How many residents should we train? The USA experience

Over the past ten years, an average of 135 residents have entered neurosurgical training in the United States each year. These neurosurgeons-to-be come from about 250 applicants who annually enter the national matching program for neurosurgery. After completing training, they join a pool of practicing neurosurgeons that includes about 3,260 board certified neurosurgeons and an additional 390 practicing neurosurgeons who are still in the certification process. The pool of active neurosurgeons does not increase by 135 surgeons each year since the forces of retirement and death serve to decrease it. Judging by the experience of some large Health Maintenance Organizations, who employ no more neurosurgeons than are necessary to supply their enrolled members, the net result is that the USA has at present about the proper number of neurosurgeons necessary to meet the needs of the country. No one can predict future needs for neurosurgeons with accuracy, and it is safer not to set the number of neurosurgeons based on a guess. We do need to restrict the number of trainees to that number we can train properly. The quality of our neurosurgeons needs to be maintained. Beyond that, the market place, however imperfect, is a better long-term regulator of numbers than any governmental or privately-based committee.