Who are we training and where do they go? Trends in demographics in the pediatric neurosurgery workforce

There has been a steady increase in the number of pediatric neurosurgery fellowship applicants and positions. As more trainees graduate pediatric fellowships, it is important to identify demographic trends, and how and where graduates ultimately practice. The purpose of this study was to investigate trends over time in the demographics and practice settings of fellowship-trained pediatric neurosurgeons.

A database of all Accreditation Council for Pediatric Neurosurgery Fellowships (ACPNF) graduates since 1992 was compiled using data from the San Francisco Match and publicly available sources. ACPNF graduates were sent a survey to self-report demographic data (gender, race, and ethnicity). Trends in demographic data were evaluated, and subgroup analyses were performed by comparing practice setting, gender, and graduates by decade of graduation.

As of June 2024, 525 individuals have completed a pediatric neurosurgery fellowship, with an additional 25 matched to graduate in 2025. Female representation increased from 0% in the first fellowship graduating class of 1993 compared with 46.4% in 2023. Among the 152 individuals who self-reported race, 71.7% identified as non-Hispanic White. The highest proportion of graduates practicing in free-standing academic pediatric hospitals are those who completed fellowship between 2011 and 2020 (58.1%), followed by graduates from 2021 onward (56.2%). International medical graduates were significantly less likely to practice in a free-standing hospital (OR 0.37 [95% CI 0.24-0.57], p < 0.0001).

As the number of fellowship graduates continues to increase, a substantial proportion continue to not secure positions in free-standing pediatric hospitals. Additionally, the number of women pursuing pediatric neurosurgery continues to increase, while data on race and ethnicity remain limited. Continued ongoing data collection is crucial for monitoring these demographic trends over time.