Global Supply of Neurosurgeons: Challenges Around the World

Today, there is roughly one neurosurgeon per 100,000 people in the U.S. Such a ratio was once considered a “sufficient” neurosurgical workforce, according to a U.S. government estimate published in 1975. A more recent analysis suggests sufficient care is now one neurosurgeon for every 61,000 people in order to adequately care for a growing and aging population.

Globally, the outlook is much more grim. A 2004 estimate by the World Health Organization (WHO) calculated the global supply of neurosurgeons at 33,193, including trainees, or roughly one neurosurgeon per 200,000 people, far below the level experts recommended almost 50 years ago.

Now a new analysis has collected country-specific data on the number of neurosurgeons, something that hasn’t been done before, as the WHO only categorized data into six regions across the globe. Researchers collected numbers from 198 WHO-recognized countries and interpolated data for 40 more.

How Many Neurosurgeons Are There and Where?

The most recent WHO study, published in 2019, updated the 2004 estimate, concluding that there are approximately 49,940 neurosurgeons currently worldwide. While that number went up, more concerning is the disparity of neurosurgeons per population. Specifically:

• • The deficit is most pronounced in low- and middle-income countries, where the neurosurgeon scarcity is often exponentially higher than high income countries.
  • 33 countries either had or were predicted to have zero neurosurgeons.
  • Of countries estimated to have at least one neurosurgeon available, 35 had fewer than one per million people and were primarily located in Sub-Saharan Africa and Southeast Asia.
  • The lowest density was in the Democratic Republic of the Congo where reportedly four neurosurgeons were providing care for nearly 75 million people.
  • The highest density was in Japan where 7,495 neurosurgeons cared for a population of approximately 127 million people.

For the report, researchers used the collected data to evaluate global supply of neurosurgeons based on the following thresholds:

• • At one neurosurgeon per 250,000 people: 31 countries didn’t make the cut. Nearly all were low-income or middle-income except Saudi Arabia, Singapore and the United Kingdom.
  • At one neurosurgeon per 100,000 population, 161 countries failed to meet the standard, while 33 could. No low-income countries could meet this density.

However, there is some good news: The number of neurosurgeons increased in all geographic regions over the past decade with significant growth noted in both Africa and Southeast Asia. For example, between 2004 and 2016, the neurosurgeon growth rate in Africa was 89.9% and in Southeast Asia it was 388.3%. The authors suggest further research into these areas could shed light on practices that could be replicated in other countries.

The analysis noted that although countries may report an adequate number of neurosurgeons, the numbers may not account for retirees, part-time employees or those primarily focused on research or administration. Neurosurgeon scarcity is often exacerbated within countries, with specialists clustered in populated areas, leaving rural areas in greater need.

Providing Neurosurgical Care Despite Neurosurgeon Scarcity

The WHO predicts that by 2030, one in six people in the world will be at least 60 years old. And there’s a growing burden of neurosurgical diseases that are increasing or continue to be major causes of morbidity and mortality.

If the global neurosurgical workforce is too small, could general surgeons fill in the gaps in care? Probably not. In a study published in the World Journal of Surgery in 2022, researchers evaluated 14 studies from 11 countries and found that when general surgeons or general surgery residents performed emergency neurosurgery, mortality rates ranged from 5% for evacuation of chronic subdural hematoma in Kenya to 81% in head injured patients in Hong Kong.

One solution may be found by leveraging virtual technology. One internet platform allows collaboration without regard to physical distance. Founded by two pediatric neurosurgeons and launched in March of 2018, the platform has nearly 800 members, representing 106 different countries. Of those, 55% are neurosurgeons. Free membership allows surgeons to create “offers” and “requests” based on their specific expertise or interest. The website matches mentors with mentees for clinical training, research collaboration, education, and equipment. Membership also includes access to a virtual interactive software tool that allows for real-time guidance.