Analysis of the Caribbean Neurosurgery Workforce: Scope of Practice, Challenges, and Ways Forward

Myron L Rolle; Ashley Williams; Annegien Boeykens; Deen L Garba; Rachel McLellan; Michael Francis; Ellianne Dos Santos Rubio

doi:10.1016/j.wneu.2023.08.039

Analysis of the Caribbean Neurosurgery Workforce: Scope of Practice, Challenges, and Ways Forward

World Neurosurg. 2023 Nov:179:e150-e159. doi: 10.1016/j.wneu.2023.08.039. Epub 2023 Aug 18.

Authors

Myron L Rolle¹, Ashley Williams², Annegien Boeykens³, Deen L Garba⁴, Rachel McLellan¹, Michael Francis⁵, Ellianne Dos Santos Rubio⁶

Affiliations

¹ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA. Electronic address: ashleywilliams@oakland.edu.
³ Department of Neurosurgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands.
⁴ Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Southern Adventist University Collegedale, Collegedale, Tennessee, USA.
⁶ Department of Neurosurgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Neurosurgery, Curaçao Medical Center, Willemstad, The Netherlands.

PMID: 37597663
DOI: 10.1016/j.wneu.2023.08.039

Abstract

Background: The neurosurgical workforce in the Caribbean and surrounding countries is largely unknown due to the diversity in cultural, linguistic, political, financial disparities, and colonial history between the countries. About 45 neurosurgeons serve 16 million people in the Caribbean Community and Common Market, a trade alliance including most Caribbean nations. We aimed to understand the current scope of neurosurgical workforce in this region while highlighting any system challenges and potential solutions for upscaling the workforce.

Methods: We surveyed neurosurgeons within Caribbean countries and surrounding countries online using qualitative and quantitative methods via Qualtrics.

Results: Of the 38 countries within the Caribbean and surrounding countries, 26 (68%) were surveyed and of which 18 (69%) replied. In total, 172 regional neurosurgeons were identified, of which 61 (35%) replied-with a majority of general neurosurgeons (56%). Remarkably, the majority of countries failed to meet the threshold workforce density for safe health care-either expressed by full-time equivalent neurosurgeons or neurosurgical centers (see table). Most neurosurgical practices confirmed receiving or sending medical referrals. If so, most referrals took longer than 8 hours without significant difference regarding the destination. Lastly, challenges confronting neurosurgical advancement were found in the following: technology and equipment (40%), trained personnel (31%), hospital or medical center infrastructure (14%), neurosurgical education, and training (44%).

Conclusions: To our knowledge, this is the first qualitative and quantitative study exploring the current status of the neurosurgical workforce within the Caribbean and surrounding countries. Identifying resources and challenges can contribute to improving regionalized neurosurgical care.

Keywords: Caribbean; Delays; Gobal Neurosurgery; Health equity; LMIC.

MeSH terms

Caribbean Region
Humans
Neurosurgeons
Neurosurgery* / education
Neurosurgical Procedures
Scope of Practice
Workforce