Workforce Pressures Concern Tomorrow’s Neurosurgeons
How do we, as a specialty, deal with the progressive shortage of neurosurgeons available to serve our patients? The cover story in this issue of the AANS Bulletin quantitatively documents a trend toward a shortage of neurosurgeons and suggests some of the reasons underlying this trend. One of these reasons, as neurosurgeons know all too well, is the medical liability crisis that has prompted many to retire earlier, leave the specialty sooner, and limit their practices in an attempt to shield themselves from the inherent risks associated with the practice of neurosurgery and regain control of their lives.
Additional pressures on the specialty abound. The pressures resulting from last summer’s restriction of resident work hours to 80 hours per week, a topic discussed in detail in the summer issue of the Bulletin, is still very much on the minds of neurosurgeons.
To get an idea of current attitudes about the neurosurgical workforce, I informally surveyed neurosurgeons in different stages of neurosurgical training and practice to gauge their views on workforce issues. Anonymity was guaranteed and rewarded with 16 e-mail responses (and occasionally multiple responses from the same author). These responses, expressing emotions ranging from frustration to disillusionment to confusion, demonstrated that the workforce issue is clearly a highly charged topic for many of our colleagues.
Here are a few of their responses:
- MD No. 1: Dr. Subach, I am responding to your request for opinions regarding the ongoing changes in the neurosurgical workforce resulting from pressures on both practicing and training neurosurgeons. The 80-hour workweek may minimize sleep deprivation, however my fellow residents and I remain concerned that we will have inadequate training to go out on our own. It is ridiculous that a politician is able to tell me when to go home, but refuses to legislate against frivolous lawsuits which are killing our specialty.
- MD No. 2: The applicant pool for neurosurgery residency spots will degenerate. The competition is what kept the best people and weeded out [the others]. Since all residencies are capped at 80 hours per workweek, what is the difference now? Mediocrity will abound, and I bet the applicant pool will be diluted by less driven, less determined individuals. The workforce issue will be compounded by novice neurosurgeons with lukewarm motivation and marginal experience.
- MD No. 3: I never thought that I would worry about finding a job and supporting my family. After all these years of training, my once clear vision of the future has become cloudy.
- MD No. 4: Why is this my problem? The neurosurgeons in practice are the ones who allowed the situation to deteriorate to this point. Now it is a “crisis” and an “emergency.” Perhaps some “forethought” back then could have averted this situation. Now I have to donate time and money toward this cause. What happened to the team concept?
An Undercurrent of Unrest
These comments universally reveal an undercurrent of unrest. Neurosurgeons in training are entering a world very different from the one in which many of neurosurgery’s current leaders were trained. Now there is a limited amount of time to train, a limited amount of resources to utilize, and a world of turmoil to conquer.
I wish it were easy to identify a single cause for the workforce shortage and related problems so that the damage could simply be repaired. The reality is that the causes are complex, as likely are the solutions. However, it is clear that neurosurgeons must say enough is enough. Enough to the insurers who negotiate contracts paying 15 cents on a dollar. Enough to the five hospitals who demand our availability to their call schedule. Enough to the lawyers who cause irreparable damage to our reputations by bringing completely frivolous suits.
Yet, neurosurgeons of the next generation must do more than talk. We need to add our voices to the discussion and become involved in implementing solutions to neurosurgery’s challenges. For example, residents on the front lines of the work hour reforms can suggest refinements that are in the best interest of our specialty and our patients.
In answer to the medical liability crisis, Stewart Dunsker, MD, called for all neurosurgeons to “be part of the solution and give their ideas, time and money” in his fall Bulletin article on neurosurgery’s campaign for liability reform. Neurosurgeons of the next generation can heed his call both individually and as a group working for our common interests through the AANS Young Neurosurgeons Committee.
Brian R. Subach, MD, a neurosurgeon at The Virginia Spine Institute, Reston, Va, is secretary of the AANS Young Neurosurgeons Committee.