Pediatric Neurosurgery Workforce Initiative:
Preliminary Survey Results

Susan R. Durham, MD

Thanks to everyone in the section for participating in the Pediatric Neurosurgery Workforce Survey. The response so far has been very positive and we are nearly to our goal of a 75 percent response rate. Because of the small number of practicing pediatric neurosurgeons, we can precisely describe our current workforce and make accurate predictions about the future supply of pediatric neurosurgeons. This is unique among most workforce studies and allows us to have sound data on which to base future health policy decisions.

We were able to find 342 individuals with pediatrics as an identified part of their neurosurgical practice in the membership directories of the American Board of Pediatric Neurological Surgery, American Society of Pediatric Neurosurgeons, the AANS/CNS Section on Pediatric Neurological Surgery and those self-reporting a pediatric subspecialty in the AANS Membership Directory. Our preliminary data shows that approximately 225 of these individuals maintain a practice of greater than 75 percent pediatric cases. As many as 20 percent of our respondents indicated that they are limiting their practices to adult patients or spine cases, and 16 percent wished to no longer offer trauma or emergency room coverage. This raises concern about our ability to provide care for pediatric neurosurgical patients in many areas of the United States where there currently are few pediatric neurosurgeons.

Our recent work also suggests that less than 8 percent of U.S. neurosurgical residency graduates go on to complete pediatric neurosurgical fellowships. Since the inception of the Accreditation Council for Pediatric Neurosurgical Fellowships in 1991, there have been nine fellowship graduates per year on average, with only five or six of them going on to achieve American Board of Pediatric Neurological Surgery certification. An increasing number of foreign-trained neurosurgical graduates are filling our fellowship positions with 46 percent of our fellowship positions filled by foreign-trained graduates in 2005-2006 compared to 0.0 percent from 1998 to 2001.

Working with pediatric physician workforce researchers at the Dartmouth Institute for Health Policy and Clinical Practice, we currently are studying the changing practice patterns of specific neurosurgical procedures that are performed on children. We hypothesize that the percentage of pediatric neurosurgical procedures performed by nonpediatric neurosurgeons has declined over the past decade, despite the number of pediatric neurosurgeons remaining rather stable. This has important implications for the future of the pediatric neurosurgical workforce and the neurosurgical care of children.