical Education (ACGME)–accredited US neurosurgical programs, examining demographics and experiences with mentorship, family life, fertility, and workplace conduct.    RESULTS  A total of 115 respondents (64 men, 51 women; age range 25–67 years) had trained at 49 different US residencies. Mentorship rates were very high among men and women in medical school and residency. However, women were significantly more likely than men to have a female mentor in residency. During residency, 33% of women versus 44% of men had children, and significantly fewer women interested in having a child were able to do so in residency, compared to men. Significantly more women than men had a child only during a nonclinical year (56.3% vs 19.0%, respectively). Thirty-nine percent of women and 25% of men reported difficulty conceiving. The major difficulty for men was stress, whereas women reported the physical challenges of pregnancy itself (workplace teratogens, morning sickness, etc.). Failed birth rates peaked during residency (0.33) versus those before (0.00) and after residency (0.25).  Women (80%) experience microaggressions in the workplace significantly more than men (36%; p &lt; 0.001). Ninety-five percent of macro-/microaggressions toward female neurosurgeons were about their gender, compared to 9% of those toward men (p &lt; 0.001). The most common overall perpetrators were senior male residents and attendings, followed by male patients (against women) and female nurses or midlevel providers (against men).    CONCLUSIONS  Accurate depictions of neurosurgery experiences and open discussions of the potential impacts of gender may allow for 1) decreased attrition due to more accurate expectations and 2) improved characterization of gender differences in neurosurgery so the profession can work to address gender inequality.

Neurosurgeons in 2020: the impact of gender on neurosurgical training, family planning, and workplace culture