The number of neurosurgeons in Austria increased from 97 to 301 between 1997 and 2023, an increase of 210.3%, while the density of neurosurgeons increased from 1.22 to 3.30 per 100,000 inhabitants. This growth in the labor force significantly exceeded the growth of the population (14.3%) and the increase in the number of all specialized doctors (77.4%). Despite the expansion of the workforce, the number of neurosurgical services increased only minimally – the number of beds increased by 4.7%, hospitalizations by 28.6% and cranial procedures by only 0.1%. When the number of services was calculated per neurosurgeon, the results were negative - cranial procedures per surgeon decreased by 67.8%, hospitalizations by 58.6%, and bed capacity per surgeon by 66.3%. There were significant differences between regions in Austria, with Salzburg having the highest density of neurosurgeons (6.51 per 100,000 population), while Burgenland had the lowest (1.00 per 100,000). The study highlights the risks to the quality of training and the efficiency of health care, and therefore recommends evidence-based workforce planning and expansion of ambulatory neurosurgical services.