Diversity in Neurosurgery: Trends in Gender and Racial/Ethnic Representation Among Applicants and Residents from US Neurological Surgery Residency Programs

OBJECTIVE: To assess trends in gender, racial, and ethnic diversity of applicant pools and subsequent resident cohorts in neurosurgical residency programs in the United States. METHODS: Applicant and residency data from 2009 to 2018 were analyzed from the Electronic Residency Application Service, Journal of the American Medical Association, and National Resident Matching Program to evaluate trends in diversity. RESULTS: There was no statistically significant difference between applicant sex from 2009 to 2013 compared with 2014 to 2018 (P > 0.05). From 2009 to 2018, the percentage of female residents saw a statistically significant increase from 12.9% to 17.5% but remained less reflective of women's representativeness in the United States (50.8%). The percentage of Black and Hispanic applicants decreased across the observed period (4% and 1%, respectively). While Black people represented 5.2% of the resident pool in 2009, this decreased to 4.95% by 2018. Hispanic residents saw a <2% net increase (5.5% to 7.2%) in resident representation but still fell behind when compared with census statistics. The application pool did not see a significant change in the percentage of White and Asian applicants; however, the percentage of residents did decrease slightly over the observed decade. CONCLUSIONS: Current efforts to improve racial and ethnic diversity have not been sufficient in generating parity in the recruitment and retention of racially under-represented groups in neurosurgery. Although the presence of women in applicant and resident pools has increased,