Gender Differences in Publications, Authorship, and Match Patterns Among Neurosurgical Residency Applicants.

Recent efforts have highlighted gender disparities in neurosurgery in leadership, conference involvement, and scientific productivity. Despite efforts to improve diversity, systemic barriers persist. Given the weight publications carry in the neurosurgical match, this study analyzes gender differences in publication metrics among matched neurosurgical residency applicants, identifying opportunities to increase female representation. Neurosurgical residents from the 2023 match were examined using PubMed, Scopus, and departmental websites for detailed publication information, program details, gender, and medical school. Of the 242 successfully matched applicants, male applicants tended to work with male senior authors (84.62% vs 76.68%, P = .044), and more female applicants worked with female senior authors (23.21% vs 15.33%, P = .045). Having a female senior author increased odds of female first authorship (odds ratio = 1.64, 95%, P < .001). Compared with female-identifying applicants, male-identifying applicants had more publications (11.80 vs 6.78, P < .001), first-authorships (3.88 vs 2.00, P < .001), higher H-indices (4.74 vs 3.27, P < .001), and more unique senior authors (5.63 vs 4.37, P = .036). Male applicants published more often in spine (P < .001). Geographically, female applicants were more likely from the West, least likely from the South (P = .036), and more likely to match at home programs than male applicants (32.8% vs 19.8%, P = .037). For matched neurosurgical applicants, gender of the senior author influences likelihood of junior authorship. Specifically, having female senior authors correlates with increased likelihood of publication for female applicants and is associated with female first authorship. Gender disparities persist in publications: male applicants typically publish, collaborate with senior authors, and work with male senior authors at higher rates. These results highlight systemic barriers female applicants face in preparing competitive applications and ensuring equal residency acceptance. Research instruction and active mentorship of female applicants from both male and female neurosurgical mentors is critical to improving gender disparity in neurosurgery.