Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The presence and capability of existing pediatric neurosurgical care worldwide is unknown. The objective of this study was to solicit the expertise of specialists to quantify the geographic representation of pediatric neurosurgeons, access to specialist care, and equipment and training needs globally.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A mixed-question survey was sent to surgeon members of several international neurosurgical and general pediatric surgical societies via a web-based platform. Respondents answered questions on 5 categories: surgeon demographics and training, hospital and practice details, surgical workforce and access to neurosurgical care, training and equipment needs, and desire for international collaboration. Responses were anonymized and analyzed using Stata software.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 459 surgeons from 76 countries responded. Pediatric neurosurgeons in high-income and upper-middle-income countries underwent formal pediatric training at a greater rate than surgeons in low- and lower-middle-income countries (89.5% vs 54.4%). There are an estimated 2297 pediatric neurosurgeons in practice globally, with 85.6% operating in high-income and upper-middle-income countries. In low- and lower-middle-income countries, roughly 330 pediatric neurosurgeons care for a total child population of 1.2 billion. In low-income countries in Africa, the density of pediatric neurosurgeons is roughly 1 per 30 million children. A higher proportion of patients in low- and lower-middle-income countries must travel &gt; 2 hours to seek emergency neurosurgical care, relative to high-income countries (75.6% vs 33.6%, p &lt; 0.001). Vast basic and essential training and equipment needs exist, particularly low- and lower-middle-income countries within Africa, South America, the Eastern Mediterranean, and South-East Asia. Eighty-nine percent of respondents demonstrated an interest in international collaboration for the purposes of pediatric neurosurgical capacity building.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Wide disparity in the access to pediatric neurosurgical care exists globally. In low- and lower-middle-income countries, wherein there exists the greatest burden of pediatric neurosurgical disease, there is a grossly insufficient presence of capable providers and equipped facilities. Neurosurgeons across income groups and geographic regions share a desire for collaboration and partnership.</jats:p></jats:sec>

The initial experience of InterSurgeon: an online platform to facilitate global neurosurgical partnerships

“…Such regional partnerships have also been advocated because they facilitate context-specific surgical education and exchange between partners with greater similarity in pathology treated, socioeconomic and cultural characteristics, and resources. 6 These "near culture" interactions are an important step toward viable and sustainable surgical partnerships. 20,21 It is encouraging that 17% of the survey respondents had formed a partnership spontaneously by using the search function on the website to find and contact other neurosurgeons.…”

“…er understanding is achieved regarding the burden of untreated neurosurgical disease 2,17 and the need for a greater neurosurgical workforce. 3,6 In recent years the trend for such development has moved away from high-volume surgical mission-type trips and toward focused educational endeavors between surgeons and institutions in highincome countries (HICs) and neurosurgical partners in low-to middle-income countries (LMICs). 18 Despite enthusiasm for international collaboration by members within the organized neurosurgical community, establishing international partnerships remains challenging for many reasons.…”

Current US neurosurgical resident involvement, interest, and barriers in global neurosurgery

“…As a result, 140 million surgical cases go untreated, resulting in 47 million deaths due to preventable causes had there been adequate access to surgical care. 1,6,16,23 Neurosurgery is key to meeting the deficits of surgical care, and head and spine trauma are a primary cause of mortality that require neurosurgical care. 5 Meeting these needs will require work far beyond short-term humanitarian trips.…”

Disparity in pediatric neurosurgery provision of care: an illustration

“…The worldwide disparity in the provision of surgical care in general [1], and neurosurgery in particular, is an accepted reality that has been well researched and documented in a recent series of papers by Dewan, et al in Neurosurgical Focus and the Journal of Neurosurgery [2,3].…”