Women in Nigerian Neurosurgery: A Cross-Sectional Survey.

BACKGROUND: Although women have made remarkable strides in several medical specialties in Sub-Saharan Africa, their presence and contribution to the development of neurosurgery remain limited. We sought to study the gender differences within Nigerian neurosurgery, identify challenges resulting from these differences, and recommend how African female neurosurgeons can maximize their effects in neurosurgery. METHODS: A structured online survey captured data on neurosurgical infrastructural capacity, workforce, and training from neurosurgical consultants and residents in neurosurgical centers in Nigeria. All the collected data were coded and analyzed. RESULTS: Altogether, 82 neurosurgical consultants and 67 neurosurgical residents from 50 primary medical institutions in Nigeria completed the online survey. Only 8 of the respondents (5.4%) were women, comprising 3 consultants, 2 senior residents, and 3 junior residents. Although 40.2% of the respondents did not believe that being female affected the decision of whether to specialize in neurosurgery, 46.3% believed that being female was a disadvantage. Most did not believe that being female affected admission (57.8%), completion of a neurosurgery residency (58.5%), or life working as a neurosurgeon after graduation (63.4%). The most common challenges women face while navigating through neurosurgery training and practice are erosion of family and social life, lack of female mentors, and lack of a work-life balance. CONCLUSIONS: There is a deficit of both female consultants and trainees among Nigerian neurosurgeons. Identifying female medical students with a strong interest in neurosurgery and providing early mentorship might increase the number of female neurosurgeons.

Mapping the landscape of pediatric neurosurgery: geography, gender, and trends over time.

OBJECTIVE: Recently there has been an increase in pediatric neurosurgical fellowship graduates. It is important to understand the current pediatric neurosurgical workforce to help with prospective strategic workforce planning. The authors sought to determine 1) the geographic distribution and regional retention after training and 2) academic and leadership metrics by geographic location, era of training, and gender for practicing pediatric neurosurgeons in the United States. METHODS: Current practicing pediatric neurosurgeons were identified through American Board of Pediatric Neurological Surgery (ABPNS) certification status and the American Association of Neurological Surgeons directory. NIH RePORTER, Web of Science, and departmental and hospital networking websites were used to collect data on demographics, training, leadership, NIH involvement, and academic metrics. RESULTS: A total of 298 ABPNS-certified pediatric neurosurgeons were identified as currently practicing in the United States. Of these pediatric neurosurgeons, 26.2% were women, 74.5% were academic, and 11.7% have received current or past NIH funding. There were significant differences in the concentration of pediatric neurosurgeons per general population based on region. A total of 117 (39.3%) pediatric neurosurgeons held leadership positions; 4 (1.3%) served as neurosurgery department chairs, 67 (22.5%) served as chief of pediatric neurosurgery (9 of whom were women), 12 (4.0%) served as residency program directors, and 32 (10.7%) served as pediatric fellowship directors. Women were more likely to currently practice in the same region in which they trained for medical school (p = 0.050), have a lower academic rank (p = 0.004), and have a lower h-index (p < 0.001). Pediatric neurosurgeons practicing in the Northeast were more likely to have completed residency (p = 0.022) and medical school (p = 0.002) in the same region as their current practice. CONCLUSIONS: There are differences in the concentration of pediatric neurosurgeons based on region. In pediatric neurosurgery, women hold fewer leadership positions, have lower academic ranks, and are less academically impactful as measured by the h-index. As the demand for pediatric neurosurgeons evolves, thoughtful monitoring of the distribution and composition of the neurosurgical workforce can help ensure equitable access to care across the country.

Fulfilling the specialist neurosurgical workforce needs in Africa: a systematic review and projection toward 2030.

OBJECTIVE: Africa contributes significantly to the global neurosurgical disease burden but has only 1% of the neurosurgery workforce. This study appraises the neurosurgical workforce and training capacity in Africa and projects the workforce capacity by 2030. METHODS: The authors conducted a systematic review of the online literature on neurosurgical workforce and training in Africa obtained from three journal databases (PubMed, Embase, and African Index Medicus), as well as from a gray literature search, between September and December 2020. Included literature passed a two-level screening conducted using a systematic review software by a team of two independent reviewers. Data were extracted from selected articles and documented and analyzed on spreadsheets. RESULTS: One hundred and fifty-nine eligible articles were analyzed: 1974 neurosurgeons serve 1.3 billion people in Africa (density 0.15 per 100,000 persons, ratio 1:678,740), with uneven distribution between the regions. North Africa has 64.39% of the neurosurgical workforce (n = 1271), followed by Southern Africa (12.66%, n = 250), West Africa (11.60%, n = 229), East Africa (8.26%, n = 163), and Central Africa (3.09%, n = 61). At an exponential growth rate of 7.03% (95% CI 5.83%-8.23%) per annum, Africa will have 3418 (95% CI 1811-6080) neurosurgeons by 2030, with a deficit of 5191 neurosurgeons, based on population workforce targets. In terms of training, there are 106 neurosurgery training institutions in 26 African countries. North Africa has 52 training centers (49.05%), West Africa 23 (21.70%), East Africa 15 (14.15%), Southern Africa 14 (13.21%), and Central Africa 2 (1.89%). The major regional training programs are those of the West African College of Surgeons (24 sites in 7 countries) and the College of Surgeons of East, Central, and Southern Africa (17 sites in 8 countries). CONCLUSIONS: The study is limited as it is based on the online literature, some of which includes modeled estimates with questionable reliability. However, the results indicate that while countries in North Africa are expected to surpass their population workforce requirements, sub-Saharan African countries are likely to have significant workforce deficits accentuated by the paucity of neurosurgery training programs. To meet the 2030 population workforce requirements, the continent's exponential growth rate should be scaled up to 15.87% per annum. Scaling up neurosurgical training would help to meet this target and requires collaborative efforts from continental, regional, and national agencies and international organizations.

Do social determinants of health impact access to neurosurgical care in the United States? A workforce perspective.

OBJECTIVE: This study attempts to use neurosurgical workforce distribution to uncover the social determinants of health that are associated with disparate access to neurosurgical care. METHODS: Data were compiled from public sources and aggregated at the county level. Socioeconomic data were provided by the Brookings Institute. Racial and ethnicity data were gathered from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. Physician density was retrieved from the Health Resources and Services Administration Area Health Resources Files. Catchment areas were constructed based on the 628 counties with neurosurgical coverage, with counties lacking neurosurgical coverage being integrated with the nearest covered county based on distances from the National Bureau of Economic Research's County Distance Database. Catchment areas form a mutually exclusive and collectively exhaustive breakdown of the entire US population and licensed neurosurgeons. Socioeconomic factors, race, and ethnicity were chosen as independent variables for analysis. Characteristics for each catchment area were calculated as the population-weighted average across all contained counties. Linear regression analysis modeled two outcomes of interest: neurosurgeon density per capita and average distance to neurosurgical care. Coefficient estimates (CEs) and 95% confidence intervals were calculated and scaled by 1 SD to allow for comparison between variables. RESULTS: Catchment areas with higher poverty (CE = 0.64, 95% CI 0.34-0.93) and higher prime age employment (CE = 0.58, 95% CI 0.40-0.76) were significantly associated with greater neurosurgeon density. Among categories of race and ethnicity, catchment areas with higher proportions of Black residents (CE = 0.21, 95% CI 0.06-0.35) were associated with greater neurosurgeon density. Meanwhile, catchment areas with higher proportions of Hispanic residents displayed lower neurosurgeon density (CE = -0.17, 95% CI -0.30 to -0.03). Residents of catchment areas with higher housing vacancy rates (CE = 2.37, 95% CI 1.31-3.43), higher proportions of Native American residents (CE = 4.97, 95% CI 3.99-5.95), and higher proportions of Hispanic residents (CE = 2.31, 95% CI 1.26-3.37) must travel farther, on average, to receive neurosurgical care, whereas people living in areas with a lower income (CE = -2.28, 95% CI -4.48 to -0.09) or higher proportion of Black residents (CE = -3.81, 95% CI -4.93 to -2.68) travel a shorter distance. CONCLUSIONS: Multiple factors demonstrate a significant correlation with neurosurgical workforce distribution in the US, most notably with Hispanic and Native American populations being associated with greater distances to care. Additionally, higher proportions of Hispanic residents correlated with fewer neurosurgeons per capita. These findings highlight the interwoven associations among socioeconomics, race, ethnicity, and access to neurosurgical care nationwide.

Increases in Subdural Hematoma with an Aging Population-the Future of American Cerebrovascular Disease.

BACKGROUND: Subdural hematomas (SDHs) are a common and dangerous condition, with potential for a rapid rise in incidence given the aging U.S. population, but the magnitude of this increase is unknown. Our objective was to characterize the number of SDHs and practicing neurosurgeons from 2003-2016 and project these numbers to 2040. METHODS: Using the National Inpatient Sample years 2003-2016 (nearly 500 million hospitalizations), all hospitalizations with a diagnosis of SDH were identified and grouped by age. Numerical estimates of SDHs were projected to 2040 in 10-year increments for each age group using Poisson modeling with population estimates from the U.S. Census Bureau. The number of neurosurgeons who billed the Centers for Medicare and Medicaid Services from 2012 to 2017 was noted and linearly projected to 2040. RESULTS: From 2020-2040, SDH volume is expected to increase by 78.3%, from 135,859 to 208,212. Most of this increase will be seen in the elderly, as patients 75-84 years old will experience an increase from 37,941 to 69,914 and patients older than 85 years old will experience an increase from 31,200 to 67,181. The number of neurosurgeons is projected to increase from 4675 in 2020 to 6252 in 2040. CONCLUSIONS: SDH is expected to increase significantly from 2020-2040, with the majority of this increase being concentrated in elderly patients. While the number of neurosurgeons will also increase, the ability of current neurosurgical resources to properly handle this expected increase in SDH will need to be addressed on a national scale.

Current Workforce Status of the Neurosurgery Societies Belonging to the Latin American Federation of Neurosurgical Societies: A Survey of the Presidents of These Neurosurgery Societies.

BACKGROUND: The Latin American Federation of Neurosurgical Societies (FLANC) is a nongovernmental, nonprofit civil association, founded to promote neurosurgery in the Latin American countries. The American College of Surgeons and American Association of Neurological Surgeons has recommended a ratio of 1 neurosurgeon/100,000 inhabitants. We aimed to estimate the neurosurgical workforce of the FLANC in 2020. METHODS: We performed an internet-based survey of the presidents of the societies of the FLANC to obtain the neurosurgical workforce characteristics and demographics in their countries. We coded and blindly analyzed the information for dispersion measures and graphics using SPSS, version 25, and Microsoft Excel for map density building. We obtained ratios for the number of neurosurgeons/100,000 inhabitants and the inverse ratio (the number of inhabitants/1 neurosurgeon). RESULTS: We obtained information from 19 countries. The population totaled 650,008,765 inhabitants. The workforce included 9100 neurosurgeons for a composite within the FLANC of 1.4 neurosurgeons/100,000 inhabitants. The mean ratio among individual countries was 1.17, with as many as 9 countries having a ratio of <1 neurosurgeon/100,000 inhabitants. The proportion of female neurosurgeons in the FLANC was 9.54%. Seven countries had no neurosurgeons in a range of subspecialty fields. CONCLUSIONS: The FLANC has significant disparities in neurosurgical workforce ratios among the member countries. Central American countries probably have the greatest needs. Gender equity should also be improved among the training institutions. We encourage readers to develop future research into the local geographical distribution of neurosurgeons among the countries to better understand their needs and barriers to providing high-quality standards of care.