National organizations such as the AMA and ACGME are predicting a national shortage of physicians of about 50,000 in 2025. In meetings I have attended, every specialty represented argues that they are and will experience shortages that will impact access and even quality. Where does that leave neurology?
Currently, most private practices indicate that they have notable problems recruiting. Training programs also indicate a shortage of neurologists, particularly for patient care. It currently is a matter of belief that primary care is in very short supply now and in the future the shortage will be critical. Neurology, as a non–procedural specialty that primarily depends on evaluation and management service for the bulk of its revenue, has difficulty attracting graduating US seniors into training programs. Of the approximately 40 percent of foreign medical graduates who fill training positions, how many are able or elect to remain in the US for practice? Will the pressures on practices, with declining revenues and increased requirements for quality measurement and health IT meaningful use, cause neurologists to leave clinical practice for other roles—or retire earlier than planned?
Such questions are not just of academic interest. Sound information based on accepted methodology is critical to not only AAN policies but also to informing policies and resource allocation by federal agencies. Currently, there are extra payments for primary care physicians, why not neurology? GME funding is coming under intense scrutiny. Some proposals protect GME funding for primary care but not other specialties. Can we argue from more than just an anecdotal basis that current policies will continue to lead to a greater shortage of neurologists who care for major diseases of the elderly? Is this an issue to which the AAN needs to commit resources to address?
An AAN task force recently completed an evaluation of the neurology workforce. The charge was to identify the current number of neurologists, whether there is a current shortage, and project both out into the future. A consultant was engaged to help in the process and has validated methods. The analysis concludes that there is a significant current shortage. About 14 percent of those in training do not stay in the US after completion of training. In the future, the shortage will worsen substantially if nothing changes. The results of this task force evaluation will be published in 2013.
While we have made this argument, the rigor of the analysis will differentiate our claims from other specialties. It is a call to action for all of us to improve the situation for neurologists, attract more into the specialty, and establish adequate revenues and work environment to retain those in practice. We all believe in the importance of neurology to patient care. Shortages will degrade the quality of life for those with major neurologic diseases, especially in the elderly.
Bruce Sigsbee, MD, FAAN
In response to AAN President Bruce Sigsbee’s September AANnews® column on barriers to academic and research careers for clinician researchers, the National Institute of Mental Health provided information on several funding opportunities that support MD–PhDs:
For more information, visit www.nimh.nih.gov/about/organization/ddtr/index.shtml.