Introduction: Neurosurgical training programs serve to create a combination of generalists and subspecialists. To better understand trends in training neurosurgical subspecialists, we investigated trends in neurosurgical fellowship enrollment in North America.
Methods: Retrospective review of North American neurosurgery residents enrolled in training 1997-2016, using AANS membership data.
Results: We followed 3,619 North American neurosurgical residency graduates over 20 years, of which 40.7% (n=1,472) completed a fellowship and 4.8% (n=175) completed two or more different fellowships. Of completed fellowships, 27.2% (n=456) were in spine, 14.6% (n=245) were endovascular, 14.0% (n=235) were pediatric, 9.6% (n=161) were functional, 8.7% (n=146) were skull base, 8.7% (n=146) were open cerebrovascular, 7.2% (n=122) were neuro-oncology, 6.2% (n=104) other, 1.6% (n=26) neurotrauma, 1.4% (n=24) peripheral nerve, and 0.7% (n=11) combined endovascular/open cerebrovascular fellowships. The overall proportion of residents pursuing fellowships increased from 1997-2006 to 2007-2016 (29.1 vs. 49.6%, p<0.001). The proportion of spine, cerebrovascular, and trauma fellowships decreased by 0.5% (p=0.037), 0.3% (p=0.029), and 0.3% (p<0.001) per year, respectively, while the proportion of skull base, peripheral nerve, and combined endovascular/cerebrovascular fellowships increased by 0.5% (p=0.002), 0.2% (p=0.016) and 0.2% (p=0.001) per year, respectively. Residents from top 40 NIH-funded institutions were more likely to complete fellowships (OR=1.5, p=0.004), whereas residents in low-population cities were less likely to complete fellowships during 2007-2016 (OR=0.7, p=0.030).
Conclusions: Over the past two decades, the proportion of neurosurgical residents pursuing fellowships has significantly increased, to nearly half of all neurosurgical residents in 2016. Skull base, peripheral nerve and combined endovascular/cerebrovascular fellowship enrollments have increased, while spine, cerebrovascular and trauma fellowship enrollments have decreased. Academic interest, as assessed by departmental NIH funding, increased the likelihood of fellowship enrollment. Factors associated with academic centers in densely populated cities continue to be positive predictors for pursuit of advanced neurosurgical training.
Patient Care: Understanding the trends in neurosurgery fellowship training and associated factors can help neurosurgeons-in-training make an educated decision whether to enroll in a fellowship or not.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Understand the trends in neurosurgical fellowship training over 20 years (2) Discuss factors associated with fellowship enrollment