Impact of the Council of State Neurosurgical Societies (CSNS) Fellowship on the Development of Neurosurgical Careers: A Retrospective Study

The Council of State Neurosurgical Societies (CSNS) has sponsored annual residents who participate nationally in a socioeconomic fellowship that provides full voting privileges within the CSNS, offers early exposure to organized neurosurgery, and can lead to larger leadership roles. We sought to examine the impact of the CSNS fellowship on the development of neurosurgical careers. All prior CSNS fellows were evaluated based on the location of residency and medical school, formal mentorship, number of publications, H-index, academic versus private practice, subspecialty, gender, and leadership roles in neurosurgery. A retrospective analysis of CSNS fellows was performed using publicly available data. Among 307 fellows, 108 (35.1%) and 158 (51.5%) entered academic and private practice, respectively. Regarding educational background, 300 (97.7%) held a Doctor of Medicine (MD) degree, 22 (7.2%) held an MD/Doctor of Philosophy (PhD), and 46 (15%) held an MD with an additional degree, including a Master of Business Administration (MBA), Master of Public Health (MPH), Juris Doctor (JD), or Master of Science (MS). In comparison, 7 (2.3%) held a Doctor of Osteopathic Medicine (DO) degree. With respect to geographic distribution, 184 (60%) of fellows completed residency training on the East or West Coasts of the United States. In terms of scholarly productivity, 214 (70%) had an average H-index of 17.6, and the average number of publications was approximately 77. Subspecialty training was common, with 242 (78.7%) identified as subspecialists. Spine was the most common subspecialty (90, or 29.3%), followed by cerebrovascular (37, or 12%), pediatric (29, or 9.4%), skull base (25, or 8.1%), and neuro-oncology (24, or 7.8%). Peripheral nerve surgery was the least common subspecialty (4, or 1.3%). CSNS fellows represent a diverse subsection of neurosurgery, with a strong propensity toward academic, leadership-oriented practices. This subset of neurosurgeons demonstrated substantial publication output and scholarly impact. Overall, to our knowledge, this is the first study to demonstrate the potential impact of formalized exposure to organized neurosurgery in fostering future neurosurgical leaders.