Developmental stages in the career of an academic neurosurgeon

"Now What Do I Do?" - Practical Challenges Faced By Young Neurosurgeons in their Career Management

Neurosurgical residency is tough. Grueling hours and tough decisions require a mental makeup unlike many other specialties. But the real examination begins after the residency is over. Many young neurosurgeons are faced with a daunting task of deciding their future as soon as they step out of the medical school. Sometimes, such decisions can shape the entire career of the neurosurgeon. However, over the many years of academic teaching and learning what we are not taught is how to "Manage." Management of careers, decision making, and understanding the business end of our profession is lacking. Here, we review the career and decisions needed to be taken by a young neurosurgeon through the glass of a business management mindset. We try to define the opportunities and decisions and how they may reflect on the general population and patients as a whole.

Academic neurosurgery in Nepal: Present status and future directions

Introduction

The establishment of local neurosurgery training programs in Nepal has proven critical for the expansion of the discipline across the country. This paper aims to describe the evolution, current status, challenges, and future directions of academic neurosurgery in Nepal.

Research question

What is the current status and international standing of academic neurosurgery in Nepal?

Material and methods

Information related to growth and development in Nepal was obtained from universities and regulatory bodies in Nepal. Variables described are the current number of neurosurgeons, the number of neurosurgical centers and centers with accreditation for training, the description of existing training models, the number of graduates, and the contribution of Nepalese neurosurgeons to world literature.

Results

Formal neurosurgical training started in Nepal in 1999. Of 67 hospitals with neurosurgical facilities, 10 (14.9%) are accredited. Three training models (MCh, NBMS, and FCPS) currently exist. Of 116 neurosurgeons currently practicing in the country, 47 (40.5%) are homegrown. The contribution of the Nepalese neurosurgical community to the world includes the training of the first two Maldivian neurosurgeons and an increasing presence in world neurosurgical literature.

Conclusions

Although comparable to other countries with similar economies, Nepal still faces some challenges to the sustainability and further developments of Neurosurgery. Continued concerted efforts will help Nepalese neurosurgeons achieve the goal of securing self-reliance in neurosurgical education.

Impact of Neurosurgery Research and Education Foundation awards on subsequent grant funding and career outcomes of neurosurgeon-scientists

OBJECTIVE

The Neurosurgery Research and Education Foundation (NREF) provides diverse funding opportunities for in-training and early-career neurosurgeon-scientists. The authors analyzed the impact of NREF funding on the subsequent career success of neurosurgeons in obtaining research funding and academic achievements.

METHODS

The NREF database was queried to identify NREF winners from 2000 to 2015. The award recipients were surveyed to obtain information about their demographic characteristics, academic career, and research funding. Only subsequent research support with an annual funding amount of $50,000 or greater was included. The primary outcome was the NREF impact ratio, defined as the ratio between NREF award research dollars and subsequent grant funding dollars. The secondary outcomes were time to subsequent grant funding as principal investigator (PI), clinical practice settings, and final academic position achieved.

RESULTS

From 2000 to 2015, 158 neurosurgeons received 164 NREF awards totaling $8.3 million (M), with $1.7 M awarded to 46 Young Clinician Investigators (YCIs), $1.5 M to 18 Van Wagenen Fellows (VWFs), and $5.1 M to 100 resident Research Fellowship Grant (RFG) awardees. Of all awardees, 73% have current academic appointments, and the mean ± SD number of publications and H-index were 71 ± 82 and 20 ± 15, respectively. The overall response rate to our survey was 70%, and these respondents became the cohort for our analysis. In total, respondents cumulatively obtained $776 M in post-NREF award grant funding, with the most common sources of funding including the National Institutes of Health ($327 M) and foundational awards ($306 M). The NREF impact ratios for awardees were $1:$381 for YCI, $1:$113 for VWF, and $1:$41 for resident RFG. Awardees with NREF projects in functional neurosurgery, pediatric neurosurgery, and neuro-oncology had the highest NREF impact ratios of $1:$194, $1:$185, and $1:$162, respectively. Of respondents, 9% became department chairs, 26% became full professors, 82% received at least 1 subsequent research grant, and 66% served as PI on a subsequent research grant after receiving their NREF awards.

CONCLUSIONS

In-training and early-career neurosurgeons who were awarded NREF funding had significant success in acquiring subsequent grant support, research productivity, and achievements of academic rank. NREF grants provide a tremendous return on investment across various career stages and subspecialities. They also appeared to have a broader impact on trajectory of research and innovation within the field of neurosurgery.