Demand-supply of neurointerventionalists for endovascular ischemic stroke therapy.

OBJECTIVE

To estimate the needed workforce of trained neurointerventionalists (NIs) to perform endovascular therapy (ET) for eligible patients with acute ischemic stroke (AIS).

METHOD

Population and ischemic stroke incidence data were extracted with use of US Census and Centers for Disease Control and Prevention 2009 estimates. The annual "demand" is defined as the proportion of AIS patients who would meet inclusion criteria and clinical standards for ET. The "supply" is defined as the number of trained NIs and NIs in training. The "workforce" is the number of NIs needed to meet the demand (the number of eligible AIS patients) within an accessible geographic diameter. Data on NIs and NI fellowships were collected (Society of Neurointerventional Surgery [SNIS], Society of Vascular & Interventional Neurology [SVIN], Concentric Medical, and Penumbra Inc.).

RESULTS

The estimated number of NIs is close to 800, practicing within a 50-mile radius of major metropolitan areas in the United States, covering more than 95% of the US population. Approximately 40 NI fellows are graduating yearly from US training programs. In 5 years and 10 years, the number of NIs may reach 1,000 and 1,200, respectively. Currently, there are approximately 14,000 thrombectomy procedures performed in the United States each year. However, the percentage of AIS patients who may be eligible for ET in our estimation is 4% to 14%, or about 25,000 to 95,000 patients. This means that cases will occur at a rate of 26 to 97 per year in 5 years, or 22 to 81 per year in 10 years, for each NI. Providing 24/7 AIS coverage requires 2 to 3 NIs per medical center, adding to the challenge of providing manpower without diluting experience in areas of lower population density.

CONCLUSION

The current and projected number of NIs would adequately supply the future need if the proportion of patients requiring AIS endovascular therapy increases. However, 2 to 3 NIs per comprehensive stroke center would be needed to provide 24/7 AIS therapy with a sufficient number of cases per NI. A tertiary stroke center model similar to the trauma model may provide the manpower solution without compromising the quality of care.