Quo vadis, academia? Can academic neurosurgery be resurrected?

Clinical neurosurgery is an endangered academic discipline. Neurosurgeons have competition from many directions: orthopedists, ear, nose and throat surgeons, plastic surgeons, radio-oncologists, and interventional radiologists, among others. Academic centers are no longer the only sites of neurosurgical education at the attending level, and neurosurgery is not felt to be an indispensible part of an undergraduate medical curriculum. There are insufficient data to determine if neurosurgical services for the general population are adequate or appropriate. The traditional strengths of academic neurosurgery are gathering data, analysis, research, innovation, and teaching within a context of understanding and tradition. Future healthy development of neurosurgery ideally requires multidisciplinary teams in specialized referral centers. When this consideration is combined with the existing shortage of neurosurgeons across the country, academic neurosurgery departments must logically focus on how best to allocate resources between "routine" clinical services and research objectives. We suggest here that new relationships may be required between university centers and community health care providers. Restructuring of the neurosurgical workforce may be necessary if academic neurosurgery is to develop as a specialty of comprehensive expertise in the challenging neurological disease entities that are its research objectives.