Factors Affecting the Choice of Neurosurgery Subspecialty: A Geographic and Gender-Wise Analysis.

OBJECTIVE: To understand the factors that affect decision-making when choosing a specific subspecialty while exploring gender and geographic variables. METHODS: A cross-sectional, 13-item, nonrandomized online survey was created and shared over various social media platforms of the Neurosurgery Cocktail. Data were collected between January and April 2022. The survey focused on the amount of exposure to subspecialties during training, along with factors affecting the decision in choosing a specific subspecialty. RESULTS: A total of 207 respondents, predominantly from Asian and European countries, with an 83.6% dominance of male respondents, completed the survey. The most common subspecialties with maximum exposure were neurosurgical oncology, spine, and neurocritical care and trauma, whereas peripheral nerve surgery and stereotactic and functional neurosurgery were the least exposed. In total, 70% of the respondents had no training or degree in a subspecialty, which was the greatest in Asian and African countries (P = 0.0205). Respondents found the prestige and lifestyle of a skull base neurosurgeon very attractive (P = 0.027, 0.034 respectively), whereas the lifestyle and salary of spine neurosurgeons made it a popular subspecialty (P < 0.001, 0.008, respectively). Personal interest in neurosurgical oncology established its popularity among the respondents (P = 0.028). CONCLUSIONS: Stereotactic and functional neurosurgery and peripheral nerve surgery are the emerging subspecialties and hence their exposure and access are highly limited to the developed world whereas spine and neurosurgical oncology branches had a homogenous geographic presence. Pediatric neurosurgery had the most female representation, thereby necessitating the need to uplift women in other subspecialties.