Meaningful change in culture urged to save neurology, reduce gender gap

Allison Brashear, Dean of the UC Davis School of Medicine, is working to save the future workforce of neurology and to reduce the gender gap in the medical specialty.

More trained neurologists are needed to meet the demand for care in the U.S. More trained neurologists are needed to meet the demand for care in the U.S.

In an editorial published Dec. 3 in the journal Neurology, Brashear and colleague Nina Schor call for meaningful changes in the culture of the field—ones that aren't portrayed as concessions to accommodate women's shortcomings or special needs. Schor is deputy director at the National Institute of Neurological Disorders and Stroke.

"Burnout among all physicians and the persistent predominance of men in the neurology workforce are widening the gender gap, at a critical time when the demand for neurologists is only expected to increase," Brashear said.

In the U.S. alone, the number of trained neurologists is expected to increase by only 7% by 2025, while the projected demand for services places the increased need at 16%.

"As women increasingly make up medical school classes, choose medical fields in which they can earn the same salaries as their male colleagues, seek positions that provide flexibility in workload and work hours, and retire before 65 years of age, the specialty needs to evolve to both meet these needs and prevent the burnout that may result in early retirement and part-time status," Schor said.

Reducing the gender gap in neurology means addressing a variety of factors, from burnout and women leaving the field, to the difference in pay between male and female neurologists—a gap which is one of the largest in any medical specialty.

"In many fields and on six continents, women physicians, nurses, physician assistants and residents deal with larger clinical workloads, longer clinical hours, lower salaries and more personal caregiving and homemaking duties than their male counterparts," Brashear said. "There are also fewer women in leadership positions to advocate for change. Only 14 of 113 neurology department chairs are women."

The authors believe identifying and mitigating these factors may help narrow the gender gap and increase the supply of neurologists to better meet future patient needs. They suggest structuring positions to give more time to complete administrative tasks, offering more flexible work hours, providing daycare at the workplace, setting salaries at a level that encourages hiring help for daily tasks and chores in the home, and making it routine for all early career neurologists (men and women) to have mentors for personal and career support.