Decreasing regional neurosurgical workforce-a blueprint for disaster

Area of Science:

• Neurosurgery
• Trauma Care
• Public Health

Background:

• Traumatic brain injuries (TBIs) are a leading cause of death and disability.
• Neurosurgery (NS) is critical for managing severe TBIs, yet neurosurgeon availability is decreasing.
• Regional data on neurosurgeon shortages and their impact on patient care are limited.

Purpose of the Study:

• To analyze regional trends in neurosurgeon availability and patient care for traumatic intracranial hemorrhages (ICH) and skull fractures.
• To assess the impact of neurosurgeon workforce changes on patient management and outcomes.

Main Methods:

• Utilized a state discharge database (2004-2007) for traumatic ICH and skull fractures using ICD-9-CM codes.
• Categorized institutions based on annual ICH patient volume (>30 or <30).
• Obtained neurosurgeon numbers from the state medical society.

Main Results:

• The number of patients with significant head injuries increased from 2004 to 2007.
• The total number of practicing neurosurgeons (NS) decreased during the study period.
• Patient care increasingly concentrated in high-volume ICH centers (>30 patients/year), with a decrease in low-volume centers.

Conclusions:

• A growing number of traumatic intracranial hemorrhage (ICH) patients are managed in fewer centers, coinciding with a declining neurosurgeon workforce.
• The neurosurgical workforce shortage for traumatic ICH poses significant regional risks.
• Urgent solutions are needed to address neurosurgeon manpower issues in trauma care.