Most, but not all, residency programs have some component of basic science or clinical research. Neurosurgeons may pursue an additional training in a fellowship, after residency or in some cases, as a senior resident. These fellowships include pediatric neurosurgery, trauma/neurocritical care, functional and stereotactic surgery, surgical neuro-oncology, radiosurgery, neurovascular surgery, Interventional neuroradiology, peripheral nerve, spine surgery and skull base surgery.
In the U.S., neurosurgery is considered an extremely competitive specialty composed of only 0.6% of all practicing physicians and attracts only the top students of medical schools per year (with a <60% match rate and highest average USMLE scores).
With increasing health care cost threatening the stability of the USA economy, policymakers and health care providers have shifted focus on pay-for-performance and value-based purchasing. Current health care reforms are scrutinizing all interventions and call for a reduction in the number of procedures and treatments that are less effective, more costly, and of little “value.” Because the health care value equation cost effectiveness is being used to drive policies and health care reforms, accurate measurement of real-world effectiveness is of utmost importance. Prospective registries have emerged as a feasible way to capture and measure real-world effectiveness via patient-reported outcomes incorporating multiple domains of patients’ general health status, disease-specific health, and societal productivity. As compared with a randomized controlled trial (RCT), prospective longitudinal registries are more feasible and may more closely reflect daily clinical situations, as they measure real-world care and are not artificially constrained by research settings, strict inclusion/exclusion criteria, and loss of patients not consenting to participate in clinical trial.
The incidence of neural tube defects (NTDs) is declining in several areas of the world, including the United States. While the reasons for this are unclear, there seems to be some effect from prenatal diagnosis, genetic counseling, and possibly nutritional supplementation 1)
Approximately two-thirds of hospitals in a nationwide survey provided hospital-based neurological services. Larger hospitals and those with JC accreditation were more likely to provide neurological services, whereas small hospitals, sole community providers, and non-federal governmental hospitals were less likely to provide them 3).
Mayo Clinic Rochester, MN http://www.mayoclinic.org/departments-centers/neurosurgery
New York-Presbyterian University Hospital of Columbia and Cornell
Johns Hopkins Hospital
Massachusetts General Hospital
UCSF Medical Center
San Francisco, CA
UCLA Medical Center
Los Angeles, CA
NYU Langone Medical Center
New York, NY
Hospitals of the University of Pennsylvania-Penn Presbyterian
Northwestern Memorial Hospital