The need for neurological surgery programs to be departments

The Decade of the Brain has brought recognition of the contributions neurological surgery has made to modern medicine, and neurological surgery training programs are a cornerstone of these achievements. While neurosurgeons are celebrating their achievements, however, a number of social, political, and administrative issues threaten to undermine the future of these programs. We discuss the ramifications of departmental status to the future of neurological surgery. These include the implications for operative experience-for example, carotid endarterectomy, spine instrumentation, acoustic tumors-the economic impact of a department versus a division, the ability to direct research, administrative input at the institutional level, and self-determination. We discuss the requirements for programmatic change and recommendations for national support.