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CC BY-NC-ND 4.0 · J Neurol Surg A Cent Eur Neurosurg 2023; 84(04): 305-315
DOI: 10.1055/a-1982-3976
Original Article

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

Florian Ringel 
1   Department of Neurosurgery, University Medical Center, Mainz, Germany
,
Michael Stoffel
2   Department of Neurosurgery, Helios Kliniken, Krefeld, Germany
,
Sandro M. Krieg 
3   Department of Neurosurgery, Technische Universität, München, Germany
,
Karsten Schöller
4   Department of Spinal Surgery, Schön Klinik Hamburg, Eilbeck, Germany
,
Rüdiger Gerlach
5   Department of Neurosurgery, Helios Kliniken, Erfurt, Germany
,
Michael Conzen
6   Neurochirurgische Praxisklinik, Bielefeld, Germany
,
Patrick Schuss
7   Department of Neurosurgery, Universitätsklinikum, Bonn, Germany
,
Jürgen Kreutzer
8   Competence Center for Spine and Pituitary Surgery, Nürnberg, Germany
,
and,
Jürgen Beck
9   Department of Neurosurgery, Universitätsklinikum, Freiburg, Germany
,
on behalf of Ressort 1 of the Neurosurgical Academy (NCA) of the German Society of Neurosurgery (DGNC) the Berufsverband Deutscher Neurochirurgen (BDNC) › Author Affiliations
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Abstract

Background Although the world is experiencing a deficit in the neurosurgical workforce, the number of neurosurgeons in Germany has increased within the last two decades. The aim of the present study was to assess the neurosurgical workforce in Germany, compare it to European countries, and assess structures in neurosurgical departments in Germany.

Methods 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.

Results 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 neurosurgeons 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.

Conclusions 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.

Keywords

structure of neurosurgical care - number of neurosurgeons - resident training - neurosurgical residents - workforce


Publication History

Received: 30 December 2021

Accepted: 21 July 2022

Accepted Manuscript online:
18 November 2022

Article published online:
22 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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