There are too many neurosurgeons.
There are too few neurosurgeons.
Most neurosurgeons have seen the supply-demand debate swing back and forth. More than 20 years ago a chief resident boasted to me that he had secured “the last job in New Jersey.” (He was wrong.) The American answer to the “right number” question has been to let the marketplace decide, aided by occasional tweaking of the number of trainees. Most of us probably agree that this approach has served the public and our profession quite well.
Other models of managing the neurosurgical workforce have existed for a long time, however. The transition to peacetime after World War II left the United Kingdom with a five-fold increase in the number of neurosurgical beds for civilians. No longer needed for military casualties, these beds were filled rapidly by patients with civilian head injuries and a variety of other diagnoses, mainly brain tumors. At the same time there was a great shortage of properly trained neurosurgeons to meet the need for patient care, let alone to handle such new surgical indications as might be developed (or to participate in their development).
In 1947 the Society of British Neurological Surgeons Planning Committee published “Notes on the Neurosurgical Needs of the Population and the Training of the Neurosurgeon.” In the context of a centrally regulated health system, the committee laid out a plan for the education of medical students and neurosurgical trainees and for a rational expansion of regional centers and subcenters where tertiary neurosurgical care should be rendered.
Our British colleagues of a half-century ago were not merely addressing bureaucratic niceties. They were aware that the rigors of our profession could eventually deter trainees, and they emphasized the importance of maintaining adequate levels of compensation. As we continue to recruit and train new generations of neurosurgeons, let us heed their concluding words: “It would have been a mistake to pretend that we offered an easy and sheltered life, to invite the unwary, if such there be, to enjoy the pleasures of our life. Better to state frankly the difficulties of our tasks and to rely on the challenge being replied to by the right men.”
Michael Schulder, MD, is associate professor in the Department of Neurological Surgery and director of Image-Guided Neurosurgery at UMDNJ-New Jersey Medical School.