Departure From Active Practice Among Male and Female Neurosurgeons, 2017-2022

Introduction: Physician workforce integrity is essential to maintaining access to care. Factors associated driving the decline in active practice amongst neurosurgeons remain underexplored.

Methods: Care Compare data from the Centers for Medicare & Medicaid Services was queried for all physicians who billed Medicare from 2017 to 2023. The primary outcome was departure from active practice, as defined by cessation of Medicare billing for over 1 year. Late exit from practice was defined as cessation of Medicare billing >35 years after medical school graduation. Exclusions from the analysis included neurosurgeons affiliated with Kaiser or the Veterans Admissions, and those sub-specialized in pediatric neurosurgery. Baseline characteristics included gender, career stage, medical school rank, teaching hospital affiliation, and geographic region.

Results: : In 2017, there were 4,726 neurosurgeons (7.3% female) who were followed until 2023. Female neurosurgeons were more likely to be at an early career stage (38.4%vs.23.9%, P< 0.001) in 2017.

By 2023, there were 5,302 (9.8% female) neurosurgeons (9% growth). Meanwhile, the Medicare population grew from 58,457,244 to 66,392,459, (13.6% growth). In 2023, 1,835 neurosurgeons ceased billing Medicare, 326 of those were late exits from active practice. The overall rate of departure from active practice was 10.2%. Female neurosurgeons had higher departure rates than their male counterparts. (17.1% vs.9.5%; P< 0.001).

On adjusted analyses, departure from active practice was associated with female gender (OR 2.23; 95%CI, 1.54-3.19; P< 0.001), and practice in the West (OR, 1.67; 95%CI, 1.08-2.61; P=0.022). Those affiliated with a teaching hospital were less likely to drop Medicare as a payor (OR, 0.65; 95%CI, 0.46-0.92; P=0.012).

Conclusion : From 2017-2023, there was significant departure from active practice among neurosurgeons, with female neurosurgeons particularly affected. Affiliation with teaching hospitals correlated with lower departure rates.