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Neurosurgeons Warn IOM Committee about Looming Physician Shortages

Ralph G. Dacey, Jr., MD, President of the Society of Neurological Surgeons, testified today on behalf organized neurosurgery at an Institute of Medicine (IOM) committee hearing concerning the need to ensure an adequate neurosurgical workforce for the 21st Century. This hearing is one in a series that an IOM consensus committee is holding to evaluate the current governance and financing of the Graduate Medical Education (GME) system — which is currently facing an array of challenges.

It is well established that the country faces a severe physician manpower shortage, which will only worsen as health insurance coverage is expanded to an additional 30 million Americans and the baby boomers continue to reach retirement age. Overall, the shortage will approximate 130,600 physicians by the year 2025 — 64,800 specialty physicians and 65,800 primary care physicians.

“There are about 3,689 practicing board certified neurosurgeons for over 5,700 hospitals in the U.S., serving a population of more than 311 million people. As the population ages and more of our citizens face debilitating and life threatening neurological problems such as stroke, degenerative spine disease, and Parkinson’s and other movement disorders, this supply-demand mismatch will become even more acute,” Dr. Dacey noted. “And unlike primary care and other specialties, the pipeline for becoming a board certified neurosurgeon is long — as much as 18 years from the start of medical school to certification — so replenishing the neurosurgical workforce is no easy task,” he added.

Organized neurosurgery also recognizes that the GME system must be accountable to the public. “As a specialty, neurosurgery has re-engineered our training programs, instituting a patient-centered education that is focused on patient safety, clinical care outcomes, and advancement of the science and practice of neurological surgery,” Dr. Dacey explained. “This innovative program starts with a ‘boot camp’ where new residents learn critical skills on simulators, includes a Milestone system that ensures competence at each step of the training process, and continues with an integrated lifelong learning Matrix Curriculum that aligns our educational goals throughout the neurosurgeon’s career,” Dr. Dacey described.

To address the growing physician workforce shortage and ensure that the GME system is fully accountable to the public, organized neurosurgery recommends the following:

  • Ensure a physician workforce that is of sufficient size and specialty mix and strengthen the linkage of GME funding to ACGME-approved training programs, including expanding GME funding to fully cover the entire length of training and eliminating Medicare’s caps on GME financing;
  • Provide additional financial support for GME through an all-payer fund and maintain funding for children’s hospital and;
  • Ensure that ACGME retains its prominent role in overseeing resident training and education.

In closing, Dr. Dacey advised, “It is critical that we take the best of the current system and enhance it with sustainable financing and a learning environment that meets the needs of the public and carries physicians forth into a lifetime of practice in medicine. We must encourage high-performing programs to innovate and work to create a system that will raise the quality bar for all residents and training programs. Neurosurgery has taken steps in this direction, and it is important that the entire GME system is capable of embracing these changes. We stand ready to work with policymakers to meet this challenge.”

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