Assessment of the interventional neuroradiology workforce in the United States: a review of the existing data.

Endovascular surgical neuroradiology, also known as interventional neuroradiology, is a relatively new medical subspecialty. Endovascular surgical neuroradiology is now recognized as a specialty by the American College of Graduate Medical Education (ACGME), and training standards have been defined (1). The field has grown rapidly in the past decade and will likely continue to grow. Much of the growth in endovascular surgical neuroradiology has been driven by the success of the treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC). Carotid stent placement, intracranial angioplasty and stent placement, and acute ischemic stroke therapy are being intensively investigated and might add to the demand for endovascular surgical neuroradiologists (ESNRs). Endovascular surgical neuroradiology is a field that is procedure-based, and the complication rate in procedure-based fields of medicine is related to the individual operator’s procedure volume (2, 3). A shortage of ESNRs could result in performance of procedures by individuals with inadequate training. A surplus of ESNRs could result in performance of procedures by practitioners who perform too few procedures to remain optimally skilled. Thus, either a shortage or surplus of ESNRs could have a negative impact on patient care. An analysis of factors affecting workforce demand may help in preventing excessive shortages or surpluses. As ACGME-accredited training programs are being established, knowledge of the number of individuals who should be trained to meet the demands of the population of the United States is important. The supply of and demand for ESNRs cannot be precisely defined, but existing information exists allows for a reasonable estimation. By analyzing this information, we can also learn what important information is lacking so that we might be able to then gather additional information necessary for future workforce assessments. A History of Physician Workforce Assessments Predictions of the physician workforce are notoriously inaccurate. Physician workforce predictions depend on predictions of economic conditions, epidemiologic and demographic trends, and scientific advances, all of which are unpredictable in their own right. Also, political agendas often affect the outcome of a workforce assessment more than the scientific evaluation of the facts. Therefore, physician workforce predictions should be viewed as crude estimates at best. The Graduate Medical Education National Advisory Committee (4) evaluated the overall physician workforce in the United States in 1981. In 1992, the Council on Graduate Medical Education (5) reported ann updated assessment of the overall physician workforce. These studies examined the physician workforce as a whole, as well as the relative abundance of generalists and specialists. However, their reports are not useful for evaluating the ESNR workforce, because they were conducted before endovascular surgical neuroradiology was a recognized specialty. Workforce assessments for the specialty fields of cardiology (6–10), diagnostic radiology (11), and interventional radiology (12) must be conducted and the results published. These studies provide a historical precedent for the assessment of manpower within a specialty. Perhaps most importantly, they demonstrate that workforce assessment is a rather inexact science.