====== Caseload ======

The number of [[case]]s with which a surgeon is concerned at one time.
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Although the world is experiencing a deficit in the neurosurgical [[workforce]], the number of [[neurosurgeon]]s in [[Germany]] has increased within the last two decades. 

The aim of the study of Ringel et al. was to assess the neurosurgical [[workforce]] in Germany, compare it to [[Europe]]an countries, and assess structures in neurosurgical [[department]]s in Germany.

Data regarding the number of neurosurgeons in Germany as well as the number of departments, beds, cases, and neurosurgical procedures were gathered. A [[survey]] among German neurosurgical departments was performed to assess the structure of [[neurosurgical care]]. Furthermore, another survey among European countries was performed to acquire information regarding the number of surgeons and the regulation of training.

From 2000 to 2019, the number of board-certified neurosurgeons in Germany increased by 151% from 973 to 2,446. During the same period, the German population increased by only 1% from 82.26 million to 83.17 million. Thus, the number of [[neurosurgeon]]s per 100,000 inhabitants increased from 1.18 to 2.94. The increase of neurosurgeons is not paralleled by an increase in departments or an increase in neurosurgical procedures within the active neurosurgical departments. In comparison to the participating European countries, where the number of neurosurgeons per 100,000 inhabitants ranged from 0.45 to 2.94, with Germany shows the highest number.

German institutions of medical administration urgently need to consider [[regulation]] of neurosurgical specialist [[training]] to prevent a further uncontrolled increase in neurosurgeons in a manner that is not adapted to the needs of neurosurgical care for the German population. Actions might include a regulation of entry to the [[training]] and of the number of training sites. Furthermore, an integration of non-physician assistant health care professionals and delegation of non-surgical [[workload]] from neurosurgeons is necessary. A further increase in neurosurgeons would be associated with a decrease in the surgical caseload per surgeons during training and after board [[certification]], which might compromise the [[quality]] of neurosurgical care
((Ringel F, Stoffel M, Krieg SM, Schöller K, Gerlach R, Conzen M, Schuss P, Kreutzer J; and; Beck J; Ressort 1 of the Neurosurgical Academy (NCA) of the German Society of Neurosurgery (DGNC) the Berufsverband Deutscher Neurochirurgen (BDNC). Structure of Neurosurgical Care in Germany in Comparison to Countries Organized in the European Association of Neurosurgical Societies: A Need to Reorganize Neurosurgical Training and Care in Germany. J Neurol Surg A Cent Eur Neurosurg. 2023 Jul;84(4):305-315. doi: 10.1055/a-1982-3976. Epub 2022 Nov 18. PMID: 36400110; PMCID: PMC10226811.)).