A neurosurgeon is a physician who specializes in the diagnosis and surgical treatment of disorders of the central nervous system and peripheral nervous system including congenital anomalies, trauma, tumors, vascular disorders, infections of the brain or spine, stroke, or degenerative diseases of the spine.

Being a neurosurgeon is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion to always do better than the best. During the last two decades, the exponential deployment of operative technology has resulted in a radical transformation, making a neurosurgeon trained four decades ago, run the risk of being outdated. Expectations from patients have reached an all time high level. Socioeconomic and medicolegal aspects cannot be brushed aside. It is universally accepted that in spite of increasing longevity in the educated upper middle class, the process of ageing per se continues relentlessly. When is enough enough? Is there a risk that a “senior, experienced” neurosurgeon may even become a liability to his patients some day? Should there be a mandatory time point at which a neurosurgeon should necessarily stop operating.

The author reviews the published literature and opines that after the age of 65 years, all seniors should agree to their operating privileges being formally reviewed regularly every 2 years 1).

The World Health Organization recommends one neurosurgeon for every 100,000 for adequate neurosurgical care. Whereas in the United States, there is a neurosurgeon for every 63,000 inhabitants, in Sub-Saharan Africa, the rate is approximately one neurosurgeon to 10 million. Additionally, as the limited neurosurgical services are restricted to large urban centers, more than 90 percent of the population, with limited transportation means, may not have access to such care in some regions.

In the early days of surgery of the nervous system the surgeon was purely an operator acting under the guidance of the neurologist, who took the responsibility for the localization of the lesion and for the extent of the operative procedure.

Several factors have converged to raise concern among program directors about attracting and training the next generation of neurosurgeons. These include the relatively new duty-hour regulations, the projected physician shortage, and the preference of many current medical students for controllable lifestyles. Attracting top talent into training programs may require innovations geared to Generation X such as policies supporting work-life balance, flexible work options, lots of feedback, mentoring programs, talented leadership, and standardized communication strategies during patient handoffs. Larger programmatic changes may also be needed such as “competency-based” training and additional years of training for mastery of highly specialized procedures 2).

The Brain Surgeon By Oren Berkowitz

Dr. David Singer is a rising star brain surgeon. He did all the right things and made all the right sacrifices to get to where he is. Despite everything he has going for him, he finds himself struggling to balance his career with his newly growing family. His one-track focus is jarred by a budding friendship with a special patient who holds a mirror up to his own life. In the hypercompetitive, high stakes, and unforgiving world of neurosurgery, is it possible to find some kind of balance?

Published on: 2016-11-13

About the Author

Dr. Berkowitz is the Director of Research and afounding faculty member of the Boston University School of Medicine PhysicianAssistant Program. He holds a PhD in Epidemiology from the University ofPittsburgh and has practiced for many years as a PA in neurosurgery. Dr.Berkowitz is a researcher and a medical educator who has published numerousworks in neurosurgery and healthcare research journals. He lives with his wifeand son in Boston, Massachusetts.

Neurosurgeons may have multiple roles including clinician, educator, researcher, and administrator. Leaders in neurosurgery have the added responsibilities of setting a vision, communicating the vision, implementing a plan to achieve it, and gaining commitment from the team and other stakeholders. For success in the current era of U.S. health care, neurosurgical leaders must deliver despite challenges such as reduced resources, increased protocolized care, automation, and depersonalization. Neal and Lyons described five empowering strategies that can help leaders perform best. The steps include deepening self-awareness, leading with honesty, developing emotional intelligence, improving coaching skills, and becoming a better influencer. Leaders that take these steps to invest in their leadership skills will reap broad benefits 3).

Neurosurgery requires certain personality traits to provide the best possible outcomes for patients. This stems from the fact that neurosurgery is one of the most complex forms of surgery and therefore demands a high level of skill, precision, confidence, and leadership capabilities. However, certain personalities and associated attitudes may be harmful to patients and could result in inferior outcomes. The belief that certain personality traits could result in potentially dangerous outcomes was first recognized in aviation, as ‘‘Arrogance got more pilots in trouble than faulty equipment4).

Ganapathy K. Should neurosurgeons retire? Neurol India. 2019 Mar-Apr;67(2):370-374. doi: 10.4103/0028-3886.258036. PubMed PMID: 31085838.
Brown AJ, Friedman AH. Challenges and opportunities for recruiting a new generation of neurosurgeons. Neurosurgery. 2007 Dec;61(6):1314-9; discussion 1319-21. PubMed PMID: 18162912.
Neal MT, Lyons MK. Empowering qualities and skills for leaders in neurosurgery. Surg Neurol Int. 2021 Jan 5;12:9. doi: 10.25259/SNI_899_2020. PMID: 33500824; PMCID: PMC7827298.
Yeager C, Janos L. Yeager. New York, NY, USA: Bantam; 1985
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