Relative Shortage of Neurosurgeons in the U.S. Alarms the Medical Specialty

Newswise — Will there be enough neurosurgeons in the United States available to treat my family or me? This is the question that neurosurgeons will address when they present their findings of a recent study, "Trends in the U.S. Neurosurgical Workforce," from 10:20 to 10:30 a.m. on Thursday, May 6, 2004, during the 72nd Annual Meeting of the American Association of Neurological Surgeons in Orlando, Florida. The study, which evaluates the sufficiency of the neurosurgical workforce, will be presented by Oren N. Gottfried, MD; Richard L. Rovit, MD; and William T. Couldwell, MD, PhD. Authors of the study include: Oren N. Gottfried, MD; Richard L. Rovit, MD; A. John Popp, MD, and William T. Couldwell, MD, PhD.

Many factors affecting the field of neurosurgery, including medicolegal pressures and a stagnant number of residency program graduates, have forced to the surface the issue of what number of neurosurgeons nationwide is considered sufficient. It is estimated that from 1963 to 1973, the number of neurosurgeons in the United States increased by 36 percent, and a 1975 report revealed that neurosurgical training rates increased at 6 to 10 times the growth rate for the nation's population, leading to a perception of an excess in neurosurgeons.

More recently, this perception has changed. In a 1997 workforce study that evaluated 21 medical fields, neurosurgery was one of only four fields that did not require significant downsizing to sustain the ideal physician-to-population ratio. Data from the American Board of Neurological Surgeons indicate that the total number of practicing neurosurgeons declined after 1998, and by 2003 the number had dropped to 3,080, fewer than in 1991.

"It is important to note that while the demand for neurosurgeons has steadily increased since 1996, the number of active neurosurgeons has decreased, reflecting a relative shortage in the workforce," said William Couldwell, MD, PhD, an author of the recent study. "To summarize, the shortage in the neurosurgery workforce creates significant new pressures on the specialty, and the factors contributing to this shortage need to be immediately identified, evaluated and addressed."

In the recent study from the University of Utah and Albany Medical Center, neurosurgeons evaluated the total annual number of applicants for neurosurgery residencies, the total annual number of residency graduates choosing to enter neurosurgery, and the total annual number of board-certified practicing neurosurgeons. In addition, the total annual number of available academic and private neurosurgery staff positions was determined by examining all relevant recruitment advertisements in the Journal of Neurosurgery and Neurosurgery for the 10-year period from 1994 through 2003. The numbers of board-certified practicing neurosurgeons, graduating residents, and applicants to neurosurgery residencies were acquired from the American Board of Neurological Surgeons (ABNS) and the San Francisco Match.

The authors found that the number of neurosurgical positions advertised in the Journal of Neurosurgery and Neurosurgery increased from an average of 141.6 per year for a five-year period from 1994 through 1998, to an average of 282.4 per year for the five-year period from 1999 through 2003. It was noted that the total number of positions nearly tripled from a low of 110 in 1995 to 297 in 2003. There were more private practice than academic positions advertised in all years. In addition, the number and percentages of advertisements for subspecialists were higher for academic positions than for private practice positions; the mean percentage of subspecialty positions per year was 36.2 for academic and 6.7 for private positions.

Spine, pediatrics, and endovascular subspecialty positions were among the highest number of private practice and academic positions advertised. The complete list of subspecialty fields included pediatric, spine, vascular, endovascular, oncology, stereotactic, functional, epilepsy, pain, stereotactic radiosurgery (SRS), skull base, and trauma.

"We found that even with the ever-increasing demand for subspecialized neurosurgeons, including spine and endovascular specialists, considering the declining neurosurgical workforce, neurosurgery might lose patients to competing specialties with a greater workforce capacity," said Dr. Couldwell.

The authors noted a number of factors contributing to this decline in the number of neurosurgical specialists. A 2002 report, "Neurosurgery in a State of Crisis," discussed the impact of rising professional liability insurance rates on neurosurgeons. Of the 563 neurosurgeons surveyed, 29 percent of respondents were considering retirement, 43 percent were considering restricting their practices to low-risk surgeries, and 19 percent were considering moving in response to the liability insurance crisis.

In addition, other specialists are taking on pain management cases and performing peripheral nerve, extracranial cerebrovascular and endovascular procedures. Further, neurosurgery residency directors have reported a decreasing interest in the specialty among American medical school graduates. Medical students are pursuing other fields such as dermatology, emergency medicine and radiology, which offer fewer years of training, and a potential for decreased work hours, a regular work schedule, increased vacation time, and increased earnings.

Neither the number of graduating residents, nor the number of incoming residents has changed significantly over the last 12 years. There were 118 graduating residents in 1991 and 124 in 2003. However, in 2003 there were 297 available neurosurgery positions as estimated by advertised job opportunities.

"Neurosurgery is not seen by most medical students as a field that offers a regular work schedule and sufficient personal time," said AANS President A. John Popp, MD, a coauthor of the study. "The results of this study suggest that there is a capacity for more neurosurgeons to be trained in the country. This could be affected by increasing the positive exposure of medical students to neurosurgery."

Overall, the authors indicated that the ongoing trend toward a shortage of neurosurgeons will jeopardize patients' access to neurosurgical care and could limit the future growth of the specialty.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves.