Maintenance of the Neurosurgical Workforce: A Call for Financial Literacy Curriculum in Neurosurgery

By George L. Yang, MD
University of Cincinnati PGY-7 Resident, CAST Neurotrauma Fellow and CSNS Socioeconomic Fellow

According to the Association of American Medical Colleges, the United States faces a potential shortage of physicians of approximately 124,000 by 2034.1 This projected shortage is secondary to the increasing mismatch between supply and demand, with the primary care and subspecialty physician shortage projected to be approximately 48,000 and 77,100, respectively.1 Neurosurgery, in particular, faces a projected deficit of 1,200 by 2025.2 Population growth and age are the primary drivers of increasing demand in this period, with an estimated population growth of 10.6% and estimated growth of persons over 65 by 42.4%.1 Most of these older individuals will portend a growth in demand for physicians caring for older citizens and their chronic diseases, including neurosurgical conditions such as degenerative spine conditions, brain cancer and fall-related traumatic subdural hematomas.

There is a growing recognition that the physician shortage will affect patient access to healthcare and contribute to a rising physical and emotional toll on existing physicians and other healthcare workers, as witnessed in other specialties during the COVID-19 pandemic.3 The shortage will disproportionately affect rural and underserved areas since neurosurgical services tend to cluster around large populations.2 The problem of tackling the shortage of neurosurgeons is multifaceted, with difficulties ranging from the need for adequate federal graduate medical education funding4 and increased length of training secondary to the increasing sub-specialization in our field. This slow replenishment rate of neurosurgeons will worsen the shortage, especially given the estimate that two in five physicians will reach retirement age in the next decade.1 Research has found that 91% of Americans are now within 60 minutes of a trauma center via air or land, a significant improvement made during the 2010s after a national push to improve access to trauma care.5 However, this progress is threatened by the shrinking neurosurgical workforce, given the dependence on neurosurgeon availability at both level 1 and 2 trauma centers.6 There have been proposals to shorten the length of residency training to create “general neurosurgeons” and to seek private funding sources to bypass the need for federal funds.7 However, these problems are unlikely to have timely solutions given the difficulty of passing legislation to increase GME funding8 and increased scrutiny on the neurosurgeon training process in the post-Dr. Death era.9 While organized neurosurgery works on long-term solutions to increase neurosurgeon production, such as increasing residency positions and shortening the length of training, consideration can also be given to other additional short-term interventions to slow the attrition rate of the current workforce.

One potential high-yield target for short-term intervention is mitigating the effects of burnout with targeted financial literacy education. Studies have demonstrated burnout to be associated with early retirement10, with rates of burnout increasing year after year.11 One meta-analysis found that over half of neurosurgeons reported signs of burnout, and only one-third would recommend a career in neurosurgery.12 Rates of burnout were found to increase in those with unstable routines, high hourly workloads, reduced time for family and leisure and productivity-based compensation models.13 While these factors associated with burnout have been well studied via surveys, there is a growing body of literature in other specialties supporting increasing financial literacy to combat burnout.14-16  Key deficiencies studies have identified include knowledge about student loan repayment options, philosophies surrounding budgeting, investing, retirement planning, salary and contract negotiations, insurance policies and tax planning.  Few residency programs feature personal finance education in their curriculum. Once formal training is completed, individuals are often left seeking education through personal research, recommendations from friends and family or even the often predatory financial industry. While there are diminishing returns for happiness with growing wealth, robust financial health can lead to financial independence and facilitate gaining professional and personal freedoms to reduce burnout-associated stressors.17 Decreased dependence on compensation and productivity can empower neurosurgeons to make changes in their personal and professional lives to ensure career longevity in ways that may include: forcing changes at work to improve institutional support, adding flexibility to work schedules and chasing meaningful academic or professional pursuits that do not compensate as well.

Dramatic changes to the number of residency positions and the structure of our training programs are needed to address our upcoming workforce shortage. Hopefully, equipping neurosurgeons to at least take control of their personal lives can help mitigate the ongoing burning of the proverbial “workforce candle” from both ends.

References Cited

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