Part 1: Consultant Neurosurgeon Density
Authors
Saksham Gupta, MD, Zsombor T. Gal, BA, Tejas S. Athni, MS, Chrystal Calderon, MBBS, William É. Callison, PhD, Olaoluwa E. Dada, Winston Lie, MSc, Carolyn Qian, BS, Ramya Reddy, BS, Myron Rolle, MD, Ronnie E. Baticulon, MD, Bipin Chaurasia, MS, Ellianne J. Dos Santos Rubio, MD, Yoshua Esquenazi, MD, Alexandra J. Golby, MD, Ahmad F. Pirzad, MD, and Kee B. Park, MD, MPH
On behalf of the WFNS Global Neurosurgery Committee, EANS Global and Humanitarian Neurosurgery Committee, and CAANS Executive Leadership Committee
Objective
It is unknown whether efforts to expand access to neurosurgery worldwide have led to an increase in the global neurosurgery workforce, particularly in low- and middle-income countries (LMICs). The study’s objective is to quantify the number and distribution of consultant neurosurgeons worldwide while identifying trends and analyzing factors contributing to workforce growth.
Methods
A subanalysis of an electronic cross-sectional survey administered between October 2022 and March 2023 across 193 countries and 26 territories was conducted. The survey focused on consultant neurosurgeons and resource availability. Regression analysis identified correlations with workforce growth.
Results
Data were collected from 192 countries (99.5%) and 25 territories (96.2%), yielding estimates of 72,967 neurosurgeons worldwide. The global pooled density is 0.93 neurosurgeons per 100,000 people, with variations by country income level. The annual growth rate in workforce density was highest in lower-middle-income countries (LoMICs) at 26% and upper-middle-income countries (UpMICs) at 21.3%. Factors contributing to workforce growth included national neurosurgery societies, increasing population size, and economic factors like national GDP.
Introduction
An estimated 5 billion people worldwide lack access to safe, affordable, and timely surgical care. More than 5 million patients in LMICs who could benefit from neurosurgery do not receive the care they need each year. The study explores how the global neurosurgery workforce has grown, particularly in regions with high incidences of traumatic brain injury (TBI), hydrocephalus, epilepsy, and stroke.
Methods
The survey, conducted as part of the Global Neurosurgery Initiative at Harvard Medical School, targeted neurosurgeons from 193 countries and 26 territories. The survey aimed to quantify consultant neurosurgeon numbers and analyze trends based on income level and World Health Organization (WHO) regions.
Results
The study estimated that 72,967 neurosurgeons are practicing worldwide, with stark differences in neurosurgeon density across income levels. High-income countries (HICs) had the highest density (2.44 per 100,000 people), followed by UpMICs (1.13), LoMICs (0.37), and low-income countries (LICs) (0.12). The Southeast Asia region experienced the highest workforce growth at 33% annually.
Discussion
Although the global neurosurgeon workforce has grown, significant disparities exist across regions and income levels. LMICs continue to face challenges in accessing the resources necessary for advanced neurosurgical care, such as microscopes, angiography equipment, and neuronavigation tools. Further collaboration between global health organizations, national neurosurgery societies, and healthcare providers is essential to addressing these challenges and expanding neurosurgical capacity worldwide.
Conclusion
The global neurosurgery workforce has expanded to nearly 73,000 consultant neurosurgeons, with varying growth rates across regions and income levels. Despite progress, many countries, particularly in Africa and Southeast Asia, still face critical shortages in neurosurgical care. Continued efforts are needed to ensure equitable access to neurosurgery resources and training worldwide.
Key References
• Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare, and Economic Development. Lancet. 2015;386(9993):569-624.
• Dewan MC, Rattani A, Fieggen G, et al. Global Neurosurgery: The Current Capacity and Deficit in the Provision of Essential Neurosurgical Care. J Neurosurg. 2019;130(4):1055-1064.
• Park KB, Johnson WD, Dempsey RJ. Global Neurosurgery: The Unmet Need. World Neurosurg. 2016;88:32-35.
For more details, visit: DOI: 10.3171/2023.9.JNS231615.
