The SOSSUS report and its impact on neurosurgery

The recently completed report of the Study on Surgical Services for the United States (SOSSUS) reveals several features of interest to neurosurgeons. There are approximately 2000 individuals practicing neurosurgery in the United States at the present time. Three-fourths of them are board-certified, and about 100 residents complete their training each year. Neurosurgical training rates have been increasing at six to 10 times the growth rate for the nation's population. Despite moderate variation in regional geographic distribution of practicing neurosurgeons, there is no real evidence of underserved areas. Distribution is even in communities with a population of 75,000 and greater. A critical feature of practice is that of work loads. Diagnostic studies make up a large protion of neurosurgical work, and the SOSSUS Area Studies reveal that complex operations are relatively relatively infrequent. This has serious implications regarding the maintenance of clinical competence, and in concentration sufficient clinical experience to train future generations of neurosurgeons. It is important to realize that the number of neurosurgeons now in practice is sufficient to meet the nation's needs. Selective cutbacks in training programs by approximately 20% seem to be in order, in coordination with similar cuts in other surgical specialties as well. This should be accompanied by a readjustment to a modest growth rate, approximately 1% per 5 years, in the ratio of neurosurgeons per 100,000 population. An accurate system of data collection is needed to provide the basis for future change in response to alterations in national needs.