Differences in Neurosurgeon Fellowship Specialization by Race

Introduction: The decision to complete a fellowship in neurosurgery is multifaceted and highly individual-specific. One would expect that with equal opportunities to complete fellowships in neurosurgery, there should be relatively equal representation of groups in their respective specialties. We aim to quantify and compare the demographics of neurosurgeons in their choice of fellowship specializations.

Methods: A list of names from the AANS was collected, and information regarding the neurosurgeons’ education and race was compiled from web searches. Each fellowship was documented by the type of specialty, and percentages were calculated via a ratio of each specialty completed to all neurosurgeons that completed a fellowship for each race.

Results: A total of 5307 neurosurgeons were identified from a copy of the 2019 AANS database, and 2978 had their race identified through web-searches. Of the reported races, 77.5% of neurosurgeons were white, 12.4% were Asian, 4.3% were Hispanic, and 3.3% were Black. There were 892 neurosurgeons with reported race additionally had a fellowship reported. Asian and Hispanic neurosurgeons were more likely to complete a fellowship, and most often completed a spine fellowship (27% and 36% of Asian and Hispanic neurosurgeons, respectively). Black neurosurgeons were also most likely to complete a spine fellowship (25%) followed by neuro-oncology (21%). White neurosurgeons were most likely to complete a vascular (28%) followed by pediatric fellowship (19%). A significant difference in racial representation in those completing neuro-oncology fellowships was found (p < 0.05).

Conclusion : There are several factors that impact which specialty a neurosurgeon chooses to complete. Some of these factors may include opportunity, salary, and personal interest. The disparities in the number of neurosurgeons from each racial category make comparisons between neurosurgeons challenging, however, it is clear that neurosurgeons of different races have statistically significant differences in their choice of specialization. Ultimately, the population of neurosurgeons, particularly by specialization, is not representative of the overall US population, and efforts must remain to improve the diversity of the neurosurgical workforce.