Is There a Shortage of Neurosurgeons in the United States?
Is There a Shortage of Neurosurgeons in the United States?
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DOI：
10.1227/01.neu.0000430762.08458.49
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发表时间：
2013-08-01
期刊：
影响因子：
4.8
通讯作者：
Couldwell, William T.
中科院分区：
文献类型：
--
作者：
Rosman, Judy;Slane, Steve;Couldwell, William T.
背景：神经外科工作人员的决策通常是由1977年美国外科服务研究报告中提出的每10万人中有1名神经外科医生的比例驱动的。实际比率总是比建议的要高。目的：我们评估美国外科服务研究报告中1:10万的比例是否仍然有效，美国是否有足够的神经外科医生来满足患者的需求，以及需求是否由患者需求驱动。方法：在我们的分析中，将美国执业神经外科医生的分布与人口普查数据合并，得出各州神经外科医生密度指数；一份评估执业特征的调查通过电子邮件发送给执业神经外科医生；并对美国神经外科医生的招聘广告进行了评估。结果：关于患者需求的多变量统计分析产生了不确定的结果，因为现有的数据集不是用来确定患者需求的，而且许多神经外科医生是亚专业的。数据显示，神经外科医生与美国总人口的比例为1:65 580。在调查回复中，神经外科医生与患者的比例因州而异，并且与神经外科医生是否表示他们工作过度或工作不足的相关性不一致。305个招聘广告可能预示着人才短缺。24%的广告公司表示，他们只招聘急诊科的工作人员，另外26%的公司表示，如果不是因为急诊科的工作需要，他们可能不会招聘。结论：应按地区和亚专科重新评估需求比例，以考虑神经外科实践的变化。就业市场的“短缺”可能反映了患者需求以外的因素。
BACKGROUND: Neurosurgical workforce decision-making is typically driven by the 1 neurosurgeon per 100 000 population ratio proposed in 1977 in the Study on Surgical Services for the United States report. The actual ratio has always been higher than suggested.OBJECTIVE: We evaluated whether the 1:100 000 ratio from the Study on Surgical Services for the United States report is still valid, whether there are enough neurosurgeons in the United States to meet patient needs, and whether demand is driven by patient need.METHODS: For our analysis, the distribution of practicing US neurosurgeons was merged with census data to yield density indices of neurosurgeons by state; a survey assessing practice characteristics was e-mailed to practicing neurosurgeons; and a compilation of job advertisements for US neurosurgeons was evaluated.RESULTS: Multivariant statistical analyses yielded inconclusive results regarding patient demand because existing data sets are not designed to establish patient demand and many neurosurgeons are subspecialized. The data indicated that the ratio of neurosurgeons to total US population is 1:65 580. In the survey responses, neurosurgeon-to-patient ratios varied dramatically by state and were inconsistently correlated with whether neurosurgeons indicated they were overworked or underworked. The 305 job advertisements may indicate a shortage. Twenty-four percent of advertising practices indicated that they are recruiting only for emergency department coverage, and an additional 26% indicated that they might not be recruiting if not for the need for emergency coverage.CONCLUSION: Demand ratios should be reevaluated by region and subspecialty to consider changes in neurosurgery practice. A "shortage" in the employment market may reflect factors other than patient need.