Inequitable access to neurosurgical care in the United States

Despite a national neurosurgeon density of 1.58 per 100,000 (exceeding the WHO minimum threshold of 1 per 100,000), equitable access to neurosurgical care remains uneven in the United States. Approximately 9.8% of the US population lacks adequate access to neurosurgical services. Rural and socioeconomically disadvantaged communities are most affected. This literature review focuses specifically on the intersection of neurosurgical access and the distribution, composition, and pipeline of the US neurosurgical workforce. We conducted a narrative review of peer-reviewed literature from 2015 to 2025 using PubMed, Scopus, and Web of Science. Search terms included "neurosurgical workforce," "geographic access," "gender equity," "rural neurosurgery," "telemedicine," and "task sharing." Eighty percent of US counties lack neurosurgeons, and only 2.3% of neurosurgeons practice in nonmetropolitan areas. Unemployment, low educational attainment, and poverty independently predict reduced neurosurgeon availability. Geographic access and workforce diversity overlap. States with the fewest training programs also show the lowest representation of women in neurosurgery. Concurrently, graduating medical students interested in neurosurgery who were female, Black/African-American, or Hispanic were significantly more likely to report intention to practice in underserved areas. Addressing geographic, socioeconomic, and gender disparities simultaneously is essential to ensuring timely access to neurosurgical care for all patients. Telemedicine networks, rural training tracks, and intersectional recruitment strategies offer scalable pathways toward a more equitable workforce.