From Interest to Advancement: Confronting Structural Inequities Facing Women in Spine Surgery

Antoinette J Charles; Christiana O Oshotse; O Angel Odukoya; Nachelle Duque; Melissa Erickson; Theresa Williamson; Shaina A Lipa

doi:10.1016/j.spinee.2025.06.007

From Interest to Advancement: Confronting Structural Inequities Facing Women in Spine Surgery

Spine J. 2025 Jun 30:S1529-9430(25)00305-5. doi: 10.1016/j.spinee.2025.06.007. Online ahead of print.

Authors

Antoinette J Charles¹, Christiana O Oshotse², O Angel Odukoya², Nachelle Duque³, Melissa Erickson⁴, Theresa Williamson⁵, Shaina A Lipa⁶

Affiliations

¹ Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA USA.
² Harvard Medical School, Boston, MA, United States.
³ College of the Holy Cross, Worcester, MA, United States.
⁴ Department of Orthopedic Surgery, Division of Spine, Duke University Medical Center, Durham, NC, United States.
⁵ Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States.
⁶ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.. Electronic address: SLIPA@BWH.HARVARD.EDU.

PMID: 40602466
DOI: 10.1016/j.spinee.2025.06.007

Abstract

Women remain significantly underrepresented in spine surgery. Despite growing diversity among medical school matriculants, spine surgery continues to lag behind other specialties in recruiting, retaining, and promoting women across all stages of training and professional advancement. This perspective examines the structural inequities contributing to these disparities, including limited early exposure to the field, lack of mentorship, challenges related to family planning and pregnancy, occupational hazards, and pervasive gendered expectations surrounding work-life integration. We discuss how these issues intersect with systemic barriers such as the minority and woman tax, workplace hostility, and persistent financial inequities in compensation, research funding, and industry partnerships. Together, these factors contribute to lower representation and higher attrition among women in spine surgery, particularly among women from historically underrepresented backgrounds who experience compounded disadvantage. Drawing from national data and recent literature, we present actionable strategies to address these inequities, including early pipeline programs, protected and structured mentorship, standardized parental leave, institutional recognition of diversity-related service, equitable pay structures, and cultural reform across training and professional environments. We highlight initiatives that offer effective models for fostering interest and inclusion. Achieving gender equity in spine surgery requires more than individual resilience-it necessitates intentional, systemic change across institutions, training programs, and professional organizations. Representation is not merely a matter of fairness, but one that directly impacts the quality, innovation, and relevance of spine care in an increasingly diverse patient population.

Keywords: Workforce diversity; diversity; intersectionality; pipeline diversity; spine; spine surgery; underrepresented minorities; women in surgery.