Career trends among neurosurgery residents in Pakistan: A cross-sectional study

Neurosurgery is a specialized branch of medicine that deals with the surgical treatment of conditions affecting the nervous system, including the brain, spinal cord, and peripheral nerves. Neurosurgeons undergo extensive training to diagnose and treat a wide range of neurological disorders, from brain tumors and spinal cord injuries to movement disorders and chronic pain. This nationwide survey aimed to investigate career trends, training satisfaction, and emigration intentions among neurosurgery residents in Pakistan. A prospective cross-sectional study was conducted using a structured, self-administered questionnaire disseminated via social media and email groups. One hundred twenty-two registered neurosurgery residents participated (mean age, 30.68 ± 3.50 years), with a notable gender disparity (76.2% males). Residents' satisfaction with training improved as they progressed, with operative independence being a key factor. 82% planned to pursue a fellowship, mainly in spine and neurovascular surgery. 85.2% intended to leave Pakistan after training, favoring the UK, the Middle East, and the US. Residents in government hospitals had 7.3 times higher odds of planning emigration than those in private hospitals. Logistic regression identified private training, career uncertainty, financial pressures, and seniority as significant predictors of emigration. Latent class analysis revealed 3 challenge profiles with different emigration risks. Mediation analysis showed that satisfaction mediates the relationship between training type and emigration, particularly among junior residents. These findings highlight the urgent need for policy-level reforms to improve neurosurgical training satisfaction in Pakistan and reduce brain drain in this highly specialized field.