A Global Experience – Neurosurgeons Analyze Their Practice Environments

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The United States currently faces what is widely recognized as its greatest economic crisis since the Great Depression. Although this crisis moved healthcare reform from the forefront of the recent presidential campaign, the economic realities facing the American healthcare system are sobering. A 21 percent cut in Medicare physician payment looms in 2010, and healthcare costs continue to increase as new technologies and pharmaceuticals are introduced and the U.S. population gets older, fatter and sicker.

When the new administration takes the helm in January 2009, a concerted effort to repair the U.S. healthcare system is likely to follow. But what, exactly, are the politicians to do? The U.S. is not alone in its struggle with the conundrum of delivering cost-effective yet contemporary neurosurgical care to the greatest possible number of patients. As a point of reference, the AANS Neurosurgeon asked neurosurgeons in nine developed countries including the U.S. to describe their practice environments. The resulting summaries, while painted with a broad brush, are instructive.

Although the U.S. is the only developed country with a large uninsured population and neurosurgical residents in Europe are trained in far fewer hours than those in the U.S. and Australia, there are several commonalities. In most countries there is significant concern about low physician reimbursement and, correspondingly, neurosurgery’s future ability to compete with other professions for highly qualified candidates. Maintaining the optimal ratio of neurosurgeons to population is a challenge, particularly when ascertaining the number of neurosurgeons who are practicing in a particular country at any given time itself is difficult. Also among the shared concerns are integrating new practice patterns introduced by increasing subspecialization, paying for rapidly advancing technologies, retaining a sense of professionalism and preserving the doctor-patient relationship in an increasingly impersonal healthcare environment.

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