Characterization of neurosurgery fellowship directors: strengths and room for improvement

Factors Associated With Various Types of Industry Payments to Academic Spine Surgeons in the Open Payments Database

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

The objective of this study was to investigate associations between spine surgeon characteristics and different types of industry payments.

SUMMARY OF BACKGROUND DATA

Industry funding has played an important role in research and technological innovation within spine surgery, and industry payments supporting research have risen significantly in comparison to funding from other sources. To our knowledge, no studies have investigated academic spine surgeon characteristics associated with different categories of industry payments.

MATERIALS AND METHODS

A query was conducted of the North American Spine Society Spine Fellowship Directory from 2021 to 2022 to identify all orthopaedic or neurosurgical spine fellowship selection committee members. A PubMed search was utilized to collect information on surgeon academic productivity up through December 31, 2021. The authors then conducted a query on the Centers for Medicare and Medicaid Services open payments website from 2015 to 2021 to collect payment records of spine fellowship selection committee members.

RESULTS

On linear regression analysis, total publications (8203, P <0.001), attending years (48,823, P <0.001), and publication rate (57,528, P =0.017) were associated with higher general payments. Southeast spine surgeons (80,043, P =0.038) and fellowship directors (79,874, P =0.007) were associated with more research payments. Total publications (7409, P <0.001), attending years (47,100, P <0.001), and publication rate (47,511, P =0.040) were significantly associated with higher royalties. Having a Twitter/X account (60,800, P =0.018), being a director (51,605, P =0.034), total publications (492, P <0.001), and publication rate (6444, P <0.001) were all predictive of greater consulting payments.

CONCLUSIONS

Spine surgeons who are experienced, academically productive, fellowship directors, and engage with social media receive greater payments on average than their peers across various payment types. As industry influence continues to make its way into health care, experienced leaders in their respective fields will shoulder the responsibility to integrate private innovation in an effective and scientifically rigorous manner.

LEVEL OF EVIDENCE

3.

A comprehensive evaluation of career trajectories of the American Association of Neurological Surgeons William P. Van Wagenen fellows

Objective

To elucidate the current academic, demographic, and professional factors influencing the career trajectories of the American Association of Neurological Surgeons (AANS) William P. Van Wagenen (VW) fellows while also identifying trends that may influence future fellow selection.

Methods

Fifty-five VW fellows were identified from 1968 to 2022 from the AANS website, along with corresponding institutions, countries, and continents of study. Additional variables such as age at selection, accruing additional degrees, neurosurgical subspecialty, the number of publications at the time of selection, funding, and h-index were collected from various publicly available sources.

Results

Eighty-five percent of VW fellows were male and had a mean age of 34 ± 2.4 years. Ninety-one percent of fellows chose to study in Europe, and 40% had earned additional degrees. Univariate linear regression demonstrated a positive relationship between the year of selection and both age at selection (p = 0.0094) and the number of publications at hire (p < 0.001), while logistic regression revealed that more recently selected fellows were less likely to study in Europe (p = 0.037) and be of the white race (p = 0.0047). Logistic regression also exhibited a positive trend between the year of selection and both the likelihood that the VW fellow was currently enrolled in another fellowship (p = 0.019) and possessed additional degrees (p = 0.0019). Females were shown to have fewer publications at hire compared to males (p = 0.04).

Conclusions

Most Van Wagenen fellows are academically productive members of the neurosurgical community. Increased attention is likely to be placed on both academic, research, and individualized factors when selecting future fellows.

United States Neurosurgery Department Program Directors: A Cross-Sectional Evaluation of Current and Future Trends and Attributes

BACKGROUND

While United States (U.S.) neurosurgery residency programs have been subject to many studies, none have focused solely on the program directors (PDs). We aim to analyze the demographic, educational, and academic attributes of this cohort to understand current and future trends of PDs.

METHODS

One hundred sixteen neurosurgeons listed as PDs at U.S. accredited neurosurgical residency training programs as of August 2022 were assessed. Descriptive data including age upon acceptance of role, gender, and h-index were collected from publicly available sources.

RESULTS

Most PDs matriculated to their positions before the age of 45 years, were male, and had been hired internally. Approximately 25% of PDs had earned an additional degree. Departments with higher aggregate h-indexes were more likely to hire PDs with higher average publications per year (P < 0.001) and have a higher h-index (P < 0.001). PD subspecialty influenced h-index (P < 0.05) and total average publications per year (P < 0.05) with neuro-oncology subspecialists having higher averages in both. More recently hired PDs had a higher average number of publications per year (P < 0.05) and were more likely to hold an additional degree (odds ratio 1.14, P < 0.05). Female PDs were hired at a younger age (P < 0.05).

CONCLUSIONS

Neurosurgery PDs typically rise to their position after 10 years of practice and more recent PD hires are more likely to have additional degrees and more publications. As academic neurosurgery becomes more competitive, increased academic productivity and acquisition of additional degrees will become increasingly necessary.

Female Neurosurgery Residency Program Directors in the United States: A Cross-sectional Descriptive Analysis

BACKGROUND

The residency program director (PD) position is a valued leadership appointment in academic medicine. PDs are responsible for the success of their program and its residents. The objective of this study is to provide a cross-sectional analysis of baseline demographics and academic backgrounds of current neurosurgery program directors.

METHODS

Data was compiled on neurosurgery PDs and their residency programs, as of the end of May 2021, using publicly available resources including Doximity, FREIDA, and Healthgrades. The Mann-Whitney and Fisher exact tests were used for statistical analysis.

RESULTS

Of 113 PDs identified, 91.15% are male (P < 0.01). The majority of PDs (88.5%) received their medical degrees from U.S. medical schools. The average age of current PDs is 54 years, and the average age at appointment was 48 years. Compared to their male counterparts, female PDs are more likely to be younger at appointment (41 vs. 48 years; P = 0.001) and while holding the same position (45 vs. 55 years; P = 0.001). As a result, female PDs experience less time to appointment after residency (8.6 years vs. 14.7 years, P = 0.013). There are no significant differences regarding the gender of the PD and university affiliation, current appointment, completion of a fellowship, and resident gender ratios.

CONCLUSIONS

The position of neurosurgery residency PD is dominated by fellowship-trained men in their late 40s to 50s. The gender ratio of neurosurgery residents is consistent with the underrepresentation of women in this position. With increasing female representation in neurosurgery, more women may assume this leadership position and begin to hasten the gender balance.

Orthopaedic Shoulder and Elbow Fellowship Directors in the United States Have Substantial Research Output but Lack Diversity

Purpose

To investigate the characteristics of shoulder and elbow fellowship directors (FDs).

Methods

FDs for shoulder and elbow fellowship programs in the United States were identified. Demographic, educational, and professional background data were collected from available curricula vitarum, institutional biographies, and the Scopus database. Data collected included age, sex, race/ethnicity, training locations, graduation years, advanced degrees, current institutional information, and personal research H-index.

Results

Thirty current orthopaedic shoulder and elbow FDs were identified. The mean Scopus H-index was 25.5. The mean age of FDs was 52.1 years. In total, 29 FDs (96.7%) were male and 1 (3.3%) was female. In addition, 25 of the 30 (83.3%) were White (83.3%), 4 were Asian, and 1 (3.3%) was Hispanic. Two (6.7%) had a military affiliation. Mean time from fellowship training graduation to FD appointment was 13.5 years. Mean number of years as FD was 6.1 years, whereas the number of years tenure with an FD-affiliated institution was 13.0 years. Mean calendar years for completion of orthopaedic residency training and fellowship training were 1998 and 2000, respectively. The residencies that produced the most future FDs were Hospital of the University of Pennsylvania (n = 2) and University of Nebraska Medical Center/Creighton University Health Foundation (n = 2). The fellowship that produced the most future FDs was Columbia University (n = 6). Moderate correlation was found between age and Scopus H-index (r = 0.48; P = .04) and years as FD and Scopus H-index (r = 0.42; P = .03).

Conclusions

Women and minorities are under-represented in leadership positions in shoulder and elbow surgery. Shoulder and elbow FDs have the highest H-index of any subspecialty reported in the orthopaedic literature. Research productivity is an important qualification when considering the characteristics of shoulder and elbow FDs.

Clinical Relevance

Fellowship directors can have a profound influence on current and future orthopaedic surgeons. It is important to identify the traits that characterize current fellowship directors to have a better understanding of who we choose as leaders in our field.