Decreasing regional neurosurgical workforce-a blueprint for disaster.
BACKGROUND
Traumatic brain injuries are a frequent cause of death and a substantial source of morbidity. Neurosurgeons (NS) are commonly involved in the management of patients with moderate and severe traumatic brain injuries to minimize morbidity from both primary and secondary brain injuries. However, NS willing to care for injured patients have become increasingly scarce. Although many institutions have been individually affected by shortages of NS providing care to injured patients, data on regional changes in NS availability and the effect on patient care are limited.


METHODS
We queried a state discharge database for all traumatic intracranial hemorrhages (ICH) and skull fractures from 2004 to 2007 by International Classification of Diseases-9th Rev.-Clinical Modification codes. Institutions were categorized as those that admitted >30 or <30 ICH patients per year. The state medical society provided the number of NS practicing in the state per year.


RESULTS
The total number of patients with significant head injuries increased over the study period. The number of NS decreased over the same time period. A greater proportion of patients were managed in centers admitting >30 ICH per year, and the number of facilities admitting <30 ICH per year decreased.


CONCLUSIONS
In this state, increasing numbers of patients with ICH are being concentrated in a small number of centers, while the number of NS available to care for them has decreased. Shortages in neurosurgical workforce for patients with traumatic ICH have the potential for catastrophic consequences on a regional basis if effective solutions to this manpower issue are not created.
Harbrecht
Brian G
BG
Department of Surgery, University of Louisville, 550 S. Jackson Street, Louisville, KY 40292, USA. briang.harbrecht@louisville.edu
Smith
Jason W
JW
Franklin
Glen A
GA
Miller
Frank B
FB
Richardson
J David
JD
D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000601:surgery*; D007629:Kentucky; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D017063:Outcome Assessment, Health Care; D010820:Physicians / Q000600:supply & distribution*; D012041:Regional Medical Programs / Q000458:organization & administration; D012887:Skull Fractures / Q000601:surgery*; D000078329:Workforce