Neurologic Workforce: Is the Number of Neurologists Adequate Now and Into the Future?

November 1, 2012

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Dr. Bruce Sigsbee

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
President, AAN

Resources Available to Support MD–PhD Researchers

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:

Notice of Availability of Administrative Supplements to Enable Continuity of Research Experiences of MD–PhDs During Clinical Training

grants.nih.gov/grants/guide/notice–files/NOT–MH–11–014.html
This program provides opportunities for MD–PhD–trained individuals to continue to conduct research and to enhance their research skill set while completing clinical training, i.e., during the years of residency and clinical fellowship, and to contribute to the progress of the research grant.

NIH Loan Repayment Programs

www.lrp.nih.gov/about_the_programs/index.aspx
The NIH wants to encourage outstanding health professionals to pursue careers in biomedical, behavioral, social, and clinical research. Commit at least two years to conducting qualified research funded by a domestic nonprofit organization or US federal, state, or local government entity, and NIH may repay up to $35,000 of qualified student loan debt per year, including most undergraduate, graduate, and medical school loans. Loan repayment benefits are in addition to the institutional salary received for research. Specific loan repayment programs include:

Clinical Research LRP

www.lrp.nih.gov/about_the_programs/clinical.aspx

Pediatric Research LRP

www.lrp.nih.gov/about_the_programs/pediatric.aspx

For more information, visit www.nimh.nih.gov/about/organization/ddtr/index.shtml.