The number of neurosurgeons per million population is much lower in Europe than in the USA, where the point prevalence of neurosurgeons doubled between 1963-87. Results of a 1987 survey of USA neurosurgical practice show that surgery filled 25% of total time in professional activity. Of all cases treated, 64% were spinal disorders and 24% were intracranial disorders. Use of a relative value scale for neurosurgical procedures makes possible a rough and ready estimate of a neurosurgeon's weekly aggregate workload. However, the concept of a mean surgical workload must be examined within the context of the known variation of case mix and volume of surgical services in different practices.