Introduction: Healthcare has undergone dramatic changes impacting the practice of neurosurgery. Previous surveys of neurosurgical programs have shown adequacy in surgical training but limited exposure to socioeconomic topics. The aim of this survey was to evaluate neurosurgery resident exposure to socioeconomic issues during training and its influence on career decisions.

Methods: A 16-question survey was disseminated to all neurosurgical residents in the American Association of Neurological Surgeons (AANS) database on behalf of the Council of Neurosurgical State Societies (CSNS) between January 2014 and March 2015. Questions evaluated exposure and adequacy of socioeconomic training within residency as well as residents’ career plans.

Results: 235 residents responded (response rate 15.6%), equally representative of each post-graduate year. Replies were split among residents who planned academic careers (27.7%), combination/privademic (26.4%) and private practice (17.9%). Despite the majority describing adequate exposure to ACGME Milestones, 91.1% experienced lack of formal exposure to socioeconomic curricula. Topics inadequately addressed during training included negotiating employment contracts, evaluating new practice opportunities, practice management, business/economics of neurosurgery, medical coding, and understanding “pay for performance”. Overall, 61.3% felt clinically prepared to enter practice, but 59.1% stated weaknesses in training, mainly regarding socioeconomics, medicolegal, and transition to practice topics. Exposure to socioeconomic topics did not impact desire for subspecialty training. The ability to focus on subspecialty (p=0.0001) and research opportunities (p=0.0001) were the most important factors correlated with planned fellowship training.

Conclusions: These findings illuminate deficiencies in current socioeconomic training and trends in resident career choices. While clinical training appears to be adequate for most residents, exposure to socioeconomic issues remains limited. Regardless of practice preferences or goals of subspecialty training, residents consistently cited the need for further socioeconomic training. Such training may play a role in empowering future neurosurgeons to make more informed career choices, better advocate for patients, and serve as future leaders in healthcare.

Patient Care: The findings of this research point to specific areas of deficiencies in neurosurgical resident socioeconomic training. Armed with these findings, organized neurosurgery is now empowered to develop targeted programming aimed at filling these gaps. Such training can empower future neurosurgeons to make more informed career choices, better advocate for patients, and serve as leaders for healthcare change.

Learning Objectives: By the conclusion of this session, participants should be able to: 1. Identify deficiencies in socioeconomic training during neurosurgical residency. 2. Describe the factors most important to residents in evaluating post-residency fellowship training and practice opportunities. 3. Discuss the relationship between socioeconomic training within residency and subsequent preparedness for post-residency neurosurgical practice.

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