====== Global neurosurgical workforce ====== The neurosurgical [[workforce]] refers to the global [[community]] of [[neurosurgeon]]s responsible for diagnosing and treating [[disorder]]s of the [[nervous system]]. As of recent estimates, there are approximately 72,967 neurosurgeons worldwide, equating to a global density of about 0.93 neurosurgeons per 100,000 people. However, this distribution is uneven, with [[high-income country]] averaging 2.44 neurosurgeons per 100,000 people, while [[low-income country]] has as few as 0.12 per 100,000. The [[World Federation of Neurosurgical Societies]] (WFNS) has developed an interactive Global Neurosurgical Workforce Map to highlight these disparities and identify regions most in need of neurosurgical support. Addressing the global neurosurgical workforce deficit is crucial, as an estimated 5 million essential neurosurgical [[case]]s go unmet each year, predominantly in low- and middle-income countries. To bridge this gap, strategies include expanding neurosurgical [[training program]]s, enhancing infrastructure, and implementing task-sharing models where non-specialist healthcare providers are trained to perform basic [[neurosurgical procedure]]s. Efforts to improve the neurosurgical workforce are ongoing, with organizations like the WFNS and the American Association of Neurological Surgeons ([[AANS]]) playing pivotal roles in promoting education, research, and policy development to ensure equitable access to neurosurgical care globally. ---- A sustainable [[neurosurgical workforce]] depends on robust training [[pipeline]]s, but the size and distribution of the [[global neurosurgery]] [[trainee]] workforce have not been described. The objective of this study was to identify the types of [[training]] [[program]]s that exist in the global neurosurgery workforce, the support that trainees receive, the diversity of trainee experiences, and the accreditation processes that exist to regulate training programs. Methods: This study was a subanalysis of a cross-sectional survey administered online in all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank and the United Nations. Participants were identified through neurosurgery society leadership, the personal contacts of the coauthors, and bibliometric and search engine searches. Population-weighted statistics were constructed and segregated by country income level and WHO regions. Results: Data were obtained for 187 countries (96.9%) and 25 additional territories, states, and disputed regions (96.2%). There were an estimated 1261 training programs and 10,546 trainees within the regions sampled, representing a global pooled density of 0.14 neurosurgery trainees per 100,000 people and a median national density of 0.06 trainees per 100,000 people. There was a higher density in high-income countries (HICs; 0.48 trainees per 100,000 people) compared with upper-middle-income countries (0.09 per 100,000), lower-middle-income countries (0.06 per 100,000), and low-income countries (LICs; 0.07 per 100,000). The WHO European (0.36 per 100,000) and Americas (0.27 per 100,000) regions had the highest trainee densities, while Southeast Asia (0.04 per 100,000) and African (0.05 per 100,000) regions had the lowest densities. Among countries with training programs, LICs had the poorest availability of subspecialty training and resources such as cadaver laboratories and conference stipends for trainees. Training program accreditation processes were more common in HICs (81.8%) than in low- and middle-income countries (LMICs; 69.2%) with training programs. Conclusions: The authors estimate that there are at least 1261 neurosurgery training programs with 10,546 total trainees worldwide. The density of neurosurgery trainees was disproportionately higher in HICs than in LMICs, and the WHO European and Americas regions had the highest trainee densities. The trainee workforce in LICs had the poorest access to subspecialty training and advanced resources ((Gupta S, Gal ZT, Athni TS, Calderon C, Callison WÉ, Dada OE, Lie W, Qian C, Reddy R, Rolle M, Baticulon RE, Chaurasia B, Dos Santos Rubio EJ, Esquenazi Y, Golby AJ, Pirzad AF, Park KB; WFNS Global Neurosurgery Committee; EANS Global and Humanitarian Neurosurgery Committee; CAANS Executive Leadership Committee. Mapping the global neurosurgery workforce. Part 2: Trainee density. J Neurosurg. 2024 Jan 16;141(1):10-16. doi: 10.3171/2023.9.JNS231616. PMID: 39508227.)). ---- 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.)).