Elsevier

World Neurosurgery

Volume 160, April 2022, Pages e261-e266
World Neurosurgery

Original Article
Trends in the Neurosurgical Workforce and Implications in Providing for an Aging Population

https://doi.org/10.1016/j.wneu.2022.01.006Get rights and content

Background

The United States is projected to face increasing physician-workforce shortages. However, the shortage in the neurosurgical workforce has not yet been characterized. In the present study, we outlined the current state of the neurosurgical workforce by quantifying the divide between the number of practicing neurosurgeons and the U.S. population.

Methods

The Medicare Physician National Medicare database was queried from 2014 to 2019 to obtain the numbers of practicing neurosurgeons, which were compared with the population counts from the U.S. Census data.

Results

From 2014 to 2019, the total increase in neurosurgeons per capita was 9.4%. The Northeast neurosurgeons per capita rate (NPCR) increased by 17.1%, the South NPCR by 3.4%, the Midwest NPCR by 13.3%, and the West NPCR by 12.5%. In all regions, except for the West, the surgeon per capita ratio had decreased from 2017 to 2019. The greatest increase in the number of surgeons was 2018 to 2019 (n = 214). In 2014, the states with the lowest NPCRs were Vermont, Arkansas, and New Mexico. In 2019, these included Nevada, New Mexico, and Vermont. As of 2020, 56.6% of the neurosurgeons had practiced for >20 years.

Conclusions

Although the national NPCR has slowly increased during the past 5 years, a more recent decrease occurred within the last 3 years. Additionally, with almost 57% of surgeons having been practicing for >20 years, concern exists regarding whether current practices can sustain increasing patient needs. The results from the present study indicate that further investigation is warranted regarding the factors contributing to this shortage and the steps that can be taken to increase the production of well-trained neurosurgeons.

Introduction

The United States is currently facing a physician workforce shortage, with physician supply falling short of increasing healthcare demands from an aging population.1 A recent report by the American Association of Medical Colleges predicted a shortage of 139,000 physicians by 2033.2 Additionally, a large proportion of the current physician workforce is reaching retirement age, and it has been projected that 2 of every 5 physicians will be aged >65 years in the next decade.2 Thus, a clear and present need exists to assess the trends in the physician workforce and identify areas particularly vulnerable to workforce shortages.

Although several studies have investigated trends in workforce shortages in various subspecialties, to the best of our knowledge, no recent study has been conducted in neurosurgery. The goals of the present study were threefold. First, we sought to characterize the scope of the U.S. neurosurgical workforce shortage by quantifying the neurosurgeon per capita ratio (NPCR) from 2014 to 2019 and projecting these numbers to 2030. Second, we characterized the geographic distribution of the neurosurgery workforce across the United States. Finally, we assessed the average years of practice of the neurosurgeons active in 2020.

Section snippets

Data Source

Data on the individual neurosurgeon statistics, including the state of practice from 2014 to 2020, were obtained via the Physician Compare database, provided by the U.S. Centers for Medicare and Medicaid Services. Physicians must bill ≥1 procedure through Medicare within the calendar year to be included in this dataset. Each physician is assigned a unique national provider identifier number. Because this is a publicly available database, no institutional review board approval was required.

Results

From 2014 to 2019, the number of neurosurgeons increased by 588 (13.3%). The total increase in the U.S. population was 9,938,515 people (3.1%), yielding a significant increase in the surgeon per capita rate of 9.4% (range, 1.39%–1.52%; P < 0.00001), encompassing all states. The greatest increase was from 2018 to 2019, by 214 neurosurgeons. If these trends were to continue, by 2030, the United States would be expected to reach a population of 355.1 million, with 5869 neurosurgeons, increasing

Discussion

Physician workforce shortages threaten the stability of the U.S. healthcare systems and could further exacerbate existing socioeconomic disparities. Neurosurgeons will be in increasing demand as the U.S. population ages owing to the greater prevalence of certain neurologic disorders that are more common in the elderly, such as Parkinson disease, brain tumors, and fall-related subdural hematomas. In the present study, we identified trends in the neurosurgical workforce and presented areas that

Conclusions

Our analysis has shown that the current workforce trends, although positive, might not be adequate for future needs of an aging population or entirely reflective of the neurosurgical workforce across the United States. A lack of emergency and trauma neurosurgical care, combined with a recent decrease in NPCR throughout most regions in the United States, suggests that the workforce supply is not increasing uniformly or at a rate that can adequately provide neurosurgical care to the growing U.S.

CRediT authorship contribution statement

Rohin Singh: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing – original draft. Parth P. Parikh: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing – original draft. Nicole M. De La Peña: Writing – review & editing. Archis R. Bhandarkar: Writing – review & editing. Matthew K. Doan: Software. Naresh P. Patel: Project administration, Resources.

References (29)

  • T. Miller

    Neurosurgical workforce shortage: the effect of subspecialization and a case for shortening residency training

  • Story map series – rural America

  • K. Orrico

    Statement of the American Association of Neurological Surgeons, American Board of Neurological Surgery, Congress of Neurological Surgeons, and Society of Neurological Surgeons before the Institute of Medicine on the Subject of Ensuring an Adequate Neurosurgical Workforce for the 21st Century, December 19, 2012

  • O.N. Gottfried et al.

    Neurosurgical workforce trends in the United States

    J Neurosurg

    (2005)
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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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