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

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. 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.

NIH funding trends for neurosurgeon-scientists from 1993-2017: Biomedical workforce implications for neurooncology.

INTRODUCTION: Neurosurgeons represent 0.5% of all physicians and currently face a high burden of disease. Physician-scientists are essential to advance the mission of National Academies of Science (NAS) and National Institutes of Health (NIH) through discovery and bench to bedside translation. We investigated trends in NIH neurosurgeon-scientist funding over time as an indicator of physician-scientist workforce training. METHODS: We used NIH Research Portfolio Online Reporting Tools (RePORTER) to extract grants to neurosurgery departments and neurosurgeons from 1993 to 2017. Manual extraction of each individual grant awardee was conducted. RESULTS: After adjusting for U.S. inflation (base year: 1993), NIH funding to neurosurgery departments increased yearly (P < 0.00001). However, neurosurgeon-scientists received significantly less NIH funding compared to scientists (including basic scientists and research only neurosurgeons) (P = 0.09). The ratio of neurosurgeon-scientists to scientists receiving grants was significantly reduced (P = 0.002). Interestingly, the percentage of oncology-related neurosurgery grants significantly increased throughout the study period (P = 0.002). The average number of grants per neurosurgeon-scientists showed an upward trend (P < 0.001); however, the average number of grants for early-career neurosurgeon-scientists, showed a significant downward trend (P = 0.05). CONCLUSION: Over the past 23 years, despite the overall increasing trends in the number of NIH grants awarded to neurosurgery departments overall, the proportion of neurosurgeon-scientists that were awarded NIH grants compared to scientists demonstrates a declining trend. This observed shift is disproportionate in the number of NIH grants awarded to senior level compared to early-career neurosurgeon-scientists, with more funding allocated towards neurosurgical-oncology-related grants.

The Pursuit of Training Meritorious Learners of Diverse Backgrounds: Mayo Clinic College of Medicine and Science.

The doors of the Mayo Clinic College of Medicine and Science (MCCMS) are open to all meritorious learners, including learners who come from communities that have endured longstanding and profound health and economic disparities. In our contemporary world, upward mobility in socioeconomic status is often a function of successful attainment of higher education. One may justifiably ask if all sociodemographic groups in the United States have equal access to higher education so they can gain knowledge and acquire skill sets often necessary to lead a productive life. Several biopsychosocial factors may determine as to whether those that see the "mountain" of higher education at a distance will eventually succeed at surmounting obstacles to rise to the highest peaks. In this article, our earlier experiences are analyzed with the goal of offering insights into novel approaches to train meritorious learners from all sociodemographic groups, including those who come from underserved communities. In addition, we highlight an apolitical and academically rigorous social cognition model that informs the contemporary academic agenda of diversity and inclusion, and we trace its root to the work of the founding father of experimental social psychology.

An Analysis of Political Contributions from Neurosurgeons in the United States.

BACKGROUND: As the uncertainty surrounding the future of U.S. health care policy intensifies, political advocacy and campaign contributions have become increasingly relevant. This study describes the trends of political contributions of U.S. neurosurgeons from the years 2003-2019. METHODS: Individual contribution data from 2003-2019 were obtained from the Federal Election Commission website. Contributions were filtered for occupation lines matching either "neurosurg," "neurologic surgeon," or "neurological surgeon." Each contribution is designated to a recipient committee associated with a political candidate or group. The party designations of these committees were used to catalogue donations as "Republican," "Democratic," or "Independent." RESULTS: From 2003-2019 a total of 9242 political donations were made by self-identified neurosurgeons amounting to $8,469,121. Most of these contribution dollars were directed to Independent committees (47.9%). Of all Independent contribution dollars from 2005-2019, 95.9% were directed to the American Association of Neurological Surgeons Political Action Committee. The total number of unique contributions increased from 442 contributions in 2003 to 650 in 2019. Democrats experienced the most substantial increase in support, from 4.8% of all contribution dollars in 2003 to 26.3% in 2019. Republican support was noted to be more widespread across the United States compared with Democratic support. CONCLUSIONS: Political contributions from U.S. neurosurgeons have increased steadily over time. Donations were largely Independent but became increasingly partisan in recent years. Overall, this displays an increase in political involvement among the neurosurgeon community. Future studies are warranted into how this involvement translates to representative health policy.

Preoperative assessment of meningioma stiffness using magnetic resonance elastography.

OBJECT: The object of this study was to determine the potential of magnetic resonance elastography (MRE) to preoperatively assess the stiffness of meningiomas. METHODS: Thirteen patients with meningiomas underwent 3D brain MRE examination to measure stiffness in the tumor as well as in surrounding brain tissue. Blinded to the MRE results, neurosurgeons made a qualitative assessment of tumor stiffness at the time of resection. The ability of MRE to predict the surgical assessment of stiffness was tested using a Spearman rank correlation. RESULTS: One case was excluded due to a small tumor size. In the remaining 12 cases, both tumor stiffness alone (p = 0.023) and the ratio of tumor stiffness to surrounding brain tissue stiffness (p = 0.0032) significantly correlated with the surgeons' qualitative assessment of tumor stiffness. Results of the MRE examination provided a stronger correlation with the surgical assessment of stiffness compared with traditional T1- and T2-weighted imaging (p = 0.089), particularly when considering meningiomas of intermediate stiffness. CONCLUSIONS: In this cohort, preoperative MRE predicted tumor consistency at the time of surgery. Tumor stiffness as measured using MRE outperformed conventional MRI because tumor appearance on T1- and T2-weighted images could only accurately predict the softest and hardest meningiomas.