Perspectives Commentary on: Improving Medical Student Recruitment into Neurological Surgery: A Single Institution’s Experience by Agarwal et al. World Neurosurg 80:745-750, 2013
Francesco Tomasello, M.D. Chairman and Professor Department of Neurosurgery University of Messina
Neurosurgical Recruitment: The Gold Rush Francesco Tomasello
T
he shortage of surgeons is probably a world issue. Completely different reasons exist in different countries according to social, economic, and health system conditions. In Italy, for example, in the past years in some surgical residency programs there were fewer applications than available positions. In 2013, the number of available neurosurgical residency positions was reduced to 53, with a greater expected requirement of new neurosurgeons per year. On the other hand, there is no objective basis for predicting how many neurosurgeons are needed and, consequently, how many residency positions should be provided. The neurosurgeon to population ratio has a high variability, almost in all Western countries, according to different factors related to health organization and evolving practice conditions. If we consider the number of neurosurgeons in a specific geographic area according to the demand of its population, probably we are wrong. The globalization of neurosurgery will likely change the ratios and the paradigms used to offer the training programs worldwide. This has already occurred within Europe, where the access to specialists is free and the training programs are monitored through the Joint-Residency Advisory and Accreditation Committee, a committee of the European Association of Neurosurgical Societies and the European Union of Medical Specialists. One of the reasons for the shortage of neurosurgeons is the increase in medical liability and malpractice risk (5). In addition, the conflict between professional and personal life, because of the workload and the risk of burnout, is sometimes clearly felt by neurosurgeons and well known to medical students.
Key words Medical student education - Neurosurgery interest group - Neurosurgical residency - Neurological surgery - Residency recruitment -
Abbreviations and Acronyms WFNS: World Federation of Neurosurgical Societies
WORLD NEUROSURGERY - [-]: ---, MONTH 2014
In a recent report on physician career satisfaction, neurosurgeons appeared at the lowest place among different medical specialties. All the surgical specialties were in the lower part of this special ranking, with pediatric emergency and geriatric medicine in the first two places (4). Agarwal et al. stated that irregular hours, medical malpractice lawsuits, loss of autonomy, and secular decline in pay compared with other specialties are major causes for neurosurgeon dissatisfaction. Neurosurgeons usually have high expectations when they enter this career and the difference with their real day life is the basis for frustration. This unbalance leads to further disappointment, as demonstrated for other jobs (2). These issues are comparable in most developed Western countries. Different concerns should be considered in developing countries. The lack of neurosurgical services and the high cost needed to maintain the existing ones are the main reasons for the shortage of neurosurgeons in these countries. The World Federation of Neurosurgical Societies (WFNS) stated in its constitution and bylaws that one of its purposes is “promoting, implementing and improving minimum and higher standards of neurosurgical care and training worldwide.” Thus, two of the WFNS priorities are “The training of neurosurgeons from developing areas” and “The donation of instruments and equipment, together with the necessary technical advice to allow them to be implemented in the neurosurgical units in economically challenged regions.” The improvement of young neurosurgeons recruitment and their training should be the benchmark of the success of the WFNS. In addition, the initiative called Africa 100, with the aim to train 100 African neurosurgeons in Africa, mostly by African mentors, should be even more sponsored and supported in the near future.
Department of Neurosurgery, University of Messina, Messina, Italy To whom correspondence should be addressed: Francesco Tomasello, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2014). http://dx.doi.org/10.1016/j.wneu.2013.11.004
www.WORLDNEUROSURGERY.org
1
PERSPECTIVES
Coming back to the issue of neurosurgical recruitment in developed countries, the question is: “If there are neurosurgeons not satisfied of their job and career, how can we encourage medical students to apply in residency programs?” Neurosurgeons disaffection is not homogeneously distributed. Klimo et al. (3) find that most neurosurgeons responding to their questionnaire were satisfied with their career, whereas Balch et al. (1) find the opposite results. These two studies differ basically for the number of academic neurosurgeons involved. Academic neurosurgeons appear more satisfied. Probably, the role as educators and mentors is a major source of gratification. I remember that the main reasons to become a neurosurgeon were the appeal of brain surgery as a discipline and the reputation of neurosurgeons as physicians. At that time, I faced charming and charismatic mentors. Academic neurosurgeons have a responsibility in recruiting new neurosurgeons and assuming the task of their education with special reference to the humanistic approach to the patient, to clinical evaluation, and to the decisionmaking process and surgical skill. Probably, a new era should start at the present. I believe that we should face a new challenge of our career: “the gold rush.” I mean that gold corresponds to the most appropriate investment that we can place on young generations. Recruitment of more motivated and enthusiastic neurosurgeons is the best way of improving our satisfaction and thus, indirectly, our patient care. In addition, young neurosurgeons should be involved in research and innovation in our evolving discipline, which has been marked with one of the greatest advances in medicine. Another important issue is the demand of subspecialists in addition to generalists. When we think about head and spine
REFERENCES 1. Balch CM, Shanafelt TD, Sloan JA, Satele DV, Freischlag JA: Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Ann Surg 254:558-568, 2011.
2. Clark AE, Oswald AJ: Satisfaction and comparison income. J Public Econ 61:359-381, 1996.
2
www.SCIENCEDIRECT.com
trauma care, spinal surgery, functional neurosurgery, neurovascular procedures, pediatric neurosurgery, and neuro-oncology we understand that we need skilled neurosurgeons in several subspecialties that, at present, are not homogeneously distributed. Therefore, local and regional conditions, geography, and demographics are likely to change the demand for neurosurgeons according to problems of relative overabundance and shortage of subspecialists. Agarwal et al. describe an institutional project to increase the recruitment of medical students in the neurosurgery residency program. The project took into consideration four phases and several initiatives that were progressively adopted. These included the incorporation of a 2-week neurosurgical experience into the neurology/psychiatry third year clerkship; the recruitment of undergraduate students for research projects through a summer research program; an elective neurosurgical course added for third and fourth year medical students; and the creation of a “neurosurgical interest group.” The program resulted in a significant increase in the number of medical students recruited at this institution. Since the beginning of the initiative, the department of neurological surgery has demonstrated a boom in scientific productivity. The student enthusiasm led to the increase in number of submitted abstracts and articles. This result confirms our previous assumption that involving students in research and innovation in neurosurgery represents a mutual opportunity of growth for both mentored and mentors. The article by Agarwal et al. is well written and the topic is of definite interest to neurosurgeons. It should even be known by policy makers who are involved in the future health system organization and related educational programs.
3. Klimo P Jr, DeCuypere M, Ragel BT, McCartney S, Couldwell WT, Boop AF: Career satisfaction and burnout among U.S. neurosurgeons: a feasibility and pilot study. World Neurosurg 80:e59-e68, 2013. 4. Leigh JP, Tancredi DJ, Kravitz RL: Physician career satisfaction within specialties. BMC Health Serv Res 9:166, 2009. 5. Nahed BV, Babu MA, Smith TR, Heary RF: Malpractice liability and defensive medicine: a
national survey of neurosurgeons. PLoS One 7: e39237, 2012. Citation: World Neurosurg. (2014). http://dx.doi.org/10.1016/j.wneu.2013.11.004 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2014 Elsevier Inc. All rights reserved.
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2013.11.004
Francesco Tomasello, M.D. Chairman and Professor Department of Neurosurgery University of Messina
Neurosurgical Recruitment: The Gold Rush Francesco Tomasello
T
he shortage of surgeons is probably a world issue. Completely different reasons exist in different countries according to social, economic, and health system conditions. In Italy, for example, in the past years in some surgical residency programs there were fewer applications than available positions. In 2013, the number of available neurosurgical residency positions was reduced to 53, with a greater expected requirement of new neurosurgeons per year. On the other hand, there is no objective basis for predicting how many neurosurgeons are needed and, consequently, how many residency positions should be provided. The neurosurgeon to population ratio has a high variability, almost in all Western countries, according to different factors related to health organization and evolving practice conditions. If we consider the number of neurosurgeons in a specific geographic area according to the demand of its population, probably we are wrong. The globalization of neurosurgery will likely change the ratios and the paradigms used to offer the training programs worldwide. This has already occurred within Europe, where the access to specialists is free and the training programs are monitored through the Joint-Residency Advisory and Accreditation Committee, a committee of the European Association of Neurosurgical Societies and the European Union of Medical Specialists. One of the reasons for the shortage of neurosurgeons is the increase in medical liability and malpractice risk (5). In addition, the conflict between professional and personal life, because of the workload and the risk of burnout, is sometimes clearly felt by neurosurgeons and well known to medical students.
Key words Medical student education - Neurosurgery interest group - Neurosurgical residency - Neurological surgery - Residency recruitment -
Abbreviations and Acronyms WFNS: World Federation of Neurosurgical Societies
WORLD NEUROSURGERY - [-]: ---, MONTH 2014
In a recent report on physician career satisfaction, neurosurgeons appeared at the lowest place among different medical specialties. All the surgical specialties were in the lower part of this special ranking, with pediatric emergency and geriatric medicine in the first two places (4). Agarwal et al. stated that irregular hours, medical malpractice lawsuits, loss of autonomy, and secular decline in pay compared with other specialties are major causes for neurosurgeon dissatisfaction. Neurosurgeons usually have high expectations when they enter this career and the difference with their real day life is the basis for frustration. This unbalance leads to further disappointment, as demonstrated for other jobs (2). These issues are comparable in most developed Western countries. Different concerns should be considered in developing countries. The lack of neurosurgical services and the high cost needed to maintain the existing ones are the main reasons for the shortage of neurosurgeons in these countries. The World Federation of Neurosurgical Societies (WFNS) stated in its constitution and bylaws that one of its purposes is “promoting, implementing and improving minimum and higher standards of neurosurgical care and training worldwide.” Thus, two of the WFNS priorities are “The training of neurosurgeons from developing areas” and “The donation of instruments and equipment, together with the necessary technical advice to allow them to be implemented in the neurosurgical units in economically challenged regions.” The improvement of young neurosurgeons recruitment and their training should be the benchmark of the success of the WFNS. In addition, the initiative called Africa 100, with the aim to train 100 African neurosurgeons in Africa, mostly by African mentors, should be even more sponsored and supported in the near future.
Department of Neurosurgery, University of Messina, Messina, Italy To whom correspondence should be addressed: Francesco Tomasello, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2014). http://dx.doi.org/10.1016/j.wneu.2013.11.004
www.WORLDNEUROSURGERY.org
1
PERSPECTIVES
Coming back to the issue of neurosurgical recruitment in developed countries, the question is: “If there are neurosurgeons not satisfied of their job and career, how can we encourage medical students to apply in residency programs?” Neurosurgeons disaffection is not homogeneously distributed. Klimo et al. (3) find that most neurosurgeons responding to their questionnaire were satisfied with their career, whereas Balch et al. (1) find the opposite results. These two studies differ basically for the number of academic neurosurgeons involved. Academic neurosurgeons appear more satisfied. Probably, the role as educators and mentors is a major source of gratification. I remember that the main reasons to become a neurosurgeon were the appeal of brain surgery as a discipline and the reputation of neurosurgeons as physicians. At that time, I faced charming and charismatic mentors. Academic neurosurgeons have a responsibility in recruiting new neurosurgeons and assuming the task of their education with special reference to the humanistic approach to the patient, to clinical evaluation, and to the decisionmaking process and surgical skill. Probably, a new era should start at the present. I believe that we should face a new challenge of our career: “the gold rush.” I mean that gold corresponds to the most appropriate investment that we can place on young generations. Recruitment of more motivated and enthusiastic neurosurgeons is the best way of improving our satisfaction and thus, indirectly, our patient care. In addition, young neurosurgeons should be involved in research and innovation in our evolving discipline, which has been marked with one of the greatest advances in medicine. Another important issue is the demand of subspecialists in addition to generalists. When we think about head and spine
REFERENCES 1. Balch CM, Shanafelt TD, Sloan JA, Satele DV, Freischlag JA: Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Ann Surg 254:558-568, 2011.
2. Clark AE, Oswald AJ: Satisfaction and comparison income. J Public Econ 61:359-381, 1996.
2
www.SCIENCEDIRECT.com
trauma care, spinal surgery, functional neurosurgery, neurovascular procedures, pediatric neurosurgery, and neuro-oncology we understand that we need skilled neurosurgeons in several subspecialties that, at present, are not homogeneously distributed. Therefore, local and regional conditions, geography, and demographics are likely to change the demand for neurosurgeons according to problems of relative overabundance and shortage of subspecialists. Agarwal et al. describe an institutional project to increase the recruitment of medical students in the neurosurgery residency program. The project took into consideration four phases and several initiatives that were progressively adopted. These included the incorporation of a 2-week neurosurgical experience into the neurology/psychiatry third year clerkship; the recruitment of undergraduate students for research projects through a summer research program; an elective neurosurgical course added for third and fourth year medical students; and the creation of a “neurosurgical interest group.” The program resulted in a significant increase in the number of medical students recruited at this institution. Since the beginning of the initiative, the department of neurological surgery has demonstrated a boom in scientific productivity. The student enthusiasm led to the increase in number of submitted abstracts and articles. This result confirms our previous assumption that involving students in research and innovation in neurosurgery represents a mutual opportunity of growth for both mentored and mentors. The article by Agarwal et al. is well written and the topic is of definite interest to neurosurgeons. It should even be known by policy makers who are involved in the future health system organization and related educational programs.
3. Klimo P Jr, DeCuypere M, Ragel BT, McCartney S, Couldwell WT, Boop AF: Career satisfaction and burnout among U.S. neurosurgeons: a feasibility and pilot study. World Neurosurg 80:e59-e68, 2013. 4. Leigh JP, Tancredi DJ, Kravitz RL: Physician career satisfaction within specialties. BMC Health Serv Res 9:166, 2009. 5. Nahed BV, Babu MA, Smith TR, Heary RF: Malpractice liability and defensive medicine: a
national survey of neurosurgeons. PLoS One 7: e39237, 2012. Citation: World Neurosurg. (2014). http://dx.doi.org/10.1016/j.wneu.2013.11.004 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2014 Elsevier Inc. All rights reserved.
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2013.11.004
