Is There a Shortage of Neurosurgeons in the United States?

BACKGROUND: Neurosurgical workforce decision-making is typically driven by the 1 neurosurgeon per 100 000 population ratio proposed in 1977 in the Study on Surgical Services for the United States report. The actual ratio has always been higher than suggested. OBJECTIVE: We evaluated whether the 1:100 000 ratio from the Study on Surgical Services for the United States report is still valid, whether there are enough neurosurgeons in the United States to meet patient needs, and whether demand is driven by patient need. METHODS: For our analysis, the distribution of practicing US neurosurgeons was merged with census data to yield density indices of neurosurgeons by state; a survey assessing practice characteristics was e-mailed to practicing neurosurgeons; and a compilation of job advertisements for US neurosurgeons was evaluated. RESULTS: Multivariant statistical analyses yielded inconclusive results regarding patient demand because existing data sets are not designed to establish patient demand and many neurosurgeons are subspecialized. The data indicated that the ratio of neurosurgeons to total US population is 1:65 580. In the survey responses, neurosurgeon-to-patient ratios varied dramatically by state and were inconsistently correlated with whether neurosurgeons indicated they were overworked or underworked. The 305 job advertisements may indicate a shortage. Twenty-four percent of advertising practices indicated that they are recruiting only for emergency department coverage, and an additional 26% indicated that they might not be recruiting if not for the need for emergency coverage. CONCLUSION: Demand ratios should be reevaluated by region and subspecialty to consider changes in neurosurgery practice. A "shortage" in the employment market may reflect factors other than patient need.