Gender disparity and workforce trends in German neurosurgery: A longitudinal national analysis

Neurosurgery remains one of the most gender-imbalanced specialties worldwide, with women continuing to hold only a minority of positions, especially senior levels despite their growing presence in the medical field.

This study aimed to quantify gender-specific workforce trends in German neurosurgery from 1991 to 2023 and to project the future proportion of female neurosurgeons.

A retrospective longitudinal analysis was performed using official national registry data from the German Medical Association and the Federal Health Reporting System. Trends in gender distribution, sectoral employment, and board certification were analyzed. Linear and segmented regression models were used to forecast future representation.

The quota of female neurosurgeons increased from 6.2 % in 1991 to 21.9 % in 2023. Women were more often employed in inpatient care (23.5 %). Projections based on historical workforce data estimate female representation to reach 25.9 % by the year 2030. The female share of the neurosurgical workforce is estimated to reach the 30 percent critical mass threshold by the year 2039 (95 %CI: 2037.5-2040.7). Compared to other specialties, neurosurgery along with orthopedic surgery remains among the most gender-imbalanced fields.

Despite a steady increase in female representation in neurosurgery in Germany, substantial disparities remain across all age groups and employment sectors. At the current pace, only one-quarter of the neurosurgical workforce will be female by 2030, with gender parity unlikely to happen before 2079. Strategic interventions, including mentorship and family-friendly policies, appear to be essential to accelerate equity and retention within the field.