Whether you are hiring a pediatric neurosurgeon, looking for a position as a pediatric neurosurgeon, or a resident contemplating doing a fellowship in pediatric neurosurgery – here is news you can use.
The number of pediatric neurosurgery fellows looking for jobs has outpaced the number of jobs available for full-time pediatric neurosurgeons for several years, giving employers negotiating power and leaving many pediatric neurosurgery job-seekers frustrated with the types of positions available. While there may be open positions that offer some pediatric cases, those positions could be hard to fill and not considered desirable by pediatric fellowship-trained neurosurgeons.
How could it be hard to fill a position when there is an oversupply of job seekers? The reason is that many of the available positions do not offer enough volume to keep a pediatric neurosurgeon busy full-time doing pediatric neurosurgery. Instead, many recruitments for a pediatric neurosurgeon are opened because of the need for another pediatric neurosurgeon on the call schedule. New graduates are rightfully concerned that if there isn’t enough volume to keep a newly trained pediatric neurosurgeon busy with elective cases, they may not be able to do enough cases to become American Board of Pediatric Neurological Surgery (ABPNS) Board-Certified. If the position offers a mix of adult and pediatric neurosurgery cases to provide a busy overall caseload, job seekers might also be worried that they will end up with a majority adult practice, which was not what they planned.
What can be done to make the available positions more satisfying for pediatric neurosurgery job seekers?
- Passing the Torch: Senior members of the practice may need to feed the younger neurosurgeons pediatric neurosurgery patient volume; which may be at the expense of their own practices. This may be understandably undesirable for many experienced neurosurgeons who want to maintain their own value to the practice, particularly as they near retirement age.
- Increased Marketing: Marketing a practice may be helpful in increasing market share, however, many pediatric neurosurgeons have expressed concern that no amount of marketing can really improve their case volumes due to insurance constraints or control of patient flow by the health systems in their areas. Further, most pediatric neurosurgeons are employed by health systems and do not control the efforts of the health system marketing team, which might not be motivated to make marketing pediatric neurosurgery a priority. While marketing might not solve the problem, it should be part of a comprehensive strategy to build as much volume as possible. Look for gaps in the market that your current pediatric neurosurgeon could provide as a way to increase market share.
- Part-Time Positions or Locum Tenens: If the primary need of a practice is for pediatric neurosurgery call help, and there aren’t enough cases to keep a full-time pediatric neurosurgeon busy, the appropriate solution is likely long-term, consistent locum tenens to help with call. Locums are expensive and a hospital employer may prefer to incentivize its current pediatric neurosurgeons to take a more-than-reasonable amount of call to avoid this solution. Occasionally, a practice may find a neurosurgeon who wants a part-time neurosurgery position who will become a regular part-time employee of the practice to assist with call. Practices should expect to compensate a part-time neurosurgeon with a guaranteed salary that may seem disproportionate to the number of elective cases the neurosurgeon performs; that is part of the cost of doing business in a practice where the call burden is unsustainable for the existing neurosurgeons, but there is not enough elective volume for another full-time surgeon.
- Mixed Adult-Pediatric Neurosurgery Positions: An imperfect, but increasingly common solution is the creation of mixed adult-peds neurosurgery positions. Since most fellowship-trained pediatric neurosurgeons prefer a 100% pediatric neurosurgery practice, and a certain number of pediatric neurosurgery cases is required for ABPNS Board Certification, this is a less-than-perfect solution. In addition, it is usually only implemented successfully when the pediatric neurosurgeon is joining a large group with both adult and pediatric neurosurgeons.
- Straight Salary: In situations where elective case volume may be lacking or if a neurosurgeon has a majority of pediatric patients with lower RVUs, institutions will need to guarantee their pediatric neurosurgeons a salary that will provide competitive compensation.
For pediatric neurosurgeons seeking a position, the best advice is, “Be flexible!” If you have an opportunity to join a practice that offers you the opportunity to develop a robust practice, it may be worthwhile to be very flexible about geography and other wish-list items.
Despite the imperfections of many of the available positions, we believe the long-term future remains bright for pediatric neurosurgery job-seekers…as long as people don’t expect perfection. Many pediatric neurosurgeons are edging toward retirement, and the demand for call help is a very real market demand, even in the absence of robust elective case volume. Those who expect imperfection won’t be disappointed….and in time, with retirements on the horizon, those who are struggling to develop busy pediatric neurosurgery practices today will likely have more opportunity to develop robust practices in the future.
By Judy Rosman, J.D.
