Introduction: Neurosurgery remains a critical wartime specialty for the United States military. Here we investigate the objective and subjective factors impacting recruitment and retention of military neurosurgeons.

Methods: The Council of State Neurosurgical Societies in conjunction with the Joint Military Committee surveyed military neurosurgeons regarding objective and subjective factors related to military service. Military neurosurgeons were directly queried as to whether they would or would not recommend military neurosurgery to a neurosurgery colleague. This question served as a surrogate marker for military neurosurgery recruitment.

Results: A total of 121 current or previously affiliated military neurosurgeons responded to the question regarding whether they would recommend military neurosurgery to a colleague. 76.9% (93/121) would recommend military service to a fellow neurosurgeon. Of these, the most rewarding factors in their service were: pride and patriotism (93.6%, 87/93), camaraderie (78.5%, 73/83), treating military patients (72.0% 67/93), and focus on clinical care/not the business of medicine (66.7%, 62/93). On multivariate analysis those who felt empowered by their military service with a sense of patriotism were 4.3 times more likely to recommend military service to another neurosurgery (p = 0.027, CI 1.19 - 16.82). Likewise, those who developed a sense of camaraderie within their military service showed a statistical trend to being more likely to recommend military service to their peers (p = 0.058, CI 0.95 - 9.78). Those with a current military obligation were .28 times (p=0.02, CI 0.09-0.85) as likely to recommend service as a military neurosurgeon as compared to those neurosurgeons who are separated or retired. Branch served in and rank obtained was not found to be statistically significant in predicting the likelihood of referring a neurosurgery colleague into military neurosurgery.

Conclusions: Service in the United States military is a positive experience with camaraderie, patriotism, and unique military experiences being stated as positive and predictive of military neurosurgery recruitment. These factors should be explored and fostered regarding recruitment and ultimately retention of military neurosurgeons. It remains vitally important to continue to have a strong military neurosurgery corps.

Patient Care: This will help ensure that best quality care for military service members by illustrating the factors needed to increase recruitment to the military neurosurgery ranks.

Learning Objectives: 1) Understand the importance of military neurosurgery in both academic and clinical care delivery. 2) Understand the need to recruit the best possible individuals into military neurosurgery 3) Understand the factors that aide in recruitment of military neurosurgeons.

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