Warning over US neurologist shortage

Neurologists are urging the US Congress to undertake policy changes that will encourage more medical residents to specialize in neurology to ensure patient access to care.

Research, published in Neurology, shows that while rates of diseases such as dementia, Alzheimer's, and stroke will continue to increase in future, fewer new doctors are choosing the specialty, exacerbating the current shortfall of neurologists.

"Through 2025 demand for neurologists is projected to grow faster than supply, creating a serious limitation of access to care for those patients with neurologic disease," say authors Timothy Dall (HIS Healthcare & Pharma, Washington, DC) and colleagues.

Using database information, the authors estimate that in 2012 there were 16,366 pediatric and adult neurologists practicing in the USA, although they note that this is likely an overestimate as some will be involved in teaching and research, while residents and fellows require clinical supervision.

This suggests that there is already a shortfall of neurologists in the USA, as they estimate that the current demand for neurologists is 18,180.

And, using modelling, they forecast that this will increase to 20,920 by the year 2025, requiring an additional 220 pediatric and 2520 adult neurologists.

They also calculate that after the introduction of the Patient Protection and Affordable Care Act (PPACA) in 2014, which will increase access to medical coverage, an additional 520 adult neurologists could be required.

Combined with projections of residency specializations, neurologist working hours, retirement, and mortality patterns, this means that the current shortfall of 11% would rise to 16% by 2025, and could reach 19% once the impact of PPACA is accounted for.

Dall and colleagues say that along with reports of difficulties filling vacancies for neurologist posts, long patient wait times for appointments, and poor access to neurology services for Medicaid (means-tested) patients, their results point to a national shortfall of neurologists.

They caution: "The magnitude of the future shortfall may be even greater than suggested by our findings. As more residents subspecialize (e.g., in sports medicine, as hospitalists, and in neurointensive care), there may be even fewer neurologists to provide care to patients with chronic conditions."

"These findings underscore the importance of some combination of increasing the supply of neurologists, increasing the supply of nurse practitioners or other physician extenders who can assist with caring for patients with neurologic disease, and finding innovative ways to deliver care that improves provider productivity," the authors conclude.

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