APPENDIX I - Lippincott Williams & Wilkins



Supplemental Content. Questionnaire sent to practicing U.S. neurosurgeons in Fall 2010 to assess practice characteristics (e.g., neurosurgical subspecialty), workload (e.g., perceived workload, relative value units (RVUs), number of emergency rooms covered), and patient demand (e.g., wait time).

APPENDIX I

Survey of Neurosurgeons

Hypothesis 1: The number of neurosurgeons currently practicing in the United States is lower than the number of neurosurgeons which would be ideal based on an analysis of the ideal neurosurgeon to population ratio (i.e. the “equilibrium number” of neurosurgeons).

Hypothesis 2: The demand for recruitment of neurosurgeons exceeds the supply of available candidates for work.

Hypothesis 3: Patients have access to emergency neurosurgical care when needed and the ability to have elective neurosurgical cases performed in a timely manner in nearly all areas of the United States.

Hypothesis 4: Hospital-sponsored recruitment of neurosurgeons is common even in communities where neurosurgeons compete for elective cases. This recruitment is driven by a hospital’s desire to ensure emergency room coverage.

Hypothesis 5: Hospital employment of neurosurgeons has increased significantly and is anticipated to continue to increase.

Hypothesis 6: Patient demand for neurosurgical procedures is likely to increase due to the increasing average age of the population.

Q1. What is your subspecialty? Please check all that apply.

1. General neurosurgery/no subspecialty

2. Brain tumor/neuro-oncology

3. Cerebrovascular neurosurgery

4. Endovascular neurosurgery

5. Functional neurosurgery

6. Neuroendoscopy

7. Pain neurosurgery

8. Pediatric neurosurgery

9. Peripheral nerve surgery

10. Skull base neurosurgery

11. Stereotactic radiology

12. Spine

13. Other

Q2. Please tell us approximately what percentage of your time is devoted to:

1. Cranial neurosurgery: ______

2. Spine neurosurgery:________

Q3. Approximately how many hours per week, on average, do you devote to clinical neurosurgery?

Q4. Which statement best describes your workload?

1. I could do more work.

2. I am doing approximately the right amount of work.

3. I am overworked.

Q5. On average, how many cases do you perform per year? Please include open and minimal access surgeries (procedures performed in the OR), radiosurgery, interventional/intravascular procedures (diagnostic or therapeutic). Do not include office-based or minor procedures (e.g. lumbar punctures, nerve blocks, epidural injections, shunt taps, etc.).

Q6. Please tell us approximately how many work RVUs you produce in an average year:

Q7. What is the current approximate wait time for new non-emergency patients in your practice (in weeks)?

Q8. Which of the following best describes your community?

1. Our community has too many neurosurgeons.

2. Our community has enough neurosurgeons to meet patient demand for elective cases, but there are too few neurosurgeons to adequately cover the emergency rooms in our community.

3. Our community has enough neurosurgeons to meet patient demand for both elective cases and to provide emergency room coverage.

4. Our community does not have enough neurosurgeons to meet patient demand for elective cases nor emergency room coverage.

Q9. Have you seen patients from outside your community who have come to you in the past 12 months because they thought the wait times for neurosurgeons in their community were too long?

1. Yes

2. No

3. Do not know

Q10. What is the approximate wait time, in weeks, for a patient to be seen by you for a non-emergency condition?

Q11. How many years have you been employed by your current employer (or if self-employed, how long have you been in independent practice in your current location)?

Q12. How would you describe your neurosurgical practice?

1. Hospital-employed community practice (go to Q14)

2. Independent/private community practice

3. Academic (go to Q14)

Q13. Are you considering becoming hospital employed in the next 24 months?

1. Yes (go to Q17)

2. No (go to Q17)

Q14. In what year did you become hospital employed or academic?

Q15. Were you previously in an independent practice?

1. Yes

2. No (go to Q17)

Q16. When you were in independent practice, approximately how many hospital emergency rooms did you cover?

Q17. How many hospital emergency rooms do you cover now?

Q18. Do you provide emergency room coverage for (please check all that apply):

1. A hospital with no trauma center designation

2. Level 1 trauma center

3. Level 2 trauma center

4. Level 3 trauma center

5. I do not provide ER coverage

Q19. Please describe your current situation:

1. I am willing to take more call than I am currently taking, independent of reimbursement for call.

2. I would be willing to take more call if reimbursement for call was acceptable.

3. I am not interested in taking additional call regardless of reimbursement.

4. I do not take call.

Q20. Are you in charge of recruitment for your practice, department, division or service line within your group?

1. Yes

2. No (go to Q27)

Q21. Is your practice actively recruiting a neurosurgeon or neurosurgeons?

1. Yes

2. No (go to Q26)

Q22. Approximately how many positions are you trying to fill (within the scope of your recruiting responsibility)?

1. 1 Neurosurgeon

2. 2 Neurosurgeons

3. 3 Neurosurgeons

4. 4 or more Neurosurgeons

Q23. If you have recently filled a position, approximately how long did it take you to find a neurosurgeon?

1. Less than 6 months

2. 6 months to 1 year

3. Longer than 1 year

Q24. Please rank the reasons you are recruiting with 1 being the most important and 4 being the least:

__ Need for ER coverage

__ Need additional staff for business development and outreach clinics

__ Anticipation of retirement or departure by a current neurosurgeon

__ Need additional staff for existing case volume

Q25. If you did not have a need for additional ER coverage, would you be recruiting?

1. Yes

2. No

3. Not sure

Q26. Has your willingness and/or ability to hire a non-US board eligible or certified neurosurgeon increased in the last 3 years?

1. Yes

2. No

3. Not sure

Q27. In order to best assess the supply of available neurosurgeons, kindly tell us if you are currently seeking a new position? (We will add a comment to this question that says: As a recruitment firm conducting this survey, we recognize that this question can seem self-serving. All survey data is completely confidential and will be aggregated by an independent researcher. No individual results will ever be released.)

1. Yes

2. No

Q28. Do you believe that demand for neurosurgical services will increase due to the following factors (check all that apply):

1. ___________ Aging population

2. ___________ Changes in technology

3. ___________ Other: ________________

4. ___________ There is not likely to be any significant change in demand.

Q29. Please tell us your zip code:

Thank you for participating in our survey. We appreciate your time! If you would like to receive a copy of our survey results to thank you for your participation, kindly provide us with your email address.

If you would like to comment on any issues related to the neurosurgery workforce study, we would love to hear from you.

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