This, the 75th anniversary year of the AANS, is a time of celebration, but perhaps more importantly it is a time of evaluation and preparation for the organization’s — and the specialty’s — future. The cover story in this issue of the AANS Bulletin offers an assessment of the neurosurgical workforce and provides useful information for those concerned that patients in the future will have access to neurosurgical care when they need it.
Current data indicate that practicing in the United States are 850,000 physicians. Of these, neurosurgeons number approximately 3,200, a number that has remained static over the last 10 years. There are currently 60,000 students in U.S. medical schools with 16,000 graduating annually, and there are 104,000 in postgraduate training. In response to projections of a severe physician shortage in the near future, the American Association of Medical Colleges is recommending an increase in the number of medical students by 15 percent in the next 10 years. The 120 medical schools in the United States include five added in the last five years, while five more are planned in the next five years. In addition, 12 medical schools already have increased the number of students admitted by 30 percent.
Neurosurgery this year has experienced increases in registrants for the neurosurgical match, number of positions offered, and number of positions filled. There are 863 residents in 97 neurosurgical residency programs overseen by the Accreditation Council of Graduate Medical Education. Of 172 neurosurgical residency positions offered, 165 positions were filled through the match.
Neurosurgery needs to attract the best and brightest physicians. Great advantages in this endeavor are that our subject is so fascinating and the possibilities, virtually unlimited. A disadvantage is that neurosurgery is perceived as incompatible with a balanced lifestyle; it is seen by many as too demanding, too difficult. So that negative stereotypes can be dispelled, medical students need to be exposed early in their careers to neurosurgery. To accomplish this goal, neurosurgeons need to become a force for change.
Neurosurgeons in contact with medical students need to provide “shadowing” opportunities for first-year students. Medical school curriculum committees need to be persuaded that all students in their major clinical year should rotate through neurosurgery. This will allow medical students to be exposed to the major categories of neurological disease and their neurosurgical management, to ascertain what neurosurgeons can offer their patients regardless of the field they choose to specialize in, and to find out if neurosurgery might be the career choice for them. Neurosurgeons need to teach students basic surgical skills and provide them with general opportunities for patient interaction; in short, neurosurgeons need to be the best teachers that medical students encounter.
Encourage Women to Consider Neurosurgery
Thus far, there has been significant gender inequality within neurosurgery. Today 25 percent of physicians in the United States are women and 50 percent of medical students are women, but only 5 percent of practicing neurosurgeons are women. The percentage of women neurosurgical residents is now an encouraging 10 percent, and the fact that women neurosurgeons now occupy leadership positions throughout the specialty demonstrates real progress. In neurosurgery as in society in general there continue to be barriers to the advancement of women in their careers regardless of their qualifications or achievements: inflexible work environments, negative stereotypes, lack of support and networking, and absence of role models. All of these hurdles must be overcome in a systemic fashion in order for our specialty to thrive.
It is clear that mentorship of women is essential and that role modes are needed. An excellent source of role models is Women in Neurosurgery, a group devoted to the encouragement and advancement of women in our field. A fascinating role model is Louise Eisenhardt, MD, the only woman, thus far, to have been president of the AANS. She initially worked with Cushing to collect data on his cases and, through his mentorship, determined that she could make more of a contribution as a doctor. She graduated from Tufts Medical School in 1925 with the highest marks of any student to that date and became a neuropathologist who made major contributions in the field. She was the first editor of the Journal of Neurosurgery, holding that position for 21 years and setting the standard of excellence for this premier neurosurgical journal.
The inaugural Louise Eisenhardt Lecture at the 2007 AANS Annual Meeting will be delivered by an excellent role model, Sally Ride, PhD, the first woman astronaut in space and a physics professor at the University of California at San Diego. Another outstanding role model featured at the meeting is Lisa Randall, PhD, who will deliver the Rhoton Lecture. A physics professor at Harvard University, she is a cosmologist, an expert in particle physics and string theory, and the author of the highly acclaimed book Warped Passages: Unraveling the Mysteries of the Universe’s Hidden Dimensions.
Like these two outstanding scientists as well as Cushing, Eisenhardt, and many others, each neurosurgeon is a potential role model. I invite you to give this responsibility serious consideration, and also to join me April 14-19 in Washington, D.C., when the AANS celebrates 75 years as a force for change.
Donald O. Quest, MD, is the AANS president. He is the J. Lawrence Pool Professor of Neurological Surgery at Columbia University, College of Physicians and Surgeons, New York, N.Y.