Harold L. Rekate
Susan R. Durham and Scott A. Shipman
The Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF) was established in 1992 to oversee fellowship training in pediatric neurological surgery. The present study is a review of all graduates from 1992 through 2006 to identify predictors of American Board of Pediatric Neurological Surgery (ABPNS) certification.
Basic demographic information including sex, year of graduation from residency, residency training program, year of fellowship training, and fellowship program was collected on each graduate from each of the 22 ACPNF programs. Individuals who did not meet ACPNF requirements (39 trainees) and those currently practicing in Canada (11 individuals) were excluded. Univariate and multivariate analysis were used to identify predictors of ABPNS certification.
Of the 193 ACPNF graduates, 143 individuals met the criteria for analysis. Currently, 70 (49%) are ABPNS certified. There is a mean period of 5.1 ± 2.4 years (range 2–13 years) between finishing fellowship and ABPNS certification. If those who are not expected to be sitting for the boards yet (2002–2006 graduates, 57 individuals) are removed, the rate of ABPNS certification is 66.3%. On average, 9.5 ±3.0 (range 4–16) fellows are trained per year. There is no statistically significant relationship between fellowship or residency training program and ABPNS certification.
Although the present training infrastructure has the theoretical capacity to train > 20 pediatric neurosurgeons each year, this analysis suggests that current levels will provide ~ 6 ABPNS-certified pediatric neurosurgeons annually. This raises the question of the sufficiency of the future pediatric neurosurgical workforce.
Susan R. Durham, Jessica R. Lane and Scott A. Shipman
The purpose of this study was to determine a reliable estimate of the size, demographic, and practice characteristics of the current pediatric neurosurgical workforce. The authors also sought to differentiate pediatric from nonpediatric neurosurgical practitioners and compare the demographic and practice characteristics of these 2 groups. The term “pediatric practitioner” will be used in this study to describe a practitioner whose practice is > 75% pediatric patients in accordance with the American Board of Pediatric Neurological Surgery (ABPNS) requirements for board certification in pediatric neurosurgery. Those practitioners with < 75% pediatric patients in their practice will be designated as “nonpediatric practitioners.”
The authors aggregated multiple databases of professional neurosurgical societies in an effort to identify pediatric neurosurgical practitioners. A 30-question survey was then administered to all identified practitioners, and responses were collected for 6 months. Primary analysis of pediatric versus nonpediatric practitioners was performed. Subgroup analyses of the characteristics of the pediatric practitioners were also performed to identify the effects of practitioner age, sex, and practice setting on survey responses.
A total of 342 practitioners received the survey, and 267 responded (78.1% response rate); 158 pediatric practitioners and 92 nonpediatric practitioners were identified. Seventeen respondents were excluded from analysis. Pediatric practitioners were more likely to be women, ABPNS certified, have completed a pediatric fellowship, do fewer operative cases per year, have a more frequent call schedule, practice in a freestanding children's hospital, be in academic practice, and in need of recruiting additional faculty. Pediatric practitioners spent fewer hours per week in patient care, and were less likely to have a productivity-based salary or salary incentive based on relative value unit–production. Among pediatric practitioners, American Board of Neurological Surgery and ABPNS certification rates differed significantly among age groups, with older age groups being more likely to be certified by the American Board of Neurological Surgery and ABPNS. The rate of pediatric fellowship completion was significantly higher in the younger age groups. Anticipating retirement by age 65 was significantly more likely in the younger age groups, and hours spent per week spent in teaching and administrative duties were lower in the younger age groups. There were 27 female and 131 male pediatric practitioners. The women were more likely to have completed a pediatric fellowship and performed fewer operative cases per year than the men. Nonacademic pediatric practitioners were more likely to have a relative value unit–based salary incentive, be reimbursed for call coverage, and spend more hours per week in patient care than academic pediatric practitioners. Academic pediatric practitioners spent more hours per week in clinical research.
The authors estimate that there are fewer than 200 pediatric neurosurgeons currently practicing in the United States. Current practice patterns unique to pediatrics may have important implications in recruiting and retaining the next generation of pediatric neurosurgeons.