The Impact of Biological Sex, Medical School Background, and Geographic Location on Diversity in U.S. Neurosurgery Residency Programs.

Background Following an analysis of the National Residency Matching Program statistics, it was found that there is a ratio of 1:1.75 of candidates matching into a neurosurgical residency. The population of students accepted into neurosurgery residency programs appears less diverse compared to other surgical specialties. The objective of this descriptive, observational study is to examine the current trends among students accepted into neurosurgical residency programs and increase exposure to a more diverse demographic within the field of neurosurgery. Methodology A bibliometric analysis of neurosurgical residents across U.S. neurosurgical programs was conducted from 2017 to 2024. Data were collected from the Fellowship and Residency Electronic Interactive Database and residency websites between January and March 2024. Data were further divided into postgraduate years, biological sex, and medical degree. Results A total of 1,608 neurosurgical residents from 116 residency programs were identified. A decreasing trend in osteopathic residents was found from 4.29% of residents graduating in 2025 to 2.12% graduating in 2031. A steady trend was discovered in the percentage of women residents, increasing from 23.33% for residents graduating in 2025 to 30.51% for those graduating in 2031. The highest percentage of osteopathic residents in neurosurgery programs was found in the West Pacific area (8.3%, n = 17), the second highest in the Middle Atlantic (7.8%, n = 26), and the third highest in the West South Central (6.7%, n = 13). The highest percentage of female residents was found in the New England area (37.1%, n = 47), the second highest in the Pacific region (34.1%, n = 68), and the third highest in the South Atlantic (24.7%, n = 80). Conclusions The number of osteopathic residents in neurosurgery programs suggests a potential decline, which could be attributed to geographical, academic, and other factors. The number of female residents suggests a gradual increase; however, future steps toward addressing the gender disparities should be taken.