The global neurosurgical workforce: a mixed-methods assessment of density and growth

Abstract

OBJECTIVEIn 2000, the global density of neurosurgeons was estimated at 1 per 230,000 population, which remains the most recent estimate of the global neurosurgeon workforce density. In 2004, the World Health Organization (WHO) estimated that there were 33,193 neurosurgeons worldwide, including trainees. There have been no updates to this estimate in the past decade. Moreover, only WHO region–level granularity regarding neurosurgeon distribution exists; country-level estimates are limited. The neurosurgery workforce is a crucial component to meeting the growing burden of neurosurgical diseases, which not only represent high absolute incidences and prevalences, but also represent correspondingly high disability-adjusted life years affecting hundreds of millions of people worldwide. Combining the lack of knowledge about the availability of the neurosurgical workforce and the increasing demand for neurosurgical services underscores the need for a system of neurosurgical workforce density surveillance.METHODSThis study involved 3 key steps: 1) global survey/literature review to obtain the number of working neurosurgeons per WHO-recognized country, 2) regression to interpolate any missing data, and 3) calculation of workforce densities and comparison to available historical data by WHO region.RESULTSData for 198 countries were collected (158) or interpolated (40). The global total number of neurosurgeons was estimated at 49,940. Overall, neurosurgeon density ranged from 0 to 58.95 (standardized to per 1,000,000 population) with a median of 3.56 (IQR 0.29–8.26). Thirty-three countries were found to have no neurosurgeons (zero). The highest density, 58.95, was in Japan, where 7495 neurosurgeons are taking care of a population of 127,131,800.CONCLUSIONSIn 2015, the Lancet Commission on Global Surgery estimated that 143 million additional surgical procedures are needed in low- and middle-income countries each year, and a subsequent study revealed that approximately 15% of those surgical procedures are neurosurgical. Based on our results, we can conclude that there are approximately 49,940 neurosurgeons currently, worldwide. The availability of neurosurgeons appears to have increased in all geographic regions over the past decade, with Southeast Asia experiencing the greatest growth. Such remarkable expansion should be assessed to determine factors that could play a role in other regions where the acceleration of growth would be beneficial.

The impact of African-trained neurosurgeons on sub-Saharan Africa

“…Surgery in general has been left behind for many years, and neurosurgery has particularly been overlooked and falsely considered as expensive and luxury care. 3,4,11,18 In 2015, the Lancet Commission on Global Surgery estimated that 143 million additional surgical procedures are needed in lowand middle-income countries (LMIC) each year, 10,19 and further studies revealed that approximately 15% of those surgical procedures are neurosurgical. 13,15,16 Neurosurgical conditions affect people worldwide, regardless of age, sex, income, or level of education.…”

“…These diseases altogether cause more than 6.8 million deaths per year, the same number as that of deaths caused by AIDS, tuberculosis, and malaria. 11,18 Numbers show that an estimated 5 million essential neurosurgical cases go untreated in LMIC each year and that more than 23,000 more neurosurgeons are needed in these countries by 2030 to address this issue. 1,3,13 Neurosurgery arrived in Africa a bit later than in Europe and North America, especially in the sub-Saharan region; neurosurgical training came even later.…”

“…A ccording to current data, there are an estimated 49,940 neurosurgeons in the world with a great disparity in ratio among countries, ranging from 0 to 59 per 1 million people. 11 Sub-Saharan Africa (SSA) represents 17% of the world's land, 14% of the world's population, and 1% of the world's gross domestic product. 22,25 Reports from the beginning of the 21st century indicated that only 81 (16.2%) of the 500 African neurosurgeons worked in SSA, with a neurosurgeon ratio of approximately 1 per 6 million people.…”

Meeting the need: capacity building and social responsibility in neurosurgery

“…Workforce expansion plays a key role in surgical system strengthening; several approaches have been proposed and applied to overcome lack of neurosurgical care worldwide, prioritizing task sharing over task shifting [4,11,14,16]; multiple twinning projects between institutions are reported in literature, plus programs and dedicated tenure tracks in the discipline of global surgery. We applaud the systematic and carefully planned efforts of the authors in establishing a locally contextualized partnership between a LMIC Institution and a high-income country (HIC) National Society, allowing access to a broader spectrum of neurosurgical subspecialties than the ones traditionally associated with global neurosurgery (trauma, hydrocephalus, infections).…”

Editorial. Research in global neurosurgery: informing the path to achieving neurosurgical equity

“…There are 49,940 neurosurgeons globally, and the Sub-Saharan Africa and South and Southeast Asia regions have the lowest densities. 6 Using a survey, we estimated that, on average, a neurosurgeon performs 245 cases annually. 1 We then performed systematic reviews to estimate the total incidence of major neurosurgical conditions.…”