Leading the Way: An Overview of Leadership in Canadian Academic Neurosurgery.

BACKGROUND AND

OBJECTIVES

Leadership is essential for advancing patient care, education, and health system performance within neurosurgery. However, the demographic composition, career pathways, and lived experiences of academic neurosurgical leaders in Canada remain poorly characterized. To describe the current landscape of formal leadership in Canadian academic neurosurgery and explore leadership pathways, competencies, barriers, and perspectives using a mixed-methods analysis.

METHODS

A mixed-methods study was conducted across 14 accredited Canadian academic neurosurgery programs. A cross-sectional analysis identified neurosurgeons holding formal leadership roles in 2024 to 2025 using publicly available data. Demographics, training background, subspecialty, advanced degrees, and scholarly productivity were analyzed using descriptive and comparative statistics. Eligible leaders were invited to participate in semistructured interviews, analyzed using inductive thematic analysis.

RESULTS

Forty-four neurosurgeons occupying formal leadership positions were identified. Leadership roles were predominantly held by males (n = 37, 84%), with no association between sex and leadership attainment (odds ratio 0.93, 95% CI [0.36-2.71], P = .82). Median publications were 61 (IQR 27-132), and the h-index was 19 (IQR 12-33). Twenty-five leaders (57%) participated in qualitative interviews. Seven interconnected themes emerged: (1) nonlinear leadership entry and career trajectory, (2) legitimacy grounded in clinical and academic credibility, (3) limited formal leadership training, (4) influence of identity and culture, (5) incentive structures shaping leadership engagement, (6) essential leadership competencies, and (7) consensus-based, service-oriented leadership styles.

CONCLUSION

Leadership in Canadian academic neurosurgery is shaped by informal career pathways, reliance on professional credibility, and limited structured leadership development. Structured mentorship, formal training, and institutional incentives are needed to support future neurosurgical leaders.