Differences Among Generations of Women Neurosurgeons in a Department Surpassing the Gender Tipping Point.

Abstract

An increase in the proportion of women in neurosurgery may influence their professional experiences and support needs. This study examined generational differences in a Japanese department where women accounted for approximately 30% of neurosurgeons, an unusually high proportion in the country. A cross-sectional survey with open-ended questions was conducted among women neurosurgeons (n = 34) who had joined our department between 1994 and 2023. Respondents were categorized into the first/second generation (affiliated before 2012, when women represented ≤ 10%) and third generation (2013-2023, when women represented > 10%). Motivations, concerns before the specialty, gaps between expectations and reality, and essential factors for career sustainability were investigated. The response rate was 91.2%. The third generation cited "Interest in surgical procedures" as the motivation for specialty choice more often than the first/second generation (P = 0.006). "Workload and physical/mental burden" were consistent concerns across all generations. The third generation expressed greater concern about "Career development" before choosing neurosurgery. The earlier generations reported larger gaps between expectations and reality, particularly regarding private life, career development, and workplace environment, while the third generation stated fewer discrepancies. Both generations identified "Peer support" and "Life event support" as crucial for continuing their career. Increased representation of women did not decrease demands and gender-specific challenges; rather, the most recent generation placed greater emphasis on systematic support to sustain their specialty skills while managing work-life balance. Efforts to increase women's representation should be accompanied by support structures that address both persistent and evolving needs.