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Is General Neurology a Dying Specialty?

 

(In brief)

The percentage of US members of the AAN who describe general neurology as their primary subspecialty has gradually declined over the past four years. Experts discuss the reasons behind the trend, what the impact could be on patient care, and initiatives around the country to address that trend.

By 2025, we will have a 19-percent workforce shortage in neurology. The anticipated shortfall is due to both an increase in demand from the aging population and a decrease in supply of neurologists in active practice. But potentially masked within this data may be an even more ominous finding: the general neurology workforce is dwindling.

 

Indeed, the percentage of US neurologist members who describe general neurology as their primary subspecialty has gradually declined over the past four years. According to AAN member profile data, 40.1 percent identified their subspecialty as general neurology in 2015 while only 33 percent did so in 2019. An electronic survey sent to all AAN members graduating from US neurology training programs in the Spring of 2014 indicated that 93 percent of adult neurology residents reported plans to pursue fellowship training, Justin T. Jordan, MD, clinician director for neuro-oncology at the Massachusetts General Hospital, and colleagues reported in a 2016 paper in Neurology.

“The very high rate of neurology residents going on to do fellowship training both postpones their entry to the workforce and suggests a plan for most to practice within a subspecialty,” said Dr. Jordan, who serves as vice chair of the AAN Workforce Pipeline Subcommittee. “This may have a negative impact on timely access to care, and especially on access to general neurology care,” he added

The drift toward specialization may be reflected in AAN membership demographics. According to the 2019 AAN Membership Insights Report, the median age of general neurologists is 56, whereas the median age of specialists like those in movement disorders is 47, epilepsy and vascular neurology is 46, and sports neurology is 39.

The anticipated shortfall is due to both an increase in demand from the aging population and a decrease in supply of neurologists in active practice. But potentially masked within this data may be an even more ominous finding: the general neurology workforce is dwindling.

 

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